Manual Therapy and Lactation Support for Tongue Tie and Breastfeeding Babies
Written by Kylie Walsh, MHSc (Osteo), Nicole de Faymoreau, IBCLC, and Dr Shervin Yazdi, DDS.
Tongue ties are highly controversial, inspiring widespread research among pediatricians, lactation consultants, dentists, ENT specialists, and osteopaths. The goal of such research is to explore the condition’s impact on long and short-term health.
Although babies have natural reflexes that help them latch, breastfeeding is a learned skill for both the nursing parent and the baby. And support from an International Board-Certified Lactation Consultant (IBCLC), midwife, or pediatrician is often necessary to facilitate this process.
In this article, we'll reveal how a tongue tie may affect an infant's ability to breastfeed or chestfeed and what can be done about it. We’ll also answer general questions you may have and offer guidance to help you through your struggles.
What is a Tongue Tie in Breastfeeding?
Ankyloglosia, better known as “tongue tie,” refers to a condition where the band of tissue that tethers the tongue to the floor of the mouth (lingual frenulum) is too short or tight. This anomaly restricts the tongue's motion, hampering the baby's ability to latch and create an optimal suck. It results in breastfeeding difficulties.
In many people, the lingual frenulum is less obvious or separates before birth, allowing the tongue to move about with ease.
Types of Tongue Ties
Not all tongue ties are created equal – there are several types to be aware of:
• Anterior tongue tie. A short or tight frenulum located at the front of the tongue.
• Posterior tongue tie also known as mid-tongue restriction is a tight frenulum that does not extend to the front of the tongue. These tend to be less obvious on site but can cause just as much trouble nursing as an anterior tight frenulum.
The Symptoms of Tongue Tie in Babies
Tongue ties may present with a wide range of symptoms or none at all. But in symptomatic cases, we see the following signs:
Tongue Mobility Issues
The main symptom of tongue tie is a limited range of motion in the infant's tongue, often presenting as poor lateralization and inadequate lift (also known as elevation.)
Lactation Consultant Nicole de Faymoreau, states “One common sign of tongue tie that I often notice is increased oral tension—many of these babies are particularly "chompy" when I place a finger in their mouth.”
Muscular Tension in the Face
Often, a tongue tie is accompanied by muscular tension that could exacerbate the baby's symptoms. When an infant has a tight frenulum (tongue tie), the entire facial system can be impacted, affecting the neck, the head, and the jaw. Issues with these structures can make it difficult for a baby to get a good latch and suck, leading to breastfeeding/chestfeeding challenges.
Note: The above-mentioned areas of tension can be found in infants without a tongue tie. Birth is an inherently intense process and can cause residual tension in a baby's body that can materialize in breastfeeding/chestfeeding problems.
Problems for the Nursing Parent
Tongue tie’s effects extend beyond the baby and can significantly impact the nursing parent as well. Because the baby cannot use or position their tongue correctly to work in harmony with the nipple, maternal nipple compression frequently occurs, often leading to pain and damage.
This inefficient latch results in less effective milk removal and reduced stimulation for milk production, which can ultimately contribute to milk supply issues.
Additional Signs to Look Out For
Sometimes, it’s not just a tied tongue. Here are some additional signs that indicate an issue:
• Clenched fists
• Asymmetry in the head shape
• Decreased neck range of motion
• Arching of the back
• Fussiness at the breast
• Pulling off the breast
• Firm stomach
• Irregular poops
• Constipation
• Flat spot on the head
• One side of the breast is more comfortable than the other
• Painful nursing.
What to Do if Your Baby Has a Tongue Tie
How should you move forward if your infant is diagnosed with a tongue tie? It depends on multiple factors:
• The severity of the tongue tie
• How functional (strong or ordered) the tongue movement is
• Whether tongue tie symptoms are present
• Other potential causes of these symptoms
• How the tongue tie will impact the infant's facial growth and development, nasal breathing ability, and whether it will cause issues down the line.
Because of the inherent complexity of tongue ties, we suggest starting with a lactation consult and osteopathic manual therapy to help your baby and their latch. Note: Even after tongue tie correction, the secondary effects—such as infant tension—must be addressed to fully support optimal feeding and growth and development of the jaw and face.
Lactation Support for Tongue Tie in Breastfeeding
Whether you’re looking for general breastfeeding/chestfeeding assistance or need targeted tongue tie help, the first step is to get a lactation consult. Your lactation consultant will ensure that the basic needs around nursing are met. Is there enough milk? Can the baby latch? What is the suck like?
Though lactation consultants cannot diagnose tongue ties, they can identify the condition and rule out other potential issues. They can also refer you to a provider who can formally diagnose and treat the tongue tie.
Even after a tongue tie has resolved and the baby has had bodywork to help readjust the body (we’ll address this below), the baby and mom still need help to achieve the optimal latch. After my patients get a tongue tie release, I recommend that they follow up within three days to work on positioning and latching.
How Can Osteopathic Manual Therapy Fix Tongue Tie?
The goal of Osteopathic Manual Therapy, with or without a diagnosed tongue tie, is to alleviate any tension, stress, or strain that is impacting the function of the tongue, suck, and swallow. By addressing this tight musculature, the tongue will move more freely, and the jaw will open wider, which can impact the comfort and efficiency of breastfeeding/chestfeeding. It may even eliminate the need for a tongue tie release.
However, if symptoms persist unchanged after treatment (usually 3-5 sessions), a tongue tie release is often required.
When a tongue tie release is done after a series of manual therapy treatments, the baby can more easily integrate this new and improved tongue function. We can also rest assured that the baby's body is free from tension and stress that can affect them overall, from their movement to growth and development or their mood.
How Tongue Tie is Diagnosed
A tongue's minimized mobility may be deemed a mild, moderate, or severe functional issue. Here’s how the condition is diagnosed:
1. The tasked provider must start with a general health questionnaire for the baby.
2. The parents will fill out an intake form where they document their baby's specific health concerns regarding the tongue tie.
3. The provider will perform a clinical exam where they examine the baby's general observable health, such as energy level, skull shape, muscular tone, airway, shape of palate, stomach bloating, emotional dysregulation, suck strength, and elevation quality in tongue mobility. Then, they’ll directly evaluate the anatomy of the tongue tie.
Photographic documentation is highly encouraged so parents, other providers, team members, insurance companies, and the diagnosing provider can further evaluate the tongue tie if needed. Other tethered oral tissues that may be contributing to the patient's functional problems may be evaluated at this time.
What Happens During a Tongue Tie Release Procedure?
During a tongue tie release procedure, the surgeon's most important role is obviously to "do no harm." This means that each surgical provider must judiciously operate within the scope of their basic license and any additional education, training, and experience.
The basic tongue tie laser release procedure for an infant entails:
1. Wrapping the patient's body in a pediatric wrap (aka the blue burrito).
2. Securing the patient's head via a head holder assistant using their palms on either side of the head.
3. Protecting the patient's eyes with laser safety goggles.
4. Numbing the sites to be released.
5. Releasing the tissues with minimal laser energy from a true laser (laser beam vs. molten glass vs. electricity).
Since many dental and medical schools in the United States provide minimal to no comprehensive education on tongue ties, we must rely on the continuing education of surgeons. While some surgeons who provide this service are still wrestling with the idea that tongue ties are "really a thing!?", other surgeons are traveling the country teaching other surgeons how to fine-tune their tongue tie surgeries. The staff, equipment, and physical accommodations for this service can make for a smoother, safer, more comfortable experience.
It is important to note that some anterior tongue ties can be picked up early on and clipped with a scissors. This procedure still requires the same level of follow up care as outlined in the writing.
Questions to Ask Before Choosing a Provider for Tongue Tie Release
Below are some questions to consider when choosing the right provider for tongue tie release:
• What equipment do you use? Is it a capable surgical laser, or is it a diode or electrocautery?
• Are high vacuum suction and slow speed suction used to keep the baby's airway clear?
• Is there a trained assistant whose ONLY job is securing the baby's head and eyes during the procedure and absolutely nothing else?
The bottom line is to find a practice that is dedicated to your best possible outcome, preferably one that has had plenty of practice before your arrival, believes in a team approach, and can celebrate with you even if you don’t actually need the procedure.
Get Started with an Initial Consultation Today
If you are looking for support during your postpartum journey and related to breastfeeding/chestfeeding, contact Nourish Osteo & Wellness for a free 15-minute phone consultation or book an initial treatment online.
This article was also gracefully contributed to by Nicole de Faymoreau, IBCLC, and Dr Shervin Yazdi, DDS. Click here to make a dental appointment with Dr. Yazdi and his team at Castro Valley Pediatric Dentistry and Orthodontics in Castro, California. You can also book a lactation consultation with Nicole de Faymoreau, IBCLC at Sun and Moon Lactation for your lactation needs.