About Tongue-tie & Lip-tie

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The medical definition of tongue-tie is: "An embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement." 

All babies are born with some of this tissue, but for about 3-12.8% of newborns, it is so tight that they cannot move their tongues freely. They may not be able to move the tongue left to right, extend it beyond the lip or lift it up to the roof of the mouth. This can affect their ability to breastfeed and lead to poor latch, nipple pain and tissue breakdown. This can lead to decreased milk intake and a decline in milk supply over time and poor weight gain.

The medical term for tongue-tie is “ankyloglossia” and studies show the defect is likely hereditary with boys being more affected than girls. There are also theories about increased incidence of tongue-tie related to increased pre-conception folic acid consumption in our fortified foods. There may be a link between the MTHFR gene and dysfunction in breaking down folic acid resulting in higher body concentrations. More research is needed.

Many babies with a tongue-tie, also have an abnormally tight membrane attaching their upper lip to their gums (lip-tie).  Babies with a lip-tie often have difficulty flanging their lips to create a good seal around the breast or bottle. They tend to have suck blisters especially on the top lip but can be on all lip surfaces. Because air leaks in at the corners of the mouth during sucking, they swallow more air. This air in the stomach causes more spit up (reflux), gas pain and a fussy baby.

There is some research linking lip-ties with improper jaw development and spaces between the permanent teeth.

Tongue-tie symptoms for baby may include:

• Poor latch, shallow latch
• Noisy sucking or clicking
• Coughing, gagging
• Gumming, chewing the breast
• Popping on and off the breast, frustrated
• Sleepy, tired baby on the breast
• Long feedings, lasting up to an hour, frequent feedings
• Baby always hungry
• Lip blisters
• Milk leaking on the sides of the mouth
• Fussy baby, colic, gassy
• Reflux, frequent spitting up
• Poor weight gain
• Unable to hold pacifier
• Poor bottle feeding
• Noisy breathing, snoring while sleeping
• Thrush in the mouth

Mothers may experience:

• Poor milk supply
• Oversupply
• Severe pain when breastfeeding
• Bleeding, cracked or blanched nipples
• Nipple vasospasms
• Clogged ducts
• Mastitis
• Nipple thrush
• Frustration and anxiety associated with breastfeeding
• Problems bonding with the baby

Tongue-tie releases (called frenectomies) remove the tissue or tight frenulum under the tongue or upper lip to allow better mobility of the tongue and lip. Releases can be performed with scissors, diode lasers, erbium lasers, CO2 lasers, and electrocautery. Trained providers that can do frenectomies include doctors (ENTs or Pediatricians), dentists (adult or pediatric), midwives and nurse practitioners.

At Beyond Birth ABQ, we use a state of the art LightScalpel CO2 laser to perform all our tongue and lip-tie procedures.  In our experience, we have found that the advantages of using the CO2 laser include:

• Minimal bleeding during and after the procedure – the laser helps in blood clotting
• Faster healing
• Less risk of infection
• Increased precision and complete removal of a tie
• Results in less scar tissue and reattachment of tissue post procedure.

Your baby will be swaddled and held securely by an assistant during the procedure. The laser is precise and quick, only taking about 10-15 seconds per tie. The procedure will cause discomfort.  We sometimes use a topical anesthetic and will discuss the risks associated with that. Your baby will be returned to you in a few minutes and we will assist you in feeding your baby. This helps soothe the baby too.

Afterwards, there can be discomfort caused by inflammation of the tissue as well as soreness in the muscles of the jaw, neck and shoulders as the body adjusts and the baby begins to move the tongue. You will be given a handout after the procedure with the instructions for:

• Exercises for the tongue and lip to prevent reattachment
• Using baby Tylenol and Arnica to treat the discomfort (we send Arnica drops home with you)
• A referral list for oral functional professionals and body workers

Each baby is different but most babies are fussy for about 12-36 hours. Parents report that the Arnica homeopathic drops really help. The wound stretches are the least favorite part of the process but are the most important factor in preventing the tongue and lip from reattaching. We are available by phone to support you and schedule a follow-up appointment in a week. The wounds are mostly healed by 2 weeks.

Going through with a tongue-tie procedure is a very personal choice.  We try to present you with all of the information, but the decision is ultimately up to you and your family.  We 100% support you in your decision-making process and know that you will make the best choice for your baby and your family.

At Beyond Birth ABQ, we have created a unique, family-centered approach to treating tongue-tie and lip-tie. Families are at the center of this team. Care from these team members is important to the success of treating the tongue-tie and helping the mother and baby couplet thrive.

Release Provider: doctors (ENTs or Pediatricians), dentists (adult or pediatric), midwives and nurse practitioners.

This person should have special training in oral assessment and experience with tongue-tie resulting in the proper diagnosis, treatment, and aftercare of patients with tongue and lip-ties.

Wound care is extremely important to guide the healing process and prevent the tongue and/or lip-tie from growing back together.  Equally important is improving the function of the tongue because the baby must learn how to use their tongue in a new way and strengthen the muscles they have not been using. 

Oral Functional Professionals familiar with infants and tongue-tie: International Board Certified Lactation Consultant (IBCLC), occupational therapists (OT), speech language pathologists (SLP), certified orofacial myologist (COM)

• IBCLCs are one of the best professionals to help with infant feeding at the breast, bottle or with solid foods.  We work to improve latch, provide suck training exercises and address nipple pain, low milk supply and strong let down as well as other lactation support.
• We assist you with exercises to do at home to build strength in the tongue and improve sucking function.
• We recommend working with an IBCLC before and after release until feeding and weight gain are optimal.
• Melanie is also an IBCLC and provides lactation support at your appointment. If you are already working with an IBCLC, we can work with them too.
• Other oral function professionals may be a part of the team as needed.

Body workers familiar with infants and tongue-tie: chiropractor, cranial sacral therapist (CST), massage therapists, physical (PT) and occupational therapists (OT) 

• These professionals can help with alleviating muscle tension and correct structural alignment of the jaw, neck, back and the whole body. 
• We recommend babies see one of these providers 24-48 hours prior to a release and 3-5 days after the procedure. This work helps release tight muscles that may have been caused by the baby's position during pregnancy, labor or birth.
• Babies use lip, cheek, jaw, neck, shoulder and back muscles to compensate for a tight frenulum or improper suck. These muscles become tense and affect feeding.
• When a tongue-tie is released, connective tissue and muscles in the whole body can shift. Body work is needed to release tensions and correct alignment.