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About Tongue-tie & Lip-tie

Infant Laser Frenectomy for Tongue-tie & Lip-tie

Melanie offers a wholistic perspective in evaluation and treatment of the tongue-tie and lip-tie. She uses her experience as a nurse-midwife, lactation consultant and a pediatric nurse practitioner to treat the mother and baby (couplet) together.


She has been passionate about diagnosing and treating tongue-tie since 2011. This interest began with the experience she gained as a midwife at Dar a Luz Birth & Health Center. She began releasing the thin anterior tongue-ties with scissors and soon taught all the midwives at the birth center how to do these releases. This helped mothers and babies until they could see a pediatric dentist for a complete release. 


When Melanie retired from birth at Dar a Luz in December 2020, she set out on this journey to be able to offer comprehensive tongue-tie evaluation and complete laser release of the ties. She enrolled in a pediatric nurse practitioner program at UNM in Jan 2021 and also earned her IBCLC certification in June 2021. She studied tongue-tie evaluation and release with Dr Brian Hatch in Albuquerque and completed the online course by Dr Richard Baxter at the Tongue-Tied Academy later in 2021. During her pediatric training in Spring 2022, she completed an internship with Dr Cara Riek at Arizona Breastfeeding Medicine. After completing her pediatric training in May 2022, Melanie realized her dream of starting her own practice in breastfeeding medicine and laser tongue-tie release. Beyond Birth ABQ opened November 1, 2022 with Dr Cara Riek at her side mentoring her though those first 10 tongue and lip-tie releases. Melanie is committed to continuing education and became a Breathe Institute Ambassador in January 2023 and is excited to attend breastfeeding, laser and women's health conferences annually.


I am so grateful for all the support I have received from these mentors and the community to continue the work of helping mothers and babies overcome tongue-tie and thrive!

What is a Tongue-tie?

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.

What is a Lip-tie?

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.

How & why do ties affect feeding?

The ability to move the tongue is essential for feeding at the breast, bottle and later for solid foods. For proper function in feeding and swallowing, the tongue must be able to move up and down forming a negative pressure to get milk out of the breast and move in a wave-like motion to swallow. The lips must be able to flange easily and the tongue has to extend beyond the gum line to prevent the bite reflex and achieve a deep latch. 


When the tongue function is restricted by a tie, the tongue may not extend beyond the gums and baby tends to have a chewy latch.  A baby with a tied tongue and / or lip may have a shallowl latch mostly on the nipple and not including much of the areola. This compresses the nipple onto the hard palate in the baby’s mouth, leading to nipple pain, pinched nipples and skin breakdown for the mother. A tongue-tie often accompanies a high palate, which also decreases the suction and further reduces milk transfer.


Some babies with ties may pop on and off the breast and be frustrated leading to shorter feeds and not getting enough milk.  Others may remain attached to the breast for long periods of time, falling asleep and comfort nursing without getting a full feeding. Some infants compensate for poor tongue function by feeding mostly during the mother’s milk ejection reflex, or “let-down” when the milk ejects more freely but may choke on the fast flow. Depending on the mother's milk supply, the baby may not get a full feeding. 


Bottle feeding allows milk to drip into the mouth without effort, thus requiring less tongue muscle effort than is needed for breastfeeding. This can be helpful when baby is tired. There are differences in nipple types on bottles and some are better for paced bottle feeding than others. A fast flow can be difficult for the baby to manage and lead to coughing, choking and increased air intake with swallowing.


An infant’s inability to breastfeed often results in the mother giving up feeding at the breast, exclusively pumping and bottle feeding or losing her milk supply and formula feeding her baby. She may be told her baby is not gaining enough weight and  needs to start supplementing. This can lead a mom to feel like she is a failure. In reality, the problems may actually result from restricted tongue and upper lip attachments – making normal function, mobility and breastfeeding difficult or impossible no matter how hard she works.


Baby's Tongue-tie & Lip-tie Symptoms

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

How Tongue-tie & Lip-tie Affect Breastfeeding

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

How are Tongue-tie & Lip-tie diagnosed?

We all have a band of tissue under the lip and tongue and it does not always cause a problem or need to be corrected. What defines a tongue-tie or lip-tie is whether there is restricted movement that causes a functional problem. What your baby’s tongue and lip look like and how they can move are used to diagnose a tie.

 

If you are having breastfeeding problems or suspect a tie, you and your baby need to be evaluated by a practitioner who has specialized training in tongue-tie and lip-tie diagnosis and treatment. This assessment includes:

  • a medical history of the mother and baby
  • symptoms that mother and baby are experiencing
  • an exam for function and appearance of the tongue and lip
  • observe a feeding at the breast or bottle
  • baseline weight measurements and transfer of milk at a feeding
  • a discussion about the findings and the risks, benefits and alternatives for treatment


Tongue-ties come in many different shapes and sizes and are rated on their location under the tongue. Some tongue-ties are considered anterior (near the front of the tongue), while others are considered posterior (near the back of the tongue). They may be thin or thick bands of tissue with some or no ability to stretch. It is important to note that ALL levels of tongue-tie are significant since they cause a functional problem.


Untreated or undiagnosed tongue-tie can present different symptoms in toddlers and older children.  Symptoms include:

  • Food aversions due to not being able to properly manipulate food in the mouth. 
  • Speech issues, specifically pronouncing the ‘r’, ‘k’, and ‘l’ sounds.  This is because the tongue cannot properly elevate to the roof of the mouth.
  • Sleep apnea because the restriction of the tongue does not allow for the airway to be blocked off while sleeping, resulting in the tongue slipping down the throat and occluding the airway. 
  • Malocclusion of the teeth and improper jaw development. When a tongue is restricted, proper pressure is not placed on the upper or lower jaw to allow for expansion, resulting in small jaws and necessity for orthodontic care that may involve removal of adult teeth and braces to properly align teeth.


Emerging research suggests that adults with untreated tongue-ties often experience: TMJ symptoms, tension headaches, neck and shoulder pain, and sleep apnea. The reason for these symptoms is that the jaw has improperly formed over time resulting from the tongue not being able to elevate to the roof of the mouth to create a seal.  

Video about Tongue-Tie for Parents

Treatment for tongue-tie and lip-tie

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.

Video of CO2 Laser Release

Our Team Approach

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, osteopath (DO), 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.


Schedule a Consult

Training & Affiliations

Tongue-tie Related Handouts

American Academy of Pediatric Dentistry Policy on Tongue and Lip Tie 2022 (pdf)Download
Infant Tongue-tie Research Summary (pdf)Download
Does my baby have a tongue tie (pdf)Download
Tongue-Tie & Cranial Sacral Therapy (pdf)Download
Tummytime™ method original handout (pdf)Download
Essential Tummy Time Moves (pdf)Download
Bodywork Referral List 4-5-25 (pdf)Download
Infant Exercises 4-5-25 (pdf)Download
Infant Post-Procedure Care 5.14.24 (pdf)Download

Tongue-tie Videos

Tongue-tie Release & Aftercare Videos

Dr Richard Baxter

Website: 


Video for parents on Tongue and lip-tie


Video of CO2 laser release on a baby


Video of CO2 laser release on infant


Website for training:  


Tongue-Tied Book Link


Services: tongue-tie information, laser release of tongue-tie, aftercare exercise videos, resources page, blog, facebook page


Videos of Tongue Wound Stretches After Release

Tongue, lip and cheek stretches for infants


Tongue & lip stretches for children, teens and adults


Videos of Infant Oral Exercises

Infant suck training:


Infant suck training:


Infant oral exercises:


Sleep Tongue Posture Hold:


Videos on Rhythmic Movements

Rhythmic movements for breastfeeding difficulty:



Videos on Guppy Stretch or Head Hangs

Tummy Time Method Guppy Pose: 


Guppy pose or reverse tummy time:


Guppy stretch:


Videos on Tummy Time

Tummy Time Positions:


Tummy Time Method:


Tongue-tie Resources

Tongue-tie Information

Arizona Breastfeeding Medicine & Wellness - Dr Cara Riek

Website: 


Services: Breastfeeding Medicine, lactation services, tongue-tie information, adult, child and infant tongue-tie release


Dr Richard Baxter

Website: 


Services: tongue-tie information, laser release of tongue-tie, aftercare exercise videos, resources page, blog, facebook page


Dr Richard Baxter

Website: 


The Real Story of the Tongue-Tie Clinical Report from the American Academy of Pediatrics


Dr Bobby Ghaheri

Website: 


Services: tongue-tie information, laser release of tongue-tie, aftercare exercise videos, resources page, blog, facebook page


The Breathe Institute - Dr Soroush Zaghi, Dr Chelsea Pinto

Website: 


Services: provider training courses, tongue-tie information, adult and infant tongue-tie release, aftercare stretch videos


Dr Lawrence Kotlow

Website: 


Services: articles on tongue-tie


Airway for Dummies Youtube video

website:


I find this video to be very helpful in demonstrating the relationship between the tongue, oral cavity, sleep and breathing. Tongue tie and artificial nipple feeding change the shape of the oral cavity and decrease the available space for the tongue.

Deep Front Line of Fascia - Cadaver Dissection by Tom Myers

website:


This video shows how the tongue is connected to our toes by fascia running throughout the body.

How tongue mobility changes face and jaw development

Video:


Research based video on tongue mobility and facial development


Other Laser Tongue-tie Release Providers

Mountain View Pediatric Dentistry - Dr Brian Hatch

website: 


Services: pediatric dental, laser tongue-tie release for infants and children

Sandia Oral Surgery - Dr Eric Tuggle, DDS

website: 


Services: Dental procedures, cosmetic surgery, adult tongue tie release

Breathing & Airway Info

Videos and Websites

Nose Breathing vs. Mouth Breathing

Close Your Mouth and Breathe through your nose:


Nose Breathing Benefits - Oxygen Advantage:


Nasal Nitric Oxide:

Buteyko Breathing Technique

Website:


Self Help book: "Close Your Mouth" by Patrick McKeown


Snoring and sleep apnea video:



Airway & TMJ

Video:

 Great educational video explaining breathing, swallowing and TMJ disorders


Mouth breathing, forward head posture and TMJ disorders

Part 1 Video:

 

Great educational video by Dr Priya Mistry explaining the connections between breathing and TMJ disorders


Part 2 video: 


Tongue-tie Podcasts

Podcasts related to Breastfeeding & Tongue-tie

Dr Nikki Mills (pediatric ENT in New Zealand)

The functional anatomy of sucking and swallowing in breastfed babies: Part 1


Check out other interesting topics on this podcast. 

Hosted by: Lisa Paladino CNM, IBCLC

Website: 


Is there an optimal timing for release of tongue and lip tie? Dr. Rishita Jaju Episode 326


Nicole Jardim: What is it like to have your tongue tie released as an adult? Episode 325


Check out other interesting topics on this podcast. 

Hosted by IABLE

IABLE: Institute for the Advancement of Breastfeeding and Lactation Education. Offering evidence based research and breastfeeding resources.


The Research Evidence Informing Current Breast Pump Technology


Check out other interesting topics on this podcast. 

Functional Therapy Resources

Occupational, Physical, Speech Language, Myofunctional

Jean Anne Zollars, PT, CST

Website: 


Services: treating infants and children for reflux, torticollis, cranial asymmetries, sleep issues, difficult births and more. 

Jessie Swartzentruber, OT, CST

Phone: 505-331-6940


Services: advance hands-on manual therapies, with a focus on pediatric clients, treating conditions including but not limited to Torticollis, Plagiocephaly, GERD and reflux, constipation, and frenulectomy (pre and post care for tongue and lip tie releases).

Megan Sofka, DO

Phone: 505-346-7656


Website: 


Services:  Specialising in osteopathing neuromusculoskeletal medicine / osteopathic manipulative medicine (ONMM/OMM). 


Includes advance hands-on manual therapies, with a focus on pediatric clients, treating conditions including but not limited to Torticollis, Plagiocephaly, and pre and post care for tongue and lip tie releases.

Hands for Health & Harmony

 Elana Sue St. Pierre, OT, CST


Phone: 505-984-0249


Website: 


Santa Fe Services: Craniosacral therapy for infants & newborns before and after tongue-tie release. Pediatric occupational therapy. Mothers, prenatal & postpartum

Speech Language Pathologists

Website: 


Services: Speech-Language Pathologists (SLPs) work with families to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.

Speech Language Pathologists and Occupational Therapists

Website: 


Services: Speech-language pathologists work with the full range of human communication to evaluate, diagnose and treat speech, language and swallowing disorders in individuals of all ages, from infants to the elderly.

Marc D. Nez, M.S., CCC-SLP

Website: 


Services: speech therapy and occupational therapy for school age and up

Website: 


Services: speech therapy, physical therapy and occupational therapy for children to adults

Santa Fe Therapy Associates

Kinda Davis, MS, CCC-SLP, COM


Website: 


Services: Multiple providers offering speech-language therapy, orofacial myology, eating and feeding disorders, occupational therapy and physical therapy.

Southwest Myfunctional Therapy

Sandraluz Gonzales, RDH, OMT


Website: 


Services: orofacial myofunctional therapy before and after tongue-tie release for school age and up

Inspirations Early Intervention

Website: 


Services: Caring for children birth to 3 years with concerns for developmental delay or disability, and established medical condition, medical or environmental risk factors. Includes feeding and nutrition, infant massage, physical and occupational therapy, speech language pathology and social services.

BMSI - Bilingual Multicultural Services Inc

Website: 


Services: BMSI-Best for Kids is a New Mexico Family Infant Toddler (FIT) Provider Agency that offers a free home and community-based program that provides supports and services for families to help their children from birth to 3 meet developmental milestones.

  • Occupational Therapies
  • Physical Therapy
  • Speech/Language Therapy
  • Diagnostic Evaluations
  • Psychological Evaluations
  • Early Intervention
  • Family Retreats

NAPPR Early Intervention

Website: 


Services: Tribal home visiting, early intervention, early head start and dental support programs

Alta Mira Early Intervention

Website: 


Services: early childhood services, early  intervention, parenting classes, Jericho project

Chiropractic Resources

Chiropractic / Cranial Sacral Therapy

Healing Happens NM

Dr Laura Hobson


Website: 


Services: chiropractic services during pregnancy, postpartum, pediatrics, before and after tongue-tie release, nutrition consults

High Desert Chiropractic & Wellness

Dr Karen Genter


Website: 


Services: chiropractic for pregnancy, before and after tongue-tie release, massage, acupuncture

Dr Arjan Khalsa

Website: 


Services: chiropractic, cranial sacral therapy, before and after tongue-tie release care

Blessing Chiropractic

Dr Lindsay Blessing


Website: 


Services: chiropractic, pregnancy, before and after tongue-tie release care

Eric Moya, Cst-D, Ms/Mfct

Website:


Services: Body-mind-spirit therapy, Cranial sacral therapy, massage

How Chiropractic / Body Work Can Help Breastfeeding

Video on the Anatomy of Breastfeeding:


Misalignment in the body from positions in pregnancy and the birth process can affect the structure and function of the body until corrected.

Baby Massage Resources

Massage / Body Work Therapy

Revassage - Velina Vassar, LMT

Website: 


Velina has over 30 years experience and draws from many healing modalities. Her special technique is called ReVassage™ (massage, reiki, tuning forks and physical therapy techniques).


Contact: (505) 350-1200


6739 Academy Rd NE Suite 238 Albuquerque NM 87109


Services: Infant Massage, Energy Work, Sound Therapy before and after tongue-tie release

MVMT Nomadic Therapy - Jennifer Stalnaker, LMT, CST

Website: 


Contact: 505-525-1136


Jennifer has over 20 years experience in multiple healing therapies  (massage, cranial sacral therapy, somatic emotional release, myofacial release, kinesio tape). She offers these  therapies from her mobile van and parks in various locations around the city. 


Services: Infant to adult massage, cranial sacral therapy before and after tongue tie release


David M. Lang, LMT

Website: 


Contact: (505) 463-2718


Services: Advanced manual therapy, massage, cranial sacral, myofascial for babies


Infant Massage - Rebecca Leeman, CNM

Contact: (505) 604-7708


Services: Infant massage by a midwife

Tummy Time Therapy

Website: 


Services: good parent and professional information


Other Tummy Time Videos:

How to do Tummy Time

Tummy Time for Newborns

Infant Massage

Infant massage:


Facial massage:


Oral Exercise Tools

Some tools that may help in oral exercises

Evenflow Balance + Wide Neck Bottles

Website: 


I like these bottles and nipples because they allow a wider latch more like the breast.

Ninni Co Pacifier

Website:


I like these round nipples because they allow the baby to cup their tongue around the nipple and you can insert your finger for doing oral exercises and suck training.


Silicon Chew Straw


These tools aid in oral motor exercises when given correct use instructions by a feeding therapist.

Silicon Rocket Teether


These tools aid in oral motor exercises when given correct use instructions by a feeding therapist. Great for different textures and tongue movement.

Oball


These tools aid in oral motor exercises when given correct use instructions by a feeding therapist. Great for tongue movement and motor skills.

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