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I suspect my baby has a tongue tie…Now what?

So your baby is having difficulty. You’re exhausted, feeling so sorry for your little suffering baby who cannot tell you what is going on with them. Maybe you are bodyfeeding and feeling significant pain or nipple damage. Maybe baby is gassy, fussy, constipated, or having reflux. Maybe they're struggling to relax, with shoulders up to their ears, a head turn preference, leaning to one side in their bouncer and carseat.

You’ve noticed they are leaking milk from their mouth during feedings, taking FOREVER to empty the bottle, or never seeming like they’ve had their fill. Maybe you’re triple feeding, pumping, feeding so frequently it feels like it’s all you’re doing all. day. LONG!

Desperate and frustrated, you turn, where else? To the internet. Your Googling and Facebook group perusing leads to your discovery of this whole community of parents seeking help with their childrens’ similar symptoms and many of them are talking about releasing their childrens’ oral ties. Tongue ties, lip ties…buccal ties?? (What are those?!) You may be wondering if this could be the cause of your child's difficulties, and if so, what to do about it.

It can be confusing to know where to turn or how to get started when looking for solutions to problems when there are suspected tethered oral tissues. There is a growing body of evidence surrounding this condition, and as with anything “new” (ties are not new, but as they’re gaining more attention, it seems it), it can be difficult to find reliable information, trusted sources, even reassurance and support. To some, tethered oral tissues are even controversial (an article for another day…). This may be because some of the symptoms common to babies struggling with ties can absolutely be caused by other things, further confusing the issue. But, this “controversy” may lead to issues that ARE tie-related to be dismissed, misdiagnosed, or missed entirely.

So here are a few steps to get started investigating if you suspect oral ties:

  1. Discuss the difficulties you are having with your pediatrician. They will formulate a list of diagnoses that could encompass and/or explain your baby’s or your symptoms. Depending on what they come up with, you should be provided with a list of options to address the concerns, be it medication, referrals, etc. If there is difficulty with feeding, a referral to an IBCLC should be on that list. (What if you’re formula or exclusively bottle feeding? The answer is still a referral to IBCLC. They are experts in infant feeding. There are definitely other appropriate providers, but often IBCLCs will holistically assess the parent, infant, home environment (if within a home visit), situation, etc. and provide insight.)

  2. If you are already working with an IBCLC, ask them to assess your infant’s oral motor function and mobility. This is a hands-on evaluation. It is not just watching a feed or looking at latch. Visually/externally a latch (on breast or bottle) can “look good” but not feel good (breast) or be functional. If the exam does not include a full-body assessment of the infant, a thorough, hands-on assessment inside the mouth, move on.

  3. If you and/or your other providers continue to suspect tethered oral tissues are part of the picture, seek the opinion of a release provider: an ENT or dentist. Healthcare providers must always first and foremost “do no harm”. Therefore, any reputable provider (this goes for any specialty) will not perform a procedure when it is not needed. When meeting with a release provider, feel free to ask questions such as, “In what instances would you NOT recommend releasing tongue/lip ties? How often do you meet with a client and not end up performing the procedure? What are your best recommendations for OUR situation? What options do we have? What, if anything, do you recommend we try before the procedure?” Most release providers DO offer the procedure on the exact same day as the consultation. This does NOT mean you NEED to consent to the procedure on the same day. Let the office know ahead of time you are coming for a consultation ONLY, if that is what you are most comfortable with. You will ask your questions and make an informed decision. Most release providers will also offer you some options of providers to see prior to release (and hopefully also after) if they detect things that are worth working on and exploring as contributing factors to your baby’s difficulties.

  4. Check out some of the other providers as recommended by your peds, release provider, or lactation professional. My next post will be about the various types of providers who are commonly working with babies, children, and adults who have suspected or diagnosed oral ties, and how they can help!

It can be confusing to know where to turn or how to get started when looking for solutions to problems when there are suspected tethered oral tissues.

Some extra thoughts on this process…

I know first hand that sometimes parents feel the squeeze to get the release procedure done (or at least to do what feels like the most direct route to improvement). Parental leave time goes like sand through a sieve: at first it appears to be going by slowly, then as the impending return to work approaches, the time seems to slip away so rapidly. It may feel like you’re on the clock to get your baby to take a bottle efficiently or to figure out the issues and address it before you’ve got even less time in the day with your baby to practice a home program, perform wound care/aftercare, or work on feeding and establish a strong supply before you’re pumping 4-5 times a day away from your child. First of all, F the patriarchy for making us feel like this. Let’s all think about how we can put the squeeze on lawmakers instead to advocate for better parental leave policy. Second, it is for this reason that a team approach is recommended. Not to give you several different appointments to juggle and make it so you’ve got a zillion places to run around, but so that you’ve got help in managing the multiple aspects of care involved, but also so that hopefully, you’ve got some recommendations for providers that can address the whole body. More on that in the next post.

Lastly, if you feel like you are getting dismissed or what you are trying is not working, keep looking for answers. If you feel like you’re being convinced or pressured, rather than guided and educated, seek help elsewhere. Whether you’re a first time parent or a tenth-time parent, each baby is a new learning experience. And the foray into the world of tethered oral tissues can be fraught with confusion and controversy (more on that later, too). Just know that at some point every parent going through this has questioned themselves, or had providers question them or challenge them. Do your best to ask questions, stay open-minded, advocate for yourself and your child, and seek multiple opinions.

Have questions about your child's symptoms or need guidance on selecting providers? Please don't hesitate to connect with me! I am happy to help. Contact me here.

Find out more about some of the symptoms common to tied babies (but can be caused by or occur otherwise!), and how PT helps by checking out these posts on my Instagram:

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