Who is on Team Tongue Tie?

Where to go to have your baby (child, or self) evaluated and treated for oral ties.

First, understand that not all providers are trained in ties. So if based on symptoms and your own understanding of your baby and what you’ve learned about the topic so far, you suspect a tie, you would want someone who can perform the necessary proper exam to identify it and its impacts. If you took your baby to their doctor because you knew something was wrong with their breathing, and they didn’t provide a thorough exam of their lungs, you’d think, “well perhaps I should see a pulmonologist” if you still suspected something was truly wrong and you hadn’t received a valid reason why.

Sometimes you need to ask outright a provider's level of knowledge and educational background with respect to diagnosing and treating this condition. As stated previously there’s some level of controversy, or at minimum, much disagreement about the diagnostic criteria, methods, treatment approaches, and market for treating TOTs but I won't be discussing that here. The reason I bring this up again is to make it clear that there are going to be times when providers are going to allow their bias and lack of training to inform their diagnosis and advice. (As with ANY area of clinical practice! Not saying it's right, just saying it happens, and it's almost inevitable! I am sure I am/have been guilty of this wittingly or unwittingly.)

Some questions to ask to get a feel for your provider’s basis on which they’re making their recommendations:

1. Have you seen/treated babies with this condition and what did you advise? How does that usually work out for families?

2. Are you experienced with working with this condition, or is there someone in the practice who deals with this regularly?

3. Have you taken any education in this area specifically? (This one’s pretty direct. I don’t know if many folks would actually ask their provider this, but in case you needed permission to do so, here it is.)

Dentist or ENT (release provider)

I specifically say go to a release provider because in my opinion, they’ve invested the time and resources to become trained in release procedures because they want to help families reap the benefits of the release. Devil’s advocate: someone might say, surgeons want to cut (we hear it often in the ortho world) but the bottom line is that again, medical practitioners of any specialty have a responsibility to the patient. They must never perform a procedure for which there will be no benefit. Additionally, they are the professionals who are “allowed” to diagnose ties. Other providers can assess, provide referrals, guidance and insight. Be advised: many release providers are offering the procedure in the very same appointment time as the consult if the tie is identified and deemed

restrictive. Some therapists would caution against this. I would say, do what is best for your individual situation. Some folks are traveling quite a long distance to have a procedure done, and two trips is not feasible. In this case, or any other in which it may be medically, financially, or for any other reason necessary to time the release a certain way to minimize stress to the baby or family, do so. Part of the entire objective of this article is to provide info to help you plan. Therefore, if you can seek out some of the other providers around you such as therapists, chiropractors, and IBCLCs pre-procedure, you’ll have a better idea going in whether there is a tie, and also baby will have been prepped with pre-release therapy. Any good release provider will agree, this is the ideal situation: pre- and post- release work and an informed client coming to see them, ready to make a sound decision, having anticipated the recommendation and procedure.

IBCLC and other lactation professionals

The infant feeding gurus. LCs work with the feeding dyad: feeder and eater (feedee?). IBCLCs are internationally board certified and work with complex breastfeeding issues. But they also work with bottle fed babies and exclusive pumpers! Just because you are not directly breastfeeding or choosing breastmilk at all does not mean you can’t benefit from the wealth of knowledge and experience of a lactation professional. LCs generally screen babies head to toe and check out any factors on the feeder’s end to figure out the root cause of any issues. From there, they train parents and/or make referrals as needed! IBCLCs are not able to “diagnose” ties technically, but those who are trained can accurately identify restrictions in tissues, as well as provide initial treatment strategies.

Physical therapist, Occupational therapist, Chiropractor

Chiropractors who are specially trained in treating pediatrics, especially infants, get lots of questions about their methods due to the perception that chiropractic care involves cracking necks and backs. People can’t imagine a baby being handled with that level of force, and they’d be correct in not doing so because the way chiropractors describe the amount of pressure or force used to make adjustments in infants is the same amount you would use to test the ripeness of an avocado. A little bit goes a long way when it comes to little bodies. Chiropractors help people develop resiliency and regulation of their nervous system. PTs and OTs who treat infants should be addressing the nervous system as well. Nervous system is queen, I say (because matriarchy, obvs).

PTs and OTs (and possibly some chiropractors as well) will facilitate developmentally appropriate positioning and activity, provide education about feeding (depending on their training, as feeding has typically been a speech/OT domain, but falls within the realm of other disciplines, depending), and address impairments which can co-occur with TOTs. Some common ones include torticollis or tortisoma, reflux and digestive issues, colic, plagiocephaly (problems with head shape) and more. These disciplines can work with the whole family to address positional dysfunction, overuse aches and pains, pelvic floor, and more.

Speech-language pathologist, OT, feeding therapy, Orofacial myofunctional therapist

As stated above, traditionally feeding therapy falls under ST and OT as they really specialize in these processes. Feeding therapists address the many aspects that go into the process of eating. Especially for older babies struggling with solids and children, it can be beneficial to have a feeding therapist take a holistic look at your child’s feeding from environment and routine, to how food is presented visually and how you speak to your child about eating and food. They assess body posture, strength and overall tone to determine readiness from a physical perspective. They assess oral structure and function, as well as swallowing for different food texture types. And they can assess your child’s sensory preferences and presentation in order to determine if there are aspects of their sensory processing that contribute to how they experience food. Myofunctional therapy is a less widely-practiced, but very specific and helpful treatment modality that some describe as “physical therapy for the mouth”, which is reductive of course (for OMT and PT alike!). But it gets the idea across that OMT (orofacial myofunctional therapy) is a systematic approach to treating orofacial myofunctional disorders (OMDs) in children and adults. OMDs can include dental dysfunctions, jaw size and position problems, temporomandibular joint dysfunction, tongue thrusting, thumb sucking, prolonged bottle or pacifier use, and more, and is therefore addressed from a multi-disciplinary standpoint. An airway-focused dentist, dental hygienist, ST, PT, OT, or other licensed professional may become an OMT or contribute in the care of OMDs.

Massage, craniosacral therapy (CST)

Massage therapy and/or CST are great supplements to pre- and post-op therapy for frenectomy. My recommendation is to utilize massage and CST in conjunction with other allied health provider treatment for best results. The reason is because CST and massage is working generally only on the structure portion, and not directly addressing the function (I say directly because relieving the tissues of some restriction will allow normal function to follow, which makes sense!). You need to work the tissues in all ways in order to see results. It is less ideal to have the release procedure without the pre- and/or post-op care for the same reason: the procedure addresses the structures, but not necessarily the function. Depending on the timing, the patient may have developed compensations for restrictions which need to be retrained. CST and massage are amazing, gentle, generally very tolerable interventions for patients undergoing frenectomy. As with any other provider, discover the practitioner’s comfort level and training with respect to treatment of infants, if applicable.

There may be other provider types which I have missed, but in general, these tend to be the big players in the oral ties arena. If you need assistance locating a provider to address your needs, please reach out and contact me here - I would love to connect you to the right person! If you’re looking for pre- or post- frenectomy PT that meets you where you’re at - right in the comfort of your home - then #letsbegintogether! Submit my contact form today and let’s get you and your baby ready!

In case you missed it, check out my previous post, I suspect my baby has a tongue tie. Now what?