Tongue/Lip Tie (Click here for a List of Preferred Providers)

Jen H., January 2016.

Tongue/Lip Ties and Their Relation to Infant Reflux

When you swallow, the tongue goes up to the palate (that’s what protects the airway when you swallow). When the tongue is tied, it is stuck to the floor of the mouth. It can’t move to the proper position. The result is swallowing extra air. Also for tied babies, it means they have trouble with the typical suck/swallow pattern. Since their tongue has restricted overall movement, they have trouble controlling the flow of milk (breast or bottle), so they choke a lot more in addition to taking in extra air.
Also proper tongue movement stimulates the vagus nerve which lets the rest of the body know that food is coming and to get ready. If that doesn’t happen, then the whole digestive system is off- can be sluggish/cause constipation, etc.
This explains the part about the vagus nerve: The following quote is from here: https://nursingrubysue.wordpress.com/tag/vagus-nerve/

The Vagus nerve…is the nerve that connects the digestive system to the brain. Amazingly, it runs right under the tongue.
This is why tongue-tie is such a problem! The vagus nerve is stimulated to release signal the digestive system to work by the tongue moving. If tongue is tied down by a tight or restrictive frenulum, then the vagus nerve is not stimulated. It never gets the message.
It’s like having mail at the post office that you don’t know is there for you and a mail man that won’t deliver the letters to you. You never get the message.
Your stomach never knows to make acid. So the food doesn’t digest timely. It ferments in the belly and bubbles up into the esophagus causing reflux. Most babies that take reflux medicines just need a tongue-tie revision.

Tongue tied babies often have a hard time maintaining their latch (you hear a clicking sound), and when they lose suction they swallow air.
The following quote is from here: Weight Gain is Not the Only Marker of Successful Breastfeeding

Parents can often feel or hear air in their child’s stomach, and burping doesn’t always work to get it out. This air can act as propellant, causing silent reflux, spitting up or even projectile vomiting. The baby can have significant abdominal discomfort as a result.

Jen H., April 2017.

Advice for Tongue/Lip Ties and Reflux

Use a preferred provider to make sure that the tongue is completely released
Get a team in place to help with breastfeeding and recovery of baby (before revision, if possible). Include: a lactation consultant, cranio sacral therapist/ bodyworker who’s experienced with ties, and speech therapist. Here is a List that is specific to finding bodyworkers for tongue tie. Search for Myofasial Therapy in this Directory.
Be patient, average time for baby to figure out tongue movement and improve on feedings is a couple of weeks to about a month.
Do bodywork before and after procedure, if possible. I cannot stress the importance of cranio sacral therapy, cst, enough! Find a CST; It is so helpful to have bodywork to release the tensions that the body has from compensating for the ties, or even a quick birth or being malpositioned in utero. How Craniosacral-Therapy Can Improve Breastfeeding. Find if they have experience with resolving torticollis or plagiocephaly; those structural issues seem to be more common in tongue tied babies.
- Unless stitches were used, stretches after a revision are recommended to keep the tie from reattaching or developing scar tissue. Without stretches, it is likely that there is reattachment and the restriction is still present: The Importance of Active Wound Management Following Release from Ties, Frenotomy
try nursing in the laid back position, it helps baby control the flow until they get used to everything.
white noise (loud) can help a distracted/frustrated baby settle down to nurse.
make sure to do stretches to prevent reattachment. Luna Lactation has some great videos on YouTube:

Video: https://m.youtube.com/watch?v=0BgGWNp0-GA

Video: https://m.youtube.com/watch?v=q9Io3Ush-S4

keep up with pain management for the first week.

Posterior Tongue Tie (Nancy C.)

A PTT is a tongue tie but not the typical frontal tie that most physicians and therapist were trained to examine. These were typically the tie that restricted protrusion of the tongue beyond the lip and caused a “sweetheart” appearance. That is normally a stage 1 or 2 tie or ankyloglossia. The posterior tongue tie is essentially a tether of the tongue to the floor of the mouth restricting normal movement of the tongue to collect fluid/food and propel it to the throat to trigger a swallow. The children in an effort to compensate develop an aberrant form of the swallow that cause a slew of difficulties most often associated with aspiration, reflux, “sputtering” of liquids causing coughing choking or gagging. The tether is posterior to the front tie and can only be assessed by feeling for it with the child lying flat and the head in extension on the lap of the examiner.

Two websites of colleagues, that have videos and excellent explanations:
Dr. Larry Kotlow
Dr. Ghareri

I gave you the abridged version, but they are excellent. I am a member of the IATP which provides research & data about this. We see approx 5-8 per week for diagnosis then send to a pediatric dentist for laser revision. We do not recommend surgical cut because the tethers can grow back worse since they cannot “cut” the depth of the tie that the laser can. I hope this helps!!!

Charlie:

My son was diagnosed with silent reflux at 7 weeks. We tried zantac first, then Prevacid solutabs (7.5 mg twice a day). It took a full two weeks to see some improvement in his symptoms. It wasn’t perfect, but he refused less feedings and seemed more comfortable. However, he would only nap if held or carried in the ergo. Night sleep was good- he slept for 6-7 hours, ate, then back to sleep for another 2-3.

After 6 weeks on prevacid, he started refusing feedings again (developed an aversion), was very fussy after feedings, only ate well when half asleep, and nighttime sleep fell apart. He was up every couple of hours all night and would wake at 5am, scream crying and very gassy.

After a lot of research online, I finally figured out that he had a tongue and lip tie. I had a lactation consultant confirm it and the second ENT we saw clipped it. After a week, and only some improvement with feedings/reflux/gassiness, I found out the revision was incomplete. This time, we saw an oral surgeon who revised the tongue and lip with a laser. For some reason- a lot of providers are hesitant to revise the tongue and have a wait and see approach. The thing is, the tongue tie is a midline defect- it’s not supposed to be there and it won’t get better [some believe it’s related to MTHFR]. Sometimes cst or chiro adjustment can provide some temporary relief. It’s so hard to find experienced providers! We had to do the revision twice bc the first ent did an incomplete revision. Oftentimes parents are told to wait regarding the ptt. I just know a lot of mommas that have waited because they were told the tongue wasn’t really an issue and it turned out that it was the main issue.

It took a few sessions with a cranio sacral therapist and a speech therapist to work through all of our issues (Body tension, shallow latch, feeding aversion).

Within a week of the second revision, reflux symptoms and most of the gas issues were gone. Posterior tongue tie (ptt) can cause a lot of issues. When the tongue isn’t functioning properly, it causes baby to swallow extra air, gag and choke, which causes digestive issues. The lip tie also causes extra gassiness because baby can’t get a good seal. With my son, the ptt caused all of that plus, he developed a feeding aversion- it was a lot of work for him to eat and he just got too tired. Also sleep was terrible- he was too uncomfortable to sleep during the day, except in the ergo and every morning around 4/5 am he woke up screaming bc he was so uncomfortable. Post revision (and we did ptt and lip) ALL his issues went away.

Over the course of 3 weeks, post revision, we slowly weaned off the Prevacid solutabs. (We halved the morning dose for a week, then the afternoon, and then just stopped altogether. We needed to give mylanta cherry supreme, mcs, one night, but other than that, there weren’t any acid rebound issues). That made a huge difference with gassiness and scream-crying wake ups at 5am.

By two weeks post revision, he was no longer refusing feedings. At the one month mark, I finally felt like breastfeeding was going normal- he had a great latch and was taking full feedings.

A Blurb from another mom, Dannie C., May 2015:
When born, the pediatrician in the hospital said my son was tongue tied but that she does not clip them. She informed us another pediatrician may come discuss it with us ,but to discuss it in the office with our chosen pediatrician. Our chosen pediatricians feelings were that he was latching so it was not a problem. After relocating, our new pediatrician saw his tongue tie and immediately referred us to an ENT. At this point we were already struggling with reflux for over a month. She wanted the ENT to discuss concerns with us, however her concern was the possibility of helping with reflux and she did not want speech issues in the future. The ENT has been, to this day, the most knowledgeable about reflux! At the time of the appointment we were just over two months old. He said it is best to clip as soon as possible, instead of waiting, because the younger the baby the easier and less traumatic the process. He was very upset that the pediatrician in the hospital did not clip it because he said his tongue tie was one of the tightest he’s seen. I was very concerned with pain for our son, but they numbed him and I dosed him once with advil. It honestly never phased him! Immediately his latch was no longer painful, he burped easier, and was much less gassy overall. I am so thankful we had it done! Note – the younger the revision the better per our ENT and thar most pediatricians cannot correctly diagnose ties!

Click here: It’s Not My Milk! Tongue & Lip Tie