Tongue Ties in Infants:
The early stages of a child's life are crucial for their growth and development, and ensuring their overall well-being is essential. One common condition that can affect infants is tongue tie, also known as ankyloglossia. Tongue tie occurs when the frenulum, the tissue that connects the tongue to the floor of the mouth, is shorter or tighter than usual, limiting the tongue's range of motion. This restriction can lead to difficulties with breastfeeding, speech and other oral functions.
Frenums:
There are actually 3 different ways a frenum can develop which were discovered with significant findings from research in 2019. This means that determining a tongue tie takes experienced and knowledgeable practitioners who are able to determine a true tongue tie, take all functional factors into account and advise you correctly so that you can make the best decision for your family.
Understanding Tongue Ties:
Tongue ties occur in approximately 4-11% of newborns and are more common in males than females. While some infants with tongue tie may not experience any significant issues, others may face challenges during breastfeeding or develop speech and oral function problems as they grow. The symptoms of tongue tie include difficulty latching during breastfeeding, inadequate milk transfer, poor weight gain, nipple pain or damage for breastfeeding mothers, speech difficulties, and dental issues. It’s also been shown that digestive issues, colic, sleep and breathing issues are also related.
Of course, these issues can be related to a plethora of other structures and strains in the body, so it is imperative to have a wholistic look at your infants body to identify the primary reason for their symptoms.
As an osteopath, we look at the body as an integrated whole. We are primary health practitioners, which means, it’s our job to refer you to the right place and develop an appropriate treatment plan. We can be your first point of call. We will do a thorough health check including an examination and ask a lot of questions about you and your babies history.
When to get an osteopathic assessment:
Feeding and latch issues
Colic and reflux
Poor weight gain
Excessive arching
Pain crying
Low lying tongue posture
Open mouth posture
Sleep issues
Unsettledness
When something just doesn’t feel right
Wheezing and loud breathing
Snoring
From here, we will determine if we need to develop a team approach for your care. Other trusted practitioners that we may include in a multidisciplinary treatment plan could include:
Lactation consultant
ENT
Orofacial myofunctional therapist
Functional dentist
Paediatrician
As a practitioner in Brisbane, I have done a lot of networking to create relationships with the most knowledgable and trusted practitioners in the area. This makes it’s a lot easier for you as a parent to receive top referral pathways.
Structure:
The tongue is the floor of the mouth and consists of 8 muscles. These come down and attach into the hyoid bone. You can see from the image above that these muscles are related to many structures below the jaw and come down and attach into the chest, upper ribs and shoulder complex. For appropriate tongue function, all of these other structures need to be working well. The hyoid bone needs to be able to lift and glide to allow the tongue to lift, and for this to happen the neck needs to be able to extend and the airways need to be unblocked and open.
This is a reason why you never want to just look at the one structure (the frenum) when determining a tongue tie or when addressing the function of a tethered tongue.
Reasons these structures might be restricted:
Compression at the back of the skull - There are really important cranial nerves that exit the skull and affect the tongue and gut. Compression and tension here can also cause discomfort in extending the neck which needs to happen for optimal feeding.
Shoulder dystocia at birth - Due to the relationship between the shoulder and tongue.
Torticollis - If your baby isn’t able to move their head both sides. These muscles and structures may also be affecting the jaw and tongue.
Jaw - The jaw needs to slide forward and open wide for the tongue to also come forward and to bring the breast tissue into the mouth. If there is restriction in the jaw, or if it is sitting too far back, this can affect feeding dynamics.
Pain - Pain in infants is highly misunderstood. For an infant to feel calm and safe enough to feed, there needs to be comfort in the body. If there is any underlying factor that is causing pain, then feeding can be affected. Osteopaths can identify if this is an underlying factor. Sometimes assisted births, such as the use of forceps or ventouse, can cause pain in the babies head.
Nervous system dysregulation - For a baby to feed well, their nervous system needs to be well integrated and balanced. If they experienced a difficult entry into the world, then they may be having trouble balancing their system. Generally signs at birth that may indicate this can include; meconium in the waters or straight after birth, low APGAR scores, delayed breathing, Forceps/ventouse delivery, long labours, a particularly fast delivery, posterior presentations, cord around the neck and any other birth traumas.
Birth trauma - This covers a vast span of experience. But has significant impact of the mother-baby dyad which can affect optimal feeding and bonding.
Delayed latch at birth - That initial latch is imperative for the set up of breast feeding. If this was delayed for any reason, we may need to take specific approaches with help from an IBLC
Assessment and diagnosis:
Generally, I will work closely with an experienced IBLC (International Board Certified Lactation Consultant) to determine if the dysfunctional tongue and feeding picture is indeed a true tongue tie. Sometimes, these structures mentioned above, can hold down the tongue, making it seem like a tongue tie due to the restricted lift of the tongue.
“posterior tongue tie”
This is a term that isn’t a “true diagnosis” but rather a way of saying that the restriction is deeper down that an obvious tie. An obvious anterior tie, would look like the frenum being very short, pulling the front of the tongue down and causing a heart shape tip (pretty much what you will see if you google tongue tie). You might also see that the tongue cannot be stuck out past the lower lip.
When you’ve been told that there is a “posterior tongue tie” this is usually when you'll be wanting a whole body assessment with an experienced paediatric osteopath, like myself, at More Pathways, to determine the true restriction of the tongue.
Treatment:
Going forward, there are a few directions and it’s never one size fits all.
Osteopathy is a gentle and non-invasive form of manual therapy that aims to restore balance and promote healing within the body. Osteopathic practitioners focus on the inter-relation of the muscles, bones, ligaments, nerves, fluids and connective tissues. When it comes to tongue ties in infants, osteopathy can help address the underlying structural issues contributing to the restriction of tongue movement.
By addressing these related structures, we will uncover the true functional aspect of your babies symptoms, improve the symptoms, or prepare your baby for an optimal timing of release (a frenectomy)
Sometimes, a tongue tie is difficult to determine at the beginning of the treatment pathway, because there may be, for example, a lot of tension and tight tissues. At this point, we might say that we are unsure of a tongue tie and that some manual treatment needs to happen before we can make a determination.
Sometimes, when these tissues are released, the frenum itself is revealed and we can then make a functional assessment and determine if there is a tethering.
Other times, a frenum that seems short and restricted is given more mobility with the underlying structures as well as more blood flow from releasing the tension, and the frenum, which once was feeling tight is now stretchy and functional.
This can only be determined with a few manual treatments and consultations.
All practitioners have their own approach, mine is utilising osteopathy which is gentle, subtle, without any sharp manipulations and taking the cranial bones into account. The amount of treatments vary widely according to your individual needs.
Frenectomy:
An infant frenectomy is a medical procedure performed on a newborn or very young baby. The procedure involves the surgical release of the frenulum to improve the mobility of the tongue. It is typically a quick and straightforward operation that can be performed by a functional dentist, paediatrician, oral surgeon, or ear nose and throat specialist.
There are different ways of releasing the structure that may include cutting with scissors or releasing with a laser. At the time of writing there are a few different laser options. Generally the medical professionals have had training in one approach and built experience using that particular approach. Choosing your practitioner and approach will take some reading and chatting with your team to make that informed choice (this is an entirely different blog post)
Optimal timing of release:
This term gets thrown around a lot in the tongue tie sphere. But what does it mean?
For me, it means we have addressed all the underlying issues that may be contributing to the function of feeding, you and your baby are well, both nervous systems are balanced and able to undergo the stress of a frenectomy, you are well informed, and I feel that the only puzzle piece left in improving the whole picture is to release the tethered frenum.
In conclusion
Tongue ties in infants can be challenging for both the baby and their parents. Difficulties with breastfeeding and potential long-term consequences on speech, sleep, breathing and oral development are concerns that need attention. Osteopathy offers a gentle, wholistic approach to address the underlying structural issues associated with tongue ties. By using manual techniques, cranial osteopathy, and collaborative care, osteopaths can help alleviate the restrictions and promote healthy tongue movement.
If you suspect your child has a tongue tie, consult with an experienced osteopath at More Pathways to explore how osteopathy can support your infant's well-being and development.
Glossary:
TOTs - Tethered Oral Tissues
Frenectomy - a simple surgical procedure that involves removing or reshaping the frenum located under the or tongue or upper lip.
Frenotomy - a surgical procedure to release the frenulum so the tongue can move more freely.
Ankyloglossia - Also called tongue tie, a condition in which the thin piece of skin under the baby's tongue (the lingual frenulum) is abnormally short and may restrict the movement of the tongue.
Frenum/frenulum - a small fold of tissue that secures the motion of a mobile organ in the body.
Our favourite IBLCs in Brisbane:
Jayne Vidler