Tongue ties are not something we typically think about when embarking on the crazy roller coaster of parenthood, yet tongue ties are something that can cause many issues for some families. Have you ever heard a mother say, “Breastfeeding just didn’t work for us”, “I couldn’t produce enough milk”, “It hurt too badly”, or “the baby wouldn’t latch”? When I am talking to parents and hear these phrases, I always check to ensure there is not a tongue or lip tie. In the world of tongue ties, a lot of providers are taught to look for a “heart shape” or a cleft in the tongue. Unfortunately, many posterior tongue ties get overlooked but can have a significant impact on feeding and/or speech as the child gets older.
Both are pictures of tongue ties. Not all tongue ties look the same.
As a provider, my interest in tongue and lip ties arose from personal experience. My daughter was born in 2014 and I would have been a parent saying one of the phrases mentioned above. She was able to nurse immediately and without pain but around 4-5 months adequate milk production became a problem. The days revolved around milk output and wondering if she was getting enough. A fact that many people don’t know is that women typically have an oversupply until about 12 weeks postpartum and then the milk regulates. If a child has tongue and/or lip tie and does not effectively drain the milk, your body does not get the message to make more (it’s all about supply and demand). Because of this, many women have an inadequate milk supply once the oversupply diminishes. We discovered my daughter’s lip tie when she was 18 months old (in 2016) and chose to have the revision. Due to that encounter, my eyes for tongue and lip ties have now remained open.
Speech-language pathologist complete oral mechanism evaluations as a part of speech and feeding evaluations. When a suspected tie is discovered, the next step is to refer the patient to a preferred tongue tie provider for additional evaluation and revision if necessary. Preferred providers are typically our first choice for a referral since they specialize or have additional training in evaluation and treatment of lip and tongue ties, which helps families navigate the recovery process for optimal results. When we were expecting our second child, ties were immediately on our mind. I wanted to make sure a plan was in place in the event that our child had a lip or tongue tie. Thankfully, the Therapy SPOT has built a wonderful, collaborative relationship with a preferred tongue tie provider in Columbia, South Carolina. Several patients who have been identified as having tongue and/or lip ties have decided to travel there for care. One excited 7 year old came for speech therapy the day after his procedure and said, “Look what I can do- sssss, zzzzz, la, la”. All were sounds that he was having difficulty producing due to a severe tongue tie. He is now successful with producing these sounds since the tissue restricting his tongue had been removed. Another 13 year old child came for speech therapy for help with articulation after being unable to master certain articulation skills. During the evaluation, a severe tongue tie was identified as the cause of articulation issues, as well as feeding issues. Following revision of the tongue tie, he required ONLY 4 speech therapy sessions before he mastered his goals.
The following list (provided by Southern Roots Periodontics) includes symptoms that may help identify a tongue or lip tie.
Trouble with breastfeeding or bottle feeding
*Persistently shallow latch
*Clicking, chomping, grinding, tongue thrust
*Air swallowing (gulping, gas, reflux)
*Inflammation (oversupply, vasospasms, aching)
*Poor stamina (short frequent feedings or very long feedings)
*Cracked or blistered nipples
*Low weight gain or weight gain that declines after 12 weeks old
*Blisters on the lips
*Spilling milk out of the sides of the mouth
Trouble with eating
*Gagging too much
*Pickiness about textures
*Chipmunking (piling food in cheeks)
*Food falling out of mouth while eating
Trouble with speaking
*Delays in initiating speaking
Dental & Orthodontic Issues
*High Narrow Palate
→ Teeth not fitting in mouth
→ Crooked molars
*Neck tension, torticollis
*Facial strain (especially in lips)
*Poor sinus drainage
The time came for our son to arrive and I kept this list in my mind. I am so thankful for the knowledge I gained over the last 3 years, it allowed us the opportunity to reach our personal feeding goals. Once our son was born, breastfeeding was immediately difficult; we had just about every symptom under the first category, but no traditional heart shape or clear cleft of the tongue. I was told “he was lazy”, “he had big baby syndrome”, or “he was still too young to be an efficient nurser”. Luckily, I was confident he was tied and my pediatrician agreed that there was a possible posterior tongue tie. I brought him to The Therapy SPOT and had another therapist (who was not a worried Mama) complete the Hazelbaker Evaluation, which indicated we needed to consider revision of the tongue and lip ties.
Once confident that a posterior tongue tie and lip tie were the problem, we called Dr. Rowe’s office and set up our consult. It is often recommended that the babies receive body work (chiropractor, craniosacral therapy, and occupational therapists with specialized training can provide these services) prior to surgery and be followed by a lactation consultant. Our son had his first adjustment at 5 days old and his tongue and lip revision at 2 weeks old via the LightScalpel CO2 laser. A LightScapel CO2 laser is a device that produces a concentrated beam of light. The highly focused CO2 laser beam vaporizes the tissue cleanly and precisely while sealing blood vessels at the same time. We chose to have the procedure completed via CO2 laser due to many advantages: minimized bleeding, less swelling and discomfort, reduced risk of infection, shortened procedure time, and a faster recovery. After frenectomy, the changes in breast feeding were almost immediate: less pain, deeper latch, and more effective nursing (shorter sessions with longer times in between nursing). The difference the procedure made in our life is phenomenal, it saved our nursing relationship and hopefully prevented future speech, feeding, dental, airway, and tension issues!
I can commiserate with families about the amount of work that goes into correcting a tongue/lip tie when you follow the protocol, but it is so worth it! Chiropractic care twice a week, suck training, tongue/lip stretches every 3 hours initially, speech therapy if needed, consults with an experienced lactation consultants as needed, visit to the preferred provider for frenectomy/follow ups, and all the normal doctor’s appointments that come up with a newborn. It is overwhelming and it IS challenging, but it is for such a short time and makes such a difference in your child’s quality of life, no matter if they are 1 week or 18 years old. I honestly can’t thank the professionals who helped us enough: Dr. Rowe with Southern Roots Periodontics, Caroline Bowman (speech-language pathologist) at The Therapy SPOT, Amanda Porter (Lactation Consultant), Dr. Rachel Templeton with New Life Chiropractic, and Dr. Benson at Mama Doc Pediatrics! Teamwork makes the dream work!
Our sweet son at 10 weeks old on graduation day with Dr. Rowe.
He was already double birth weight!
About the author: Danielle Carey, M.S., CCC-SLP, became a licensed speech-language pathologist in 2012, treating patients mainly in hospitals and subacute rehab centers with clinical time spent in the public school and at a private practice treating patients ages 2-60+. She received her bachelor’s degree in communication sciences and disorders with a minor in child development and family relations from East Carolina University. Danielle received her master’s degree in Speech-Language Pathology from Old Dominion University. She is a member of American Speech-Language-Hearing Association. Danielle received VitalStim certification (neuromuscular electrical stimulation) in 2014 to use for adults with dysphagia (swallowing impairment). She enjoys treating patients ranging from early intervention age through our older adults. Danielle has been a part of The Therapy SPOT team since 2015. She is passionate about speech-language pathology and enjoys completing continuing education courses and sharing knowledge with colleagues. Danielle and her husband Jared have a 3 year old daughter and infant son, and love to travel and take go on adventures. In her free time, Danielle enjoys reading, riding horses, cooking, and spending time at the beach.
The Therapy S.P.O.T. – Speech, Physical, and Occupational Therapy
Our multidisciplinary therapy center was established in 2007, and is committed to providing quality therapy services in a fun, family and child centered environment. We provide pediatric speech, feeding, physical, and occupational therapy as well as adult speech and swallowing therapy. Our therapists have unique and specialized skills and training, and we strive to pair our patients with the therapists who will best meet their specific needs. You can learn more about our services at http://www.therapyspotstatesboro.com. Questions or concerns? Call us at (912) 681-7768 for a free consultation.