Tongue and Lip Ties

Does your infant…

• Struggle to nurse or take a bottle?
• Have milk leaking out of his mouth while eating?
• Make clicking or smacking noises when eating?
• Have slow or poor weight gain?
• Have reflux of colic systems?
• Have lots of gas or experience frequent fussiness?

Does your older child…

• Sleep restlessly?
• Speak softly (mumble) or struggle to be understood?
• Eat slowly or is a picky eater?
• Choke or gag on liquids or food?

 

If so, your child may have a tongue or lip-tie.

While they aren’t usually life-threatening, oral restrictions can mean a lot of unnecessary limitations to your child’s life. We believe your child should never be held back by something so completely treatable.

Is your infant struggling to nurse?

A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air, causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle.

A nursing mother who experiences significant pain while nursing or whose baby has trouble latching on should have her child evaluated for tongue and lip-tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and the baby may be unable to hold a pacifier. The mother often reports, it’s a “full-time job” just to feed her baby, because he or she is constantly hungry, not getting enough milk, and spitting up often.

Although it can be overlooked or dismissed by other medical professionals, a tongue- and/or lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain but lead many mothers to abandon breastfeeding altogether.

Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch.  The sooner the tie is addressed the better the child will learn to function with the increased range of motion.

 

Does your toddler or older child struggle with speaking, eating, or sleeping?

While the tongue is able to compensate and some children have no speech impediments due to tongue-tie, many children continue to struggle. By the age of three, speech problems, especially articulation of the sounds L, R, T, D, N, TH, SH, and Z may be noticeable. An evaluation may be needed if more than half of a four-year-old child’s speech is not understood outside of the family circle. The child with a tongue-tie may have a lisp or have difficulty speaking when tired. It can also lead to sleep apnea, mouth breathing, other airway issues and cause difficulty chewing and swallowing food. 

Although there is no obvious way to tell in infancy which children with tongue-tie will have speech, feeding, or sleep difficulties later, the following characteristics are common:

• Heart-shaped tip of the tongue, or a thick band of fibers under the tongue.
• Inability to touch the roof of the mouth with the tongue, or get close.
• Difficulty moving the tongue from side to side.

Speech

While the tongue is able to compensate and some children have no speech impediments due to tongue-tie, many children continue to struggle. By the age of three, speech problems, especially articulation of the sounds L, R, T, D, N, TH, SH, and Z may be noticeable. An evaluation may be needed if more than half of a four-year-old child’s speech is not understood outside of the family circle. The child with a tongue-tie may have a lisp or have difficulty speaking when tired. It can also lead to sleep apnea, mouth breathing, other airway issues and cause difficulty chewing and swallowing food. 

Although there is no obvious way to tell in infancy which children with tongue-tie will have speech, feeding, or sleep difficulties later, the following characteristics are common:

• Heart-shaped tip of the tongue, or a thick band of fibers under the tongue.
• Inability to touch the roof of the mouth with the tongue, or get close.
• Difficulty moving the tongue from side to side.

 

Feeding

Children that are tongue-tied often have eating issues from infancy, such as trouble nursing or taking a bottle. When transitioning to solid foods, they may choke, gag, or spit food out and even refuse to wean. In childhood, these eating difficulties can persist and you may note that they only eat small amounts of food of “graze” throughout the day.  They will also be slow eaters.

These issues are because difficulty swallowing can lead to distraction. Pickiness, especially with textures, can often occur, as certain types of food are challenging to swallow. Soft, mushy foods and meats are typically the most difficult, but children can struggle with chewy and hard foods as well.

Sometimes it is not an evident tongue tie but a “hidden” posterior tongue tie that is often missed in a routine exam by healthcare providers.  Even if your child has been told that he or she “does not have a tongue-tie” but exhibits all the symptoms, there is a good chance it is a posterior tongue-tie and should be evaluated.

Of course not every feeding problem is a result of a tongue-tie, but very often there is a connection, and this simple solution can be overlooked.

 

Sleep and Tonsils

A tongue-tied child will often grind his/her teeth at night, snore or experience other sleep-disordered breathing problems. Releasing a tongue-tie allows the tongue to rest on the palate, where it is supposed to rest, instead of falling back to narrow or block the child’s airway. Sleep-disordered breathing can cause frequent waking, restlessness, bed-wetting, waking up tired. This can be accompanied by difficulty focusing, which is sometimes misdiagnosed as ADD or ADHD.                                     

Because multiple factors contribute to the problem, such as large tonsils and adenoids, a narrow palate and tongue-tie, often a child will be seen by multiple specialists to try to address the problem. Children with tongue-ties often have a history of multiple ear infections, needing ear tubes, and having tonsils and adenoids removed. The mouth-breathing that frequently occurs in tongue-tied individuals often complicates the other issues due to the low resting posture of the tongue. A tongue-tie release can improve sleep quality dramatically. 

 

Dental

For children with a lip-tie, it is common to have a gap between the two front teeth. This often closes if the frenum is removed, typically done before 18 months old or around age 8, when the permanent teeth erupt. The tight lip-tie may trap food and make it difficult to remove plaque from the front teeth, leading to cavities.

 

What is a tongue-tie or lip-tie?

Tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia. Lip-tie is a condition where the upper lip cannot be curled or moved normally.

 

Before we are born, a strong cord of tissue that guides the development of mouth structures, called a frenum is positioned in the center of the mouth. There is also one located under the upper lip. As we develop in the womb, these frena are supposed to recede and thin. The lingual (tongue) and labial (lip) frena are visible and easily felt if you look in the mirror under your tongue and lip. Everyone has these, but in some people, one or both can be especially tight or fail to recede and may cause tongue/lip mobility problems.

 

The tongue and lip are a very complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie can lead to nursing, feeding, dental, sleep, or speech problems, which may be serious in some individuals. Problems can even persist into adulthood with migraines, neck pain, shoulder pain, and speech problems.

 

There are many children who have difficulties related to tongue-ties and lip-ties, but unfortunately, they’re often not identified until later in life. They can cause various nursing difficulties, failure to gain weight, speech difficulties, feeding difficulties, sleep issues, and cavities.

 

Often, ties are genetic, so while the child is in for treatment, a parent realizes they also have a tongue-tie (evidenced by speech problems, migraines, reflux, etc). The sooner a tongue or lip is released, the better the child is able to adapt to the new mobility.

 

Tongue-tie and lip-tie release is a simple procedure and there are virtually no complications when using a Laser Dentistry and good technique. The procedure may be performed as early as a couple of days after birth and as late as into your 70s! Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed the better the procedure will work and the greater the outcome will be in resolving the tongue-tie symptoms.

Using a state-of-the-art dental laser, we can easily release ties in our office with minimal to no bleeding and no stitches. We use Laser Dentistry that works faster, is less painful, and results in a better healing process. 

 

Children who are old enough to be anxious about the procedure always receive numbing medication and laughing gas and usually report no pain at all. The crying is mostly due to the discomfort of having their mouth opened and their tongues held tight.  Younger children and babies usually cry more due to us working in their mouths and holding them still than from the pain.

The laser gently removes the tight tissue with virtually no bleeding and no stitches. A baby is allowed to nurse immediately after the procedure, and older children do notice an immediate difference in mobility of the tongue. Often speech is improved within a few weeks, but speech therapy is still needed and it is recommended to work with a myofunctional therapist for children older than 4 years of age.

 

What are the expected results?

One important thing to understand when your child has a tongue or lip-tie revised is that improvement is not always immediate. The release of the frenum is usually just the first step. Your child will need some time to figure out what to do with the new mobility of his or her tongue or lip.

The tongue is a muscle, and it becomes used to functioning in a certain way, just like any other muscle in the body. When tongue function is restricted by a tongue-tie, the body adapts, and other muscles have to help compensate. When a tongue-tie is released, the child has no muscle memory of how to use the tongue effectively without the restriction. It takes time for the brain to figure this out.

While most mothers notice an immediate improvement in their infants’ ability to nurse, it is also completely normal for this to take time. In some cases, there may even be a little regression in sucking for a day or two as your child’s brain tries to sort out how to use an unrestricted tongue. It may seem to you that things get worse before they get better. Sometimes, babies need chiropractic or craniosacral therapy to address other issues, such as torticollis (tight neck muscles), that can affect nursing.

If you have any questions or feel that anything described above relates to your child, give us a call to set up a consultation with Dr. Hannah to see if this procedure is the right one for your child.