SUPPORTING MUMS AND BABIES THROUGH TONGUE TIE CHALLENGES
Tongue tie
Do you care for unsettled babies? Colicky, crying babies who do not sleep well? Babies who struggle with breastfeeding? If so, chances are you seeing babies with tongue ties.
What is tethered oral tissue?
A tongue tie, or ankyloglossia, is an abnormal membranous attachment of the frenulum between the inferior surface of the tongue and the floor of the mouth. The membrane limits the mobility and function of the tongue, thereby interfering with breastfeeding and the suck-swallow-breathe coordination. The key here is function. Our tongues are supposed to be attached to the floor of the mouth, so seeing a band under the tongue is NOT abnormal in itself. More on that later. Other types of tethers are lip and buccal ties, being of the upper lip to the gum and the cheek to the gum.
Causes
Tongue ties affect 4-10% of the population depending on who you read, and it is three times more common in males. No one knows what causes it; theories abound about a genetic predisposition, methylation problems (MTHFR), iodine deficiency and mum having supplemented with folic acid instead of the more biocompatible folate. In some cases, there is a worsening of breastfeeding, reflux or colic symptomatology when baby assumes more upright positions. Prior to this, the larynx and the soft palate will meet at the back of the throat, allowing baby to swallow and breathe at the same time. At about four months old, the larynx and hyoid will lower, pulling the posterior tongue inferior. This separates the soft palate and the larynx, requiring improved coordination of the suck-swallow-breathe pattern. When the tongue doesn’t lift properly due to ankyloglossia this pattern becomes harder to perform.
Symptoms
Symptoms in infants with tongue ties include:
Clicking or leaking while feeding
Poor latch, possibly holding the neck in flexion
Lip blisters
Short frequent feeds, falling asleep on the breast
Reflux, distended abdomen, wind
Gagging
Tongue cupping when crying
Termination of breastfeeding
Failure to thrive
Difficulties eating solid foods
Assessment
Whether the frenulum needs a surgical release (cut or laser) is a question of function. You can assess the function of the tongue by inserting a gloved finger in baby’s mouth and feeling for the seal made around your finger by the tongue and lips as baby sucks. Evaluate the strength of the suck and the peristaltic movement of the tongue from anterior to posterior. Remember, the whole tongue is involved in the transfer of milk from the nipple to the esophagus. Visualize the frenulum by placing two pinky fingers gently under baby’s tongue and carefully lifting it while you feel for mobility. If you see blanching at the attachment points under tongue and/or floor of mouth, as well as feeling restriction in the lift, this may be a restrictive tie.
Care
It is really useful to involve an experienced lactation consultant in the decision about releasing a tie, as often the breastfeeding issues can be helped with breastfeeding position and education. Either way it is incredibly important for us as chiropractors to be actively involved in stimulating proper tongue, cheek and mouth function. Upper cervical adjustments promote vagal function to restore optimal nerve supply to involved structures. Cranial adjustments may improve cranial nerve function. Release and reeducation of involved cheek, tongue, submandibular and sublingual musculature is essential. How does the hyoid function? What about the TMJ? If a surgical release is performed chiropractors are in an ideal position to help restore optimum function. Remember that the baby already has feeding muscle memory that needs to be updated for the new tongue mobility and coordination.
If you want to learn more about tongue ties, plagiocephaly, reflux or anything else baby-related, look out for the Switched-on Babies course or join the Practice Pro Mastermind program.
Dorte
