By Mary Claire Burks, MA, CCC-SLP, Speech-Language Pathologist
A “tongue tie” is a tethered band of tissue or “frenulum” that connects your baby’s tongue to the bottom of his or her mouth. An “upper lip tie” is a tethered oral tissue or “frenulum” that connects your baby’s lip to the top of his or her mouth. Everyone has tissue located underneath their tongue or lip. This tissue can be thin, thick, tight, or fibrous; however, if it inhibits movement, we can see difficulties with breast and bottle feeding, transition to solid foods, and speech sound production. A lip tie can affect a baby’s ability to flange the lip to form an appropriate seal around a nipple. A tongue tie can impact a baby from achieving optimal range of motion, such as side to side movement of the tongue, sticking the tongue out, and elevating the tongue. Your baby’s tongue needs to be able to protrude in order to draw the nipple and part of your areola into your mouth when latching. This creates a seal and allows your baby to effectively extract milk from your breast. If the tissue is hindering the baby’s tongue movements, latching correctly to the breast or bottle is often difficult to achieve. The tongue also needs to elevate and depress in order to effectively transfer milk, and side to side movement of the tongue is an important skill when introducing solid foods.
If your baby is suffering from tethered oral tissues they may present the following problems, symptoms, or difficulties:
- Irritability, Frustration, and Frequent Crying During Feedings
- Poor Weight Gain or Weight Fluctuations
- Refusal To Nurse
- Poor/Shallow Latch
- Chomping/Chewing On Breast or Bottle To Extract Milk vs. Achieving Appropriate Tongue Movements To Extract Milk
- Milk Loss From Lips Due To Improper Seal
- Coughing/Choking During Feedings
- Audible Gulping
- Quick Fatigue During Feedings
- Tucked Upper Lip Causing Poor Labial Seal
- Popping On/Off The Breast or Bottle
- Riding Milk Let Down at Breast
- Labored Breathing
- Spit Up
Tethered oral tissues may also affect mom. The following are maternal symptoms that may appear as a result of tethered oral tissues during breastfeeding:
- Soreness and/or Dry, Cracked Nipples
- Lipstick Shaped Nipples
- Breast Pain/Discomfort During or After Feedings
- Low or Decreased Milk Supply
- Emotional Stress
- Pain Due to Engorgement, Blocked Milk Ducts, or Even Mastitis – May Occur If Your Baby is Unable to Properly Extract Milk and Drain Your Breasts Due to Limited Tongue Movement
Some babies suffering from a tongue/lip tie, will effectively feed and gain weight well without issues. However, there are other side effects to consider.
- Sleep, Airway, and Orofacial Development – Tongue tie causes babies to present with improper tongue resting posture. Babies who are tongue tied may sleep with their mouth open and their tongue resting at the floor of the mouth. Adequate tongue resting posture is achieved when the tongue is resting on the palate. The tongue is responsible for shaping the palate, which is the floor of the nose. If the tongue is not resting on the palate, the palate can grow high and narrow, which affects optimal orofacial development and makes breathing and sleep more challenging.
- Digestion – Ties are often the cause of gastrointestinal symptoms, like reflux, gas, and stooling issues even if the baby is effectively transferring milk
- Posture and Developmental Movement – Ties inhibit movement from the tongue to the toes, making whole body movements restricted. Torticollis, asymmetries, and body tension are seen in babies with tethered oral tissues. Tension is typically seen in baby’s neck, shoulders, diaphragm, ankles, and thumbs.
If any of these difficulties seem familiar, it is important to seek out a trained professional and oral function expert. This may include a speech therapist or occupational therapist who is trained in evaluating and treating tethered oral tissues. A full oral structural and functional assessment will be conducted to determine the appropriate plan of care for you and your baby.
If you are concerned about your child’s ability to nurse/bottle feed effectively or want to learn more, contact the Pediatric Therapy Team at Woman’s Hospital.