5 Signs Baby is NOT Ready for a Tongue Tie Release

What is a Tongue Tie?

The tongue is connected to the floor of the mouth by a band of tissue, which is a normal part of anatomy. During development, this band should recede to allow the tongue full range of motion for practicing sucking and swallowing in the womb. A tongue tie occurs when this tissue remains tight and restrictive, hindering the tongue's use and oral development, such as causing a high palate or small jaw. It is estimated that 10% of the population has a tongue tie, with research indicating a strong genetic component. Families often seek clarity on a tongue tie diagnosis when facing breastfeeding challenges. However, identifying a tongue tie does not mean surgery is the next step. Tethered oral tissues have a structural and functional impairments, meaning that simply cutting the tissue under the tongue won't resolve all issues. Enhancing function through feeding therapy should be the first step to improve feeding skills and prepare the baby for better release outcomes if surgery becomes necessary. Specialists in oral function include International Board Certified Lactation Consultants (IBCLC), Infant Speech-Language Pathologists (SLP), and Occupational Therapists (OT). A provider with advanced training in tongue ties is ideal, as there are nuances in best practices and timing for release to achieve optimal results.

5 Signs Baby is Not Ready for a Tongue Tie Release

1. Colic or Constant Fussiness

If baby cries hours a day, needs to be latched to mom or a pacifier in order to stay calm, they are not ready for a release. Why? Because their nervous system is in overdrive. Babies who are in a constant state of fight-or-flight have:

• Increased muscle tone- tension in the jaw, tongue, neck, and body. This not only interferes with feeding function, it also makes baby a high risk for reattachment should a release be done too soon.

• Breathing irregularities- short, rapid breathing, which can interfere with suck-swallow-breathe coordination, critical during feeding.

• Disruption to Feeding Reflexes. When babies are under stress, they may have disorganized or weak suck, poor latch, and increased difficulty coordinating swallowing.

2. Neck & Shoulder Tension

If baby is holding their shoulders up to their ears, has a strong head turn preference, head tilt, or you notice red creases in the neck folds, they are not yet ready for a tongue tie release. These symptoms tell us that baby is not moving optimally, and therefore, neither is the tongue. Where there is tension, there is also muscle weakness. Babies benefit from therapy to reduce tension, increase strength, and free the tongue for better range of motion and coordination. If a tongue tie release is still warranted, baby is lower risk for reattachment when tension is addressed first.

3. Hyperactive Gag

The gag reflex is a window into oral sensory processing. It can be overactive in tongue tied infants and interfere with optimal latch and tongue function. It's important to normalize the gag prior to release, so that therapy can address tongue strength and sucking motion. This leads to shorter recovery time and decreases the burden on families when they are triple feeding (i.e., offering breast, bottle, and pumping at each feeding). Therapy works to normalize oral sensory motor skills through a whole body approach that optimizes sensory processing.

4. Suck Dysfunction

Soft suck, disorganized tongue movements, flat and chompy- are all signs of oral dysfunction. By addressing the above areas of concern, we are also improving oral function. Proper sucking supports optimal latch, efficient feeding, weight gain, and shorter recovery times when we address strength and function prior to release.

5. Poor Weight Gain.

Families may be pursuing a release because weight gain is a struggle, but the truth is, it may not make a difference. And in some cases, feeding skills can get worse before they gets better. For this reason, it is imperative to work with your IBCLC or pediatrician to support weight gain before a release, and have a plan for alternative reeding, if needed. By working in feeding therapy to address the above concerns, baby is more ready for a release, and will likely have a shorter recovery period.

Nourish Therapy specializes in infant feeding and whole body therapy for tethered oral tissues. If your baby was diagnosed, or you suspect oral ties, schedule a phone consultation to get started. We practice therapeutic readiness to see your family fully supported for best outcomes.