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Baby Has a Tongue Tie. Now What?

Updated: Sep 7, 2022

Before rushing off to have it released, let's review best practice, including the key players in a team approach and optimal timing for a release.

Three Key Players: 1.Bodywork Provider:

  • Physical or Occupational Therapist

  • Pediatric Chiropractor

  • Osteopath

  • Cranial Sacral Therapist

2. Functional Provider (feeding therapy):

  • IBCLC (International Board Certified Lactation Consultant)

  • Speech-Language Pathologist

  • Occupational Therapist

3. Release Provider:

  • Pediatric Dentist

  • ENT/otolaryngologist

  • Oral Surgeon

What is Bodywork? Bodywork is a gentle therapeutic technique that manipulates the body through touch, in order to relieve tension and support neurological integration. Tension is always present when there is a tongue tie. Babies can be born with tension or develop tension, such as torticollis (asymmetrical head/neck position). It impacts breathing, feeding, gross motor and neurological development. Bodywork before and after a release improves range of motion, body symmetry, and state of regulation (ie, happy baby). Babies have a greater chance of a complete release and are less likely to have reattachment when bodywork has been initiated pre-op.

What is Feeding or Myofunctional Therapy?

Feeding, or myofunctional therapy, improves strength and coordination of orofacial muscles. A release alone does not improve feeding. We have to train the muscles of the mouth how to function normally. A tongue-tied baby has been compensating, and they will continue to do so unless they learn the correct way to eat. Prior to a release, a feeding therapist will:

  • Complete a functional assessment of baby (and parent's) symptoms and determine baseline function and identify co-existing conditions that may be contributing to feeding difficulties (e.g., tension, laryngomalacia, low tone, cranial nerve dysfunction).

  • Prepare the family for the procedure and active wound care management to reduce risk of reattachment. Sometimes preparation involves desensitizing the patient to intraoral stretches, as we cannot have optimal outcomes if post-op care is going to be a struggle. We also troubleshoot potential challenges, like a feeding strike. This is best done before the procedure, and not in the moment when challenges arise.

  • Support family with an interim feeding plan. Impaired oral motor skills for feeding are often what lead families to pursuing having a tongue tie assessment. Because of these impairments, feeding is likely challenging for the child, and if breastfeeding, also painful for the parent. An interim feeding plan may include a nipple shield, at breast supplementer, or bottle that is matched to baby's current abilities. Interim feeding plans should be faded out as oral motor skills improve.

  • Lastly, your therapist will initiate feeding therapy, based on your infant/child's symptoms and feeding challenges. Exercise is different from stretches. This is "neuromuscluar reeducation". We have to improve the strength and coordination of oral muscles for feeding. A release alone will not improve function. This is so important for families to understand, a release alone will not improve function.

Following the release, your feeding therapist will continue to support oral motor rehabilitation, modifying exercises as appropriate, with follow up until feeding goals are met.

The ideal functional provider by age:

  • Birth-6 Months: Lactation Consultant, Speech-Language Pathologist, or Occupational Therapist

  • 6 months to 4 years: SLP/OT

  • 4+ years: SLP or Dental Hygienist, specialized in myofunctional therapy

A Note About Release Providers:

The ideal provider in all categories (bodywork, functional, release provider) will have training and expertise specific to tethered oral tissues (TOTs). Do not assume everyone has the same training, it is highly dependent on the continuing education of that individual provider. There are different techniques used for a release, and although a CO2 laser is considered the gold standard, many will say that a skilled provider is more important than the tool.

The bodywork and functional providers are the best team members to determine readiness for a release. There is no magic timeline. This is patient-specific and depends on tension, responsiveness to oral motor work, and desensitization for post-op care.

At Nourish Therapy we provide lactation support + feeding therapy. We have extensive training in tethered oral tissues, and team members throughout Spokane to help you navigate the process. Have questions? We offer free phone consultations.

Nourish Therapy (509)508-0725

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