As more women return to breastfeeding, there's been a large increase in latching problems, nipple pain and babies being diagnosed with tongue and lip ties. Some health professionals have suggested that a mother-baby breastfeeding dyad has approximately 14 days to establish an effective breastfeeding connection before giving up and moving on to other options. One of the greatest benefits of early chiropractic care for a newborn is improved latching and breastfeeding. As pediatric chiropractors, we are acutely aware of the relationship between a newborn's nervous system and the biomechanics of their upper neck, jaw and tongue and recognize the need for pediatric chiropractic care to support a healthy latch & breastfeeding experience.
In this article we take a deep dive into TOTs (tethered oral tissues) and provide you with the most up to date information and recommendations for what you should do if you get this diagnosis or think your baby may have a tongue or lip tie. This article is dedicated to helping parents learn more about why tongue ties happen, how to check if your child has one and what to do if you've been told your baby needs a release! Our doctors will take you through all the details about what you need to know to support a healthy transition back to breastfeeding after a tongue-tie release and what to do to avoid needing a second or third revision.
What is a Tongue-Tie?
The medical term for tongue-tie is ankyloglossia and is defined by an unusually short, thick or tight band of tissue (lingual frenulum or frenum) that attaches the bottom of the tongue to the floor of the mouth. At this time, there isn't a consensus as to the cause except to say that they are congenital (you are born with it) and that there seems to be a genetic or hereditary pre-disposition.
Currently there is no gold-standard method for evaluating and diagnosing a tongue-tie or the need to have it surgically released. Most of the scientific literature recommends a pediatrician or Lactation Consultant assessment but our anecdotal evidence also show that pediatric dentists are providing care with great results and high satisfaction through a process called a Frenotomy. In fact, we learned one of our Clinic Moms went to a Pediatric Occupational Therapist because her pediatrician said "I don't know anything about tongue-ties". This is not to bash the good doctors taking care of our littles, many of them didn't get any education on this topic. However, this article aims instead to look at a deeper issue around breast-feeding, birth-trauma and how the biomechanics of a baby are supposed to work from a chiropractic perspective.
You see, there's no argument in the medical world that a baby is born and should be able to breastfeed - that is to latch, suckle, feed and swallow without help or intervention. This natural and innate ability is driven by something called primitive reflexes - a set of pre-wired neurological instructions designed to help baby humans survive and thrive in the first few months of life. These instructions are responsible for the way a baby turns her head and opens her mouth when something strokes her cheek (the rooting reflex), or how she grasps with an iron fist when you put your finger in her hand (palmar grasp reflex).
While ankyloglossia has been documented in scientific literature for over 50 years, the past few generations that fed their babies with bottles and formula, avoided current day breast-feeding problems since bottle-feeding is effectively 'easier' for the baby. Therefore, any difficulties due to tongue ties, weak latches or poor sucking mechanics weren't well documented or treated. As our current generation of mamas make the switch back to breastfeeding, these difficulties have once again moved to the public and scientific forefront and created a buzz around tongue-ties and how best to treat them.
Unfortunately at this time, the medical practitioners that diagnose and treat tongue-ties have yet to agree on the best way to assess AND correct them, despite there being a clear body of evidence supporting tongue-tie release and improved breast-feeding. So from our perspective, improved education for ourselves and you - the parents - is the best way that we can support babies during this transitional period as science and practice get synced up again!
Symptoms of a Tongue Tie
Now don't go getting all freaked out if your baby shows any or all of these signs. We know as a parent you are constantly checking your baby for all sorts of things and it's amazing how many things we can "find" if we go looking for it. Which is why we love this statement from Lisa Paladino - Midwife and International Board Certified Lactation Consultant (IBCLC):
"I worry about parents rushing to a provider for the release of TOTs because what looks like a tongue, lip, or buccal tie in a picture or by exam may not be a functional restriction. For example, we should be diagnosing how the tongue moves during feeding, not what it looks like."
So the important take home point here is that even if your baby presents with symptoms of a tongue-tie, it may not be one and conversely, your child may have a tongue tie, but the tongue is functioning well and therefore, it may not be necessary to release it! Diagnosis is based on BOTH a structural and a functional assessment.
So what are some of the symptoms that may show up if your baby has a tongue tie:
Symptoms in the Baby:
Slow or fast weight gain
Colic or gas
Reflux (spitting up)
Blisters on lip, especially upper lip
White coating on the back of the tongue
Symptoms During Feeding:
Noisy nursing (clicking)
Bites or chomps on nipple
Slips on and off the breast
Falling asleep while nursing
Nurses for a long time, then wakes up as soon as he/she is put down
Lots of sucks, fewer swallows
Read these scenarios Lisa Palladino (IBCLC) describes to see if your baby fits in to any of them:
Scenario 1: Low Milk Supply
Some babies do well until they don’t. There comes a time when milk supply becomes more dependent on baby nursing efficiently. Babies with ties need to work really hard to get milk to come down, and some babies can’t keep up with the compensations and start to lose weight. Their inefficient nursing sets up a cycle that decreases mom’s supply.
Scenario 2: Constant Feeder, Not Gaining Weight
Some babies work so hard at the breast that they burn more calories that they take in when they are feeding. These are the babies that “nurse all the time” but don’t gain adequate weight. They are often labeled as “colic” but it’s true hunger that is making them cry. Moms report not being able to put the baby down or feedings going on forever.
Scenario 3: Noisy & Distracted Eater
The baby who seems to nurse without difficulty, but exhibits signs of colic or reflux. Both colic and reflux can be a result of swallowing too much air. With tethered oral tissues, the lip and tongue can’t work as they are meant to, and the way the baby compensates can allow air to be taken in. These babies are often noisy eaters who appear to slide on and off the breast or may make a clicking sound while eating.
Symptoms in the Parent:
Painful breastfeeding (nipple and/or breast pain, cracked or bleeding nipples)
Misshapen nipples after feeding (either flattened, creased, or “lipstick” shape)
Frequently clogged milk ducts, engorgement, nipple blebs, or mastitis
Oversupply or low milk supply
How to prepare for a tongue tie release (Frenotomy):
If you've already managed to assemble the right TEAM of providers, including a highly skilled and experienced IBCLC, pediatric dentist and pediatric chiropractor, your baby is in great hands. If you haven't done that yet, connect with us and we can get you hooked up with some of our favourite people in the area to help you out.
Now you're ready to have your IBCLC complete their assessment and provide a definitive diagnosis of tongue-tie or not. Following that, your Pediatric Chiropractor will perform a neuro-functional evaluation of your baby's jaw, neck and head (your baby's head and neck need to be able to extend without contraction in the front neck muscles and your chiropractor is going to be KEY for this!). Finally, your baby's ability to recover will require a good stretching and exercise program following the procedure and your IBCLC and pediatric dentist should provide you with a ton of resources here (but if not - we've got you covered there too!).
Why do I need a Pediatric Chiropractor?
The Chiropractic Doctors at our clinic are highly certified and skilled in taking care of newborns and children. This is something that our Doctors have spent many hours acquiring additional certifications to best assess and take care of our littlest humans. Pediatric education is not standard at most chiropractic colleges so it's important to make sure that you bring your baby or kiddo to a chiropractor who is familiar and experienced with tongue-ties.
At our clinic we use a Neurofunctional Chiropractic Approach. This means that we asses how your baby's nervous system is connected to all the muscles and systems of his body. We also determine whether their body is getting the appropriate signals and instructions from the nerves. We are able to measure this with state of the art technology called the INSiGHT Scans in addition to our pediatric physical assessment.
There are 3 primary areas we look at when preparing a baby for a tongue-tie release or revision:
Nervous System State
Head, Jaw & Neck Mobility
Nerve Flow Interference
1. Nervous System State:
Every baby (and human) has an autonomic nervous system (ANS) that controls and coordinates all of their vital functions outside any conscious control. Their primitive reflexes, mentioned above, are an example of this intricately designed system. The ANS has 2 branches that function like a teeter-totter - if one is on, the other is not and vice versa. These 2 branches are the SYMPATHETIC nervous system (better known as the Fight or Flight response - but we call it your GAS PEDAL) and the PARASYMPATHETIC nervous system (or the Rest & Digest response - we call it your BREAK PEDAL).
One of our favourite INSiGHT scans that we are able to do on the youngest of babies is called Heart Rate Variability (HRV) and it directly measures the balance and activity in the ANS. This is important because many babies we see are in a SYMPATHETIC DOMINANT state - which means their nervous system is stuck in a state of fight or flight. These babies are colicky, fussy, poor sleepers, poor eaters and generally really strong (they hold their head up and meet developmental milestones quickly or even ahead of schedule). This last point is important because these babies often have really tight muscles in the neck, jaw and tongue which may be misdiagnosed as tongue-tied. This tension may also make things more difficult for the dentist to do the best job during the procedure in those babies with a true tongue-tie that require release. With safe and gentle chiropractic care, we restore proper balance in your baby's ANS to minimize the sympathetic state of high tension which can in turn improve the outcome of the release procedure and reduce the risk of re-attachment.
2. Head, Jaw & Neck Mobility
This is probably the area that most people are familiar with when it comes to chiropractic. But with baby's and tongue-ties, there are some extra areas that we need to check. Even you as parents can pick up some clues suggesting problems with your baby's alignment and mobility:
do they tilt or turn their their head more to one side?
do they breast-feed better or longer on one side?
does their head fall to one side in their car seat?
does one eye seem more droopy?
does their jaw move to one side when they yawn?
do they have a flat area on their head?
These clues are confirmed by the Chiropractor with gentle range of motion tests and palpation. Your chiropractor will also check the alignment of the facial features which can indicate poor alignment in the cranial and facial bones. The assessment will also include an intra-oral evaluation to assess how strong your baby's suck is, if there a flat or high palate on one side, how the TMJ area's are moving and if your baby can move their tongue equally from side to side. These tests can confirm mobility restrictions that may contribute to, or be a result of a tongue tie and breastfeeding problems.
3. Nerve Flow Interference
One thing that is almost absolute, and almost always overlooked after the birth process is the onset of subluxation in the cranial (skull) and upper cervical (neck) regions for infants. These are the most easily injured and altered areas simply because at such a young age they have no ability to protect those precious muscles, nerves, and joints that protect their brainstem and spinal cord from injury. The amount of force placed on a baby's skull, neck, and brainstem during a 'normal' delivery is immense and increases dramatically in deliveries requiring medical intervention including vacuum, forceps & c-section.
As a result, this can alter the nerve flow and communication from those areas. It will come as no surprise that these are the nerves that coordinate your baby's ability to suck, feed and swallow. Injuries to these nerves from birth trauma can drastically limit your baby's ability to latch and breastfeed and create symptoms similar to those exhibited by a baby with a tongue-tie.
Therefore, it's important to get rid of subluxation and nerve interference and make sure that those nerves that give instructions to suck, feed and swallow are working their best to support breast-feeding after a tongue-tie release.
Our NeuroThermal INSiGHT scan detects exactly where and what nerves are experiencing interference with a 30 second rolling scan of your baby's back and neck. This is where our neuro-functional chiropractors can really pin point the exact areas of stress that are creating problems with their ability to latch, breastfeed, turn their head, sleep, digest and so much more.
If you are struggling with breastfeeding, or have recently received a tongue-tie diagnosis, we invite you to connect with us to learn more about how Neurofunctional Pediatric Chiropractic can play an important role in your baby's success!