Pediatrician Discusses: Tongue & Lip Ties

Tongue and lip ties spark strong opinions. In this video, I clarify the confusion and emphasize function over appearance to help you decide for your child.

0:43-Why is there so much division in regards to recommendations?
1:17-Why is the diagnosis of tongue ties going up?
1:39-Do we need to clip all ties?
3:04-When should we consider releasing tongue and lip ties?
3:16-JAMA Otolaryngology- Head and Neck Surgery Research about the need for tongue tie releases in BF infants (resources listed below)
4:46-Is not releasing a tongue or lip tie destined for a suboptimal outcome?
5:36-AAPD’s stance on tongue ties and lip ties (resources listed below)
6:14-Images/classifications of maxillary lip ties
7:37-Images/classifications of tongue Ties
8:42-Tongue ties and Breast feeding
9:11-Managing a tongue tie that doesn’t impact Breast feeding
9:38-Tongue tie and speech associations
10:30-Are releases really needed for speech and feeding later in life?
11:34-Oral health and tie associations
11:59-The benefits of second opinions
13:06-Options for release
14:20-An important discussion on why we need to really evaluate a true need for these procedures

Further reading:

An article discussing places who charge a lot of money for this procedure. Is it really necessary?

Are we overdoing tongue tie releases?

AAPD Tongue statement on tongue and lip ties

JAMA Otolaryngology-Head and Neck Surgery 2019 study

****The information in this video is intended to serve as educational information and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. If a parent or guardian is concerned about their child, it is their responsibility to seek medical attention with the child’s healthcare provider.****

Listen to The PedsDocTalk Podcast available on all Podcast apps.

FOLLOW ME:

[AD-ptiy]

I have to say I don’t know that I agree with the idea of not revising/waiting to see if it’s really a problem. I definitely understand not messing with it if it isn’t necessary, but that thought process can really do a disservice to some families if their doctor doesn’t recognize there truly is a problem. My son had tongue and lip ties and was failure to thrive by 5 days old. His doctor was aware of the ties, but he seemingly latched really well and I researched so much that I handled breastfeeding so well that my postpartum nurses told me they never thought I was a first time mom till they read my chart, so his doctor decided I had low supply. He’s a DO and clearly practices as one which is why I chose and truly appreciate him for the fact that he does assess and truly consider benefit vs risk, but with this situation we didn’t have time for wait and see. The LC was too busy for me at the time and I mentally couldn’t handle the idea of her telling me I had low supply the older my son got. It took me 3 months to finally convince my son’s doctor to give a referral for a pediatric dentist based on concerns for speech (he had a tie all the way to the tip of his tongue). I dealt with constant clogs and having to hand pump (got the clogs better) frequently, so much so I got tenosynovitis in both wrists. It was excruciating. My son nursed all the time and he was still wanting 20-24 ounces of formula a day. His suck got SO much stronger after the frenectomies that it hurt because I wasn’t used to it. Within two weeks after, the most formula he would take was 8-10 ounces. I went from having multiple clogs a week to one, maybe 2, a month. Only if we went out and I gave formula and waited a little too long to nurse because I didn’t like to in public. Even though he looked like he was latching well, he couldn’t remove milk effectively before the ties were revised. My supply never fully recovered. The LC said I 100% could have exclusively breastfed if his ties had been revised early. His doctor being in this camp of not messing with it because he didn’t think it was a problem, and deciding he didn’t want to do anything from a breastfeeding standpoint, ruined my chances to EBF. 😩

My husband and I also both clearly have tongue ties and find it frustrating/annoying. I’m very confident it effects my posture, makes my neck feel tighter, and forces my tongue to sit more forward in my mouth (which makes my front teeth push out and has basically ruined the money my parents spent on braces) I have a lisp because I don’t have full range of motion of my tongue. Its not bad enough to have been noticed for speech therapy as a child, and I think it’s gotten worse in adulthood as well. It’s honestly really aggravating to know if I could just move the center of my tongue higher I wouldn’t have the lisp. I literally chose my child’s name based off names I could say without the lisp being heard. It also gets stuck between or rubs on my teeth which is annoying/painful at times. I have a lip tie as well and I hate how it pulls my lip up. I have to intentionally hold my lips shut. I was born when ties weren’t a common thing noticed or discussed and I often consider getting them revised now as an adult, but my insurance wouldn’t cover it.

The way ties are handled in newborns overall needs to change. I personally feel newborns with ties should be automatically referred to the providers who actually handle revisions to be assessed by them, but in that same thought, the doctors who handle them should be well educated in breastfeeding and the motions required for it to do more full and extensive assessments. Fully checking motion and sucking capabilities, to know if it is truly needed, would help families like mine. It would saved me a lot of figurative and literal pain and heartache.

I also feel your thoughts about therapies to improve functionality with the ties is good in theory and would do a lot for how many actually need revisions, but so many parents won’t know to push for this and so many doctors don’t think to educate or refer for these things. It’ll take the medical community cycling in the newer doctors who learned this information in school, or took it upon themselves to learn, forcing “old school” doctors to change and or lose patients before it becomes commonplace and that’s so unfortunate. So many things need to change in the ways you’ve discussed on this subject 😩

[MaaikevanBroekhovenIBCLC]

You want to release any oral restrictions when it often impacts breastfeeding, aerophagia, colic, difficulty drinking the bottle, reflux, eating solids, airway issues/ snoring, form follows function, so the jaws stay narrow with a low tongue position. Palate high which gives to little space in the nose to breathe through. The pushing motion of tied tongue pushes the teeth out of line. You can go on and on....

[MrNightrt]

My now 17yo was born with a tongue tie. He nursed well. We decided to wait. His speech came along fine. He NOW wants it snipped. He is the only student who can not till his "Rs" in AP Spanish. We're leaving it up to him and his dentist at this point.

[s]

Have you talked to any IBCLCs about what they see? You are really minimizing the effects.

[AndreaRodriguez-qzfd]

Can’t tell you how helpful this was to watch!! Thank you!

[mygirldarby]

In the old days (1970's) my brother had a tongue tie and my mom noticed he couldn't eat well when he started solid foods. My mom took him to his pediatrician and showed him. The pediatrician said, "oh yeah!" Then the doctor reached for a pair of surgical looking scissors and clipped it! My mom was shocked and so was my brother who was now screaming. My mom took my brother home, the tongue bled a little and healed quickly. He never had any further issue. Now I see all this tongue massaging, laser surgery, etc., and I always think of my brother and wonder how his tie would have been handled today.

[IceCrystalAngel]

My baby ended up in hospital due to dehydration as he wasn't extracting enough milk. After telling everyone I actually had plenty of milk supply and he's just not getting enough so I had to start bottle feeding him so he won't die, they told me to just keep bottle feeding him. Apparently they don't believe in tongue ties. 🙄 And they put his drop from 50th to 2nd percentile, as well as prolonged jaundice and dehydration down to his reflux. 🙄 In the end the dentist found her couldn't move his tongue to the side, he had a very weak and poor suction which is why I didn't have any nipple pain because he couldn't keep a seal!! He was literally on death's door until I started bottle feeding but apparently the medical community thinks tongue ties are not a thing, to the point they don't include it in their differential diagnosis. To hell with such biased medical doctors. So they say there's no evidence treating tongue tie helps, but equally there is no evidence that not treating tongue tie doesn't harm. Parents aren't mental to want to treat a tongue tie, we are the last people who want to see our babies cry or in pain. We'll do everything to avoid it first and only seek a tongue tie revision if we tried everything else first.

[MammamiaCindy]

Mobility, suck training and myofascial release should be done BEFORE and AFTER a release. As an OT/CLC and infant feeding therapist I totally agree that a functional feeding evaluation needs to be done and therapy BEFORE going for a consult for a diagnosis. Pediatricians should refer for feeding problems for breastfeeding, bottle feeding babies the same when leaking is noticed and clicking sounds are made - especially when there is body tension. Often times with good therapy we can make an impact but there are times a baby may need a release. I see the problem as the baby not getting proper intervention BEFORE a release. Informative video- parents should always be in the driver's seat but also should know what happens with the tongue and how to guide feeding safely if they do not get a release.

[lauracunningham]

I had no idea I had a tongue tie until I was 25 years old. I just got it released and I no longer have neck and shoulder tension and jaw pain that was causing debilitating migraines. I can already tell that I swallow better (I used to choke on liquids and food all the time). My dentist was very dismissive but gave me an oral surgeon referral anyway. I'm glad I self advocated and can't wait to live with less pain

[elishamartis]

Thank you for this valuable information. My child has a lip and tongue tie but we faced no issues with breast feeding or solids but with all the talk around importance of clipping I was looking for more information. You helped clear my mind from doubt and worry.

[gunnerberg]

My toddler at the age of three has been having a really bad gagging issue while eating solids, and would only want to eat soft foods and liquids. We were informed he had a class 4 tongue tie, and we never had any idea. After speech, and OT appoints and multiple dentist appointments, everyone but his pediatrician recommended the surgery. We just got it done two days ago. He’s able to stick his tongue out of his mouth. After the healing process I am confident he will want to eat more foods.

[bellakim]

Release the tongue. The tongue has more of a connection to the body than just breast feeding, speech issues, etc. The tongue is referred to the hip, digestive system, sinuses, teeth, etc. It causes many issues in the future. Prevention is better than the cure.

[jennaporter]

Thank you for this video! I find that t’s hard to find unbiased specialists because it seems like all of the “savvy” professionals (at least in my area) are so adamant and pushy about how horrible it is to leave it unrevised, despite the lack of data as you shared! I feel constant guilt for not revising my daughter’s even though she has appropriate function at this time. This makes me feel better.

[LauraAnn]

My daughter had very significant oral restriction from both a lip and tongue tie. Her lip tie inserted all the way to the papilla and her tongue tie was all the way to the tip of her tongue. She was never really able to latch and whe she did it was very painful and she wasn't able to transfer milk. On the bottle she could never form a good seal or suction. Milk would pour out of he sides of her mouth and she would be chewing on the end of the nipple instead of sucking. Her lower jaw would start to quiver during feeding which ai later learned was muscle fatigue from working so hard to transfer milk. She was not gaining weight appropriately and it would take over an hour to finish a 3 oz bottle. We had a revision at 5 weeks (a week ago now) and things have improved so much. She gained 6 oz basically just over the weekend. She will finish a bottle in a reasonable time and the best part of it all is that she is finally able to latch. It's still a work in progress but so so much better. I have lip and tongue ties that never obviously affected me like my daughter. I did have orthodontic issues and had a space between my front teeth. I had braces twice. It made me extremely self conscious growing up. I would def do it again if needed.

[edwardheins]

My grandson is two and not talking properly yet .He saw a speech therapist today .He has a severe lip tie and a tongue tie. We are gratefull its something easily repairable

[AkunahsDream]

As a Tongue Tied Adult going through my tongue tie release journey, please get your child’s tongue tie released!!!
The tongue tie has farther negative impact than feeding and speaking. It affects the formation of your skull as your tongue is not able to press on the upper palate of the mouth - resulting in a narrow upper palate which means narrow nasal cavity. Harder to breathe through the nose. Higher risk of sleep apnea. Grinding teeth in sleep. Gum recession. TMJ & facial pain. More frequent headaches and migraines. Neck and shoulder problems. The fascia is an electrical system of connective tissue and having a tongue tie restricts the fascia through the whole body.
I’m getting my tongue tie release in my 30’s because no one diagnosed me until then!!!
If you know your baby has a tongue tie, the best thing you can do for them is get it Released as soon as possible.
If you don’t believe me, just go watch some adult tongue tie release stories and listen to these other people talk about how life changing this is. I wish my tongue tie was release as an infant!!!

[ChandraCoatsBengalifornia]

I was added to what I describe as a "black market tie revision fb group" in which a LC was claiming that only her "preferred providers" were recommended rather than a pediatrician, ENT etc. This "preferred provider" concept had some people travelling hundreds of miles away and in the mean time these babies' caloric needs were possibly not being supplemented. The assumption was that pediatricians aren't "breastfeeding experts." (I know you're working on LC credentials also so which is pretty cool!)

[tejashreebagayatkar]

Thank you for clarifying on this topic. My baby have lip tie but there wasn't problem with breastfeeding. And she does speak kaka, baba.
Be safe and take care.

[bethanyruhnau]

This is awesome! The amount of parents I’ve seen say “I got my baby’s tongue tie clipped at 4 weeks and 6 weeks later he started breastfeeding better!” Is it really that inconceivable that your 10 week old would breastfeed better than your 4 week old that has had 6 weeks less practice and development? I definitely think that of course there would be ties that impact function but the number of infants receiving this surgical procedure is very alarming, not just because of the potential unnecessary pain but because of the risks you mentioned. It could be that after the tongue tie revision maybe parents are approaching feeding more positively and maybe focussing on latch etc after the tongue tie clipping because having the procedure done has piqued their awareness of this. As you said, without good data we can’t really know

[Jesscoleman_]

My 15 month old had a traumatic birth so we thought that was why he had such a hard time sleeping, he spit up a lot and always choked when being bottle fed. He has a hard time biting down on something hard and he does have a speech delay. We didn’t find out he had tongue tie until his first dentist appointment, after that we scheduled an appointment with his pediatrician and she did nothing. He we are months later and my son has not had a good nights sleep since birth and I know it’s because of his tongue tie!! We have a appointment tomorrow and I’m not leaving until she sends a referral out!