What Parents Want To Know About Tongue Ties And Lip Ties
What are tongue ties?
Anterior Tongue Tie - an anterior tongue tie includes the area from the tip of the tongue to the middle part of the tongue. An anterior tongue tie is a piece of tissue called the frenulum that “ties” the tongue to the tissue on the bottom, in this case the tip or middle of the tongue connects to the tissue under the tongue.
This makes it difficult to impossible for the tongue to move past the bottom lip (cannot stick the tongue out or trying to stick the tongue out causes tension in the tongue in the area where it is attached)
The video below shows a good example of an anterior tongue tie and release procedure
2. Posterior Tongue Tie - a posterior tongue tie includes the area from the middle of the tongue to the back part of the tongue. A posterior tongue tie is a piece of tissue called the frenulum that “ties” the tongue to the tissue on the bottom or floor of the mouth, in this case, the tissue goes too far forward.
This creates difficulty in lifting the tongue to the roof of the mouth or bringing the tongue over the bottom lip.
What are lip ties?
Upper Lip Tie - The top lip is connected to the top gums limiting the ability of the top lip to go over an object (nipple of breast or bottle) and meet the bottom lip and create a good suction that is needed for efficient feeding.
Bottom Lip Tie - The bottom lip is connected to the bottom gums limiting the ability of the bottom lip to go over an object (nipple of breast or bottle) and meet the top lip to create a good suction that is needed for efficient feeding.
The video below shows a good example of an upper lip tie and release procedure
What are cheek ties?
Top Cheeks (right and/or left): Cheek ties also known as buccal ties is an abnormally tight pieces of tissue connecting the cheek to the upper gums.
Bottom Cheeks (right and/or left): Cheek ties also known as buccal ties is an abnormally tight pieces of tissue connecting the cheek to the lower gums.
Cheek ties or buccal ties are the least common ties that cause difficulty in function in children and adults. They may impact the formation of dimples, increased tension in the facial tissue (cheeks/surrounding areas) and cause gum recession in adults.
Can you have a lip tie without a tongue tie?
It is typically rare to only have a lip tie and not a tongue tie. It is more common to have a lip tie and a posterior tongue tie that might not be as noticable to someone who is not an expert in tongue or lip ties.
What are the signs that my child may have a tongue or lip tie?
Difficulty with breastfeeding
Nipple damage or pain with breastfeeding
The baby appears uncomfortable during feeding
Difficulty opening the mouth
Clicking noise with feeding (tongue is popping off the nipple or lip is popping off the nipple causing a noise)
Gulping/wet coughing sounds during feedings
Gagging with breastfeeding or pacifier (ties can increase the sensitivity of the gag reflex)
Open mouth while sleeping
Snorting or snoring sounds or loud breathing while sleeping
Constipation or reflux (whole-body tension from tethered oral tissues “ties” can result in GI distress)
Elevated shoulders, red creases on the side of the neck
Difficulty or dislike of tummy time (tension in oral muscles can cause babies to dislike neck extension due to the increase in tension/pull on the front neck and mouth tissues)
Furrowed brows
Tight chin with crease (can look like they have an overbite because their mandible “jaw bone” is pulled back)
Movement Screens:
Mentalis Muscle: Can you get your finger under the bottom lip? Hold your finger and hook there and bring downward to see if you’re able to gain movement and bring the lip away from the gums.
Gupee Pose Stretch: This position stretches/elongates the front of the neck. Place the baby over your lap with their head extended, you may have your hand behind their head for support. This is easily done sitting on the floor or on the couch.
Can a baby hold this position comfortably for 10-20 seconds? Babies need to be able to attain some neck extension comfortably in order to open their mouth wide for breastfeeding (try it yourself: try to open your mouth with your chin to your chest and then try to open your mouth with your neck extended midway between full extension and upright, see which one is easier and more comfortable).Tongue Mobility: Can the baby bring their tongue to the roof of their mouth if you hold a bottle nipple or teething ring or pacifier there? Can they bring the tongue to one side of the mouth, what about the other side? Can they bring the tongue over the bottom of their lip?
Sleeping Screen: When a baby or toddler is sleeping, if you open their jaw gently is their tongue resting securely on the roof of their mouth?
How does a tongue tie or high palate affect swallowing?
How do you get a tongue tie or lip tie release?
A tongue, lip, or cheek tie can be released via a laser or scalpel procedure by a licensed EENT, Pediatric Dentist, or other certified practitioners such as an oral surgeon. Typically a child is screened for a tongue, lip, or cheek tie by a Pediatrician, IBCLC (Lactation Consultant), Nurse, or Therapist (OT, PT, SLP).
Then they are referred for a more in-depth evaluation by a EENT, Pediatric Dentist, Physician/Pediatrician, or Oral Surgeon. If it is found that there is both a tie (tethered oral tissue) AND a functional impairment (difficulty with feeding, breathing, sleeping, motor activities, etc) then a release may be recommended.
Tongue Tie Release Example (also available under what is a tongue tie)
Lip Tie Release Example (also available under what is a lip tie)
Who do I need to contact to get a tongue tie or lip tie released?
You may contact a lactation consultant (IBCLC certified recommended), feeding therapist (OT/SLP), pediatric physical therapist with additional training in TOTs (tethered oral tissues) or your pediatrician. See the example listed above for what a typical procedure for getting a tongue tie or lip tie released goes. Additionally, you may need multiple opinions as tongue ties and lip ties are seen differently by different providers as well as based on the providers experience in oral motor (mouth/throat/airway) function.
If you feel in your gut as a parent that a tie is potentially impacting your child’s ability to sleep, eat, or move, please continue to seek out expert opinions until you feel heard and you feel your child has been fully evaluated. If you’re looking for a tongue tie or lip tie release in Milwaukee, WI a list of local providers is down below.
What are the risks if I choose not to get a tongue tie or lip tie release?
If a child does not have a lip, tongue, or cheek tie released that is impeding function or causing difficulty in movement, feeding, or sleeping there are possible consequences including decreased sleep and recovery, increased fatigue and muscle soreness, difficulty with feeding including pain for the mother if breast feeding, decreased weight gain for an infant, difficulty with motor milestones such as rolling and tummy time.
That being said, it is always within the parents right to choose what they believe is best for their child. Release of ties is only recommended when there is a presence of a tie AND a difficulty in function in the following areas: sleep, feeding, speech, or movement. It is not recommended for parents to have a tongue tie, lip tie, or cheek tie release is there is NO functional activity that is delayed, difficult, or concerning.
Why do lip ties and tongue ties seem so controversial when I google information on it?
There is a wide range of viewpoints on whether tongue ties, lip ties, or cheek ties directly impact function. Both pediatricians, therapists, and EENT doctors have professional opinions that fall on both sides of the street. There is evidence that supports both sides as well.
This can be confusing for parents who simply want to do the right thing for their child. The most important piece to think about is whether you are seeing signs of difficulty with function in eating, sleeping, or movement. If so, it is my professional recommendation to rule out whether a tongue tie, lip tie, or cheek tie is impacting that function.
Research shows that the fascia from your mouth can impact all the way down to your feet. It has also shown that tension in your mouth muscles and jaw can impact pelvic floor function in both kids and adults. Oral care is important, not just for the teeth but also for the whole body.
A note on research: often time research takes a long time to become published. While it is the best we have to make sound, evidence based decisions it is also widely known that there are politics in the research that is published in journals and therefore considered our gold standard “peer-reviewed,” evidence. Research is good, but it is also not the only thing one should consider when making decisions in the medical field.
How do I know I’m making the right choice for my kid?
If you believe there is difficulty in the areas of movement (not rolling, difficulty with higher level activities such as jumping, or hates tummy time), the area of feeding (scroll the list above), or sleeping/airway concerns, my recommendation is to find an expert in tongue ties, lip ties, and cheek ties to have an evaluation done.
In my professional opinion, that expert needs to have extensive additional training in tongue ties, lip ties, and cheek ties. I would find a practitioner who has significant resources on tongue ties and lip ties on their website before ruling out a tongue/lip tie presence in your child.
Recommendations in Idaho:
Lactation Consultant:
Family Seasons - Eagle - Craniosacral, Lactation Consulting, and Occupational therapy in clinic.
Whole Child Feeding Therapy - In Home - Kristen & Kristen provide speech and occupational therapy to families using a combined mobile practice (they come to you!). During evaluation, both Kristens will be there in order to give your child the best of both worlds. For tongue ties, they provide pre and post therapy.
Baby Bonds - Boise - While releases are uncomfortable, Melanie provides Craniofacial Therapy, Rhythmic Movement, and Infant massage prior to the release and provides a space for families to nurse directly after.
Releases and Procedures:
Breathe Airway - Boise - Specializes in the airway and everyone in the location is highly educated including the amazing front desk staff. Airway development is one of the main reasons to have a tongue tie release after feeding concerns and being educated on the improvement to the airway post release can help families feel good about their decisions.
Dr. Alexis Phillips - Boise and Eagle
Chiropractic:
Purpose Driven Chiropractic - Eagle
Tune Chiropractic - Eagle
Mosaic Chiropractic - Meridian
Additional Information:
For a list of recommendations for releases, providers, and general information on tongue ties see the Baby Bonds' Tongue Tie Guide
Recommendations in Wisconsin:
Releases:
Untethered - Milwaukee - Closest and Experts in both releases and airway evaluation with high emphasis on pre/post therapy to maintain release. Is out of network with all insurance companies but will submit their services on your behalf to your insurance if you have out-of-network benefits.
Wisconsin Tongue Tie Center - Fort Atkinson - Further Location, Free Consultations, Are in network with some insurances
Other Experts:
Airway Specialists at Children’s ENT Clinic - Children’s Wisconsin - Do not list frenectomy (releases) as a treatment option on their website. Most conservative option.
Milwaukee Myo and Mequon Speech and Language Connection - Mequon, WI - SLP and feeding therapy, body work, experts in tongue and lip tie treatment.
Success Lactation - In Home Milwaukee and Southern WI - IBLC Lactation Consultation trained in Tongue/Lip Tie Assessements
If you have worked with a clinic that does tongue or lip tie releases or is an expert in tongue or lip tie assessment in the Milwaukee area that you would like to recommend, please email Dr. Baker with their website, location, and name of the clinic.
More information on Tongue and Lip Ties
What Is Body Work and Does My Baby Need It? - a blog post covering how Pediatric Physical Therapists can support babies pre and post tongue tie release and lip tie release. It also goes into further detail on how the fascia from the tie itself can impact whole body tension. Written by Dr. Hope Reyes from Moving Munchkins (Dr. Hope went to PT school with Dr. Lauren and they’re still Peds PT besties even though they don’t live near each other right now!).
Ask The Dentist created a very thorough blog post on all things tongue tie and it includes lots of pictures (which can be tough to find!). Check out Tongue Tie (Ankyloglossia): Diagnosis, Symptoms, Surgery, and More
Melanie from Baby Bonds in Boise, Idaho, was kind enough to share her Tongue Tie Guide with us. It includes a lot of information including videos for families even if you are not located in Boise! Download here.