Infants with Tongue-tie and Lip-tie

Introductory information for families

Baby with Tongue-tie Tongue-tie, professionally known as ‘ankyloglossia’, is a congenital condition in which the lingual (tongue) and/or labial (lip) frenulum is too tight, causing restrictions of mobility and functionality. These oral restrictions can cause significant difficulty with key functions of the mouth including: feeding (breast or bottle) swallowing, breathing, digestion, speech, and structure (head/neck/jaw tension, etc).

Each mother/baby dyad is unique and tongue/lip ties issues can present differently for everyone. Some common symptoms that may point to the infant being tongue/lip tie are:

Common Signs of Infant Tongue/Lip tie

  • poor latch/inability to latch
  • fatigue/sleepiness during feeds
  • irritability while feeding
  • poor weight gain
  • clicking during a feed
  • dribbling milk at the breast/ bottle
  • inability to use/hold bottle/pacifier well
  • digestive issues (such as increased gassiness, reflux, colic, vomiting, distended stomach)
  • maternal nipple pain/ damage (feels like the infant is compressing, chewing, gumming, pinching the nipple)
  • increased maternal nipple/ breast infection
  • compromised maternal milk supply

Tongue and Lip Tie Assessment

A thorough clinical examination of the appearance and function lip and tongue area is critical to frenulum evaluation. If an evaluation reveals symptoms of frenulum restriction, parents will be provided with information so they can make a fully informed choice about the course of treatment. Surgical release of a tight frenulum is called a frenectomy. Tongue or lip ties present in many different shapes and forms. Dr. Ben A. Sutter, works extensively with all forms of ties and is trained to identify less common tie presentations. Dr. Sutter provides individualized assessment, advanced laser frenectomy treatment and supportive post frenectomy care.

The variance in assessment and treatment standards can be challenging for parents trying to seek evaluation and care for their potentially tongue and lip tied infant. Families report greater support from professionals who have sought greater learning, training and experience in this area so that they can identify ties effectively and help families to seek treatment where necessary. Dr. Sutter presents the family with all the information they need to make a care plan decision moving forward.

Treatment of Tongue and Lip Tie

The treatment is carried out with a laser and is usually straightforward. General anesthesia, sutures or complex oral medications are usually not needed. The benefits of laser surgery include: excellent precision, kills oral bacteria, and reduces bleeding, swelling and pain. After treatment is done, post frenectomy care will be explained to the family including: pain relief, oral motor exercises, and post frenectomy massages/stretches which will take place gently and playfully about 6x/day for 4-6weeks.

If assessment reveals that treatment would be beneficial, and parents consent, then the laser treatment can usually be done immediately following the initial consultation. The first visit usually takes about one hour. Due to laser safety regulations, parents are not allowed in the treatment area but are encouraged to stay with the baby right before/after treatment.

You are encouraged to feed and snuggle your baby as soon as possible after treatment; there is no better way to soothe baby and start the healing process! You may see a little blood in your baby’s saliva or spit up post op and your baby may be a little fussier for the first 24-48 hrs post op.

Follow up post frenectomy support is suggested within a few days to 1 week post op with the baby returning either to Polaris directly or to their referring IBCLC. Follow ups generally take 30 min or less unless more in depth support is needed. If you notice any increased redness, swelling, fever, chills, or inconsolable fussiness then contact the emergency doctor or lactation consultant right away. If your little one seems to be extra tender or fussy, we recommend ample skin to skin care, feedings, or warm baths for soothing. If extra pain relief is needed, ask your provider what should be used and the dosage based on infant body weight.

It takes a village – collaboration and aftercare:

Feeding challenges may be multilayered and multifactorial. Therefore the treatment of feeding issues often requires a multi-disciplinary collaboration of several providers, depending on the specific situation of the infant. Tongue-tie release is only one step in the process of optimizing feeding outcomes. Some key players in the circle of care for babies dealing with tongue and lip tie include: a board-certified lactation consultant (IBCLC), the treating provider (the doctor or dentist performing the surgery), bodyworkers (chiro/craniosacral, PT, etc), or additional care providers like a speech language pathologist (SLP) or oral myofunctional therapist. Such therapies are often needed to improve function and reduce feeding stress, structural tension, improve strength and overall feeding progress. While frenectomy is an important treatment option when there are tethered oral tissues, families are strongly encouraged to collaborate with their care team to optimize feeding outcomes overall.

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