Tongue Ties and Lip Ties Occupational Therapy

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Background

Tongue-tie (ankyloglossia) occurs when the band of tissue (frenulum) that connects the tongue to the floor of the mouth is short, tight, or thick, resulting in restricted movement of the tongue. Tongue ties may have an impact on breastfeeding, eating, and speech. Lip tie is a similar condition involving the band of tissue that connects the upper lip to the gum. There is also buccal ties, which involve the cheeks.

“surgery, called frenotomy, should be considered if the tongue-tie appears to restrict tongue movement, such as inability to latch on with breastfeeding. It is a simple, safe, and effective procedure—general anesthesia is not required.” -American Academy of Pediatrics

Impact

Tongue ties may also contribute to difficulty with

• Breathing
• Chewing
• Digestion/reflux
• Swallowing

https://www.youtube.com/watch?v=ar-e6OVWObQ

Parents

May find out their newborn or child has a tongue-tie/lip tie/buccal tie upon assessment at birth or during an office visit. Lactation consultants may also identify these ties with parents who are having a difficult time with breastfeeding.

Sometimes tongue-tied babies can’t maintain a latch for long enough to take in a full feeding, and others remain attached to the breast for long periods of time without taking in enough milk. Sometimes babies with tight frenulums make it miserable for mom to breastfeed because of the way baby latches. When a newborn has a tight frenulum breastfeeding moms may experience nipple pain, or hear a distinct sound while the baby feeds.

With breastfeeding, tongue ties are not as simple as a quick surgical release that is a “quick fix”. Parents will need to continue to promote breastfeeding with good habits and consistency, positioning, wound care, and exercises/stretches.

Interventions

• Do nothing
• Surgical Release (Frenectomy)
• Laser Surgery

Frenectomies

• Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach.
• While waiting, newborns may be at risk for lowered intake and greater than 10% weight loss from birth weight.
• Frenectomies can be performed in the hospital.
• Quick procedure (several minutes)
• Done without anasthesia
• Sterile scissors are used to snip the frenulum
• If any bleeding occurs, it’s likely to be only a drop or two of blood. After the procedure, a baby can breast-feed immediately.
• Limitations: scissors can only snip the “front” anterior lip tie
• Front lip ties have a low chance of adhesion and reattachment.
• Scissor frenectomies cannot reach posterior lip ties (need laser).

Laser Release

• Completed in a dentist office with consultation
• Other benefits: dental, aesthetic, speech, GI upset
• Relatively quick procedure as well
• Recommended for newborns several weeks old (lower success rate when older)
• Pain management recommended (Infant Tylenol and Ibuprofen – with recommended dosages after consulting with doctor and pediatrician). *Ibuprofen can be safely administered to babies under 6 months old with appropriate dosing based on baby’s weight.
• Mild bleeding may occur (not major)
• Babys are encouraged to breastfeed immediately after the procedure
• Many mom’s notice functional improvement immediately (function, decreased pain)
• Follow-up: absolutely critical that parents follow an exercise/stretching program, e.g. every 4-6 hours for 5 weeks to prevent adhesion and reattachment (undo the surgery).

Occupational Therapy and Lactation Consultant Role

• Education on breastfeeding – habits, positioning, tools, exercises
• Evaluate function
• Supportive interventions for breastfeeding – pumping, hand expression (e.g., Haakaa), bottles, pacifier selection
• Comfort for mom and baby – position and pillow support (e.g., My Brest Friend)
• Nipple shields
• Real-world practice and teach-back for mom and mom’s partner.
• How to making minor adjustments (e.g., pulling upper or lower lip back)
• Routine – timing and use of adaptive equipment and apps – e.g., Huckleberry
• Exercises – Pressing down on post-surgical site on upper lip or under the tongue at the “diamond” site; other variations of exercises as recommended by doctor or dentist.
• Referrals to craniosacral chiropractic/bodywork, dentists, SLP, and other resources.
• Pain management for baby.
• Psychosocial support for frustration, stress, depression of parents.