The Trifecta Approach to Tongue Ties

The Experience

Having an infant with a tongue tie can be stressful. As breastfeeding has regained popularity as the method of choice for new moms over formula, a tongue may prevent an infant from properly nursing. Tongue ties themselves are not all the same. They come in varying levels of involvement, location, and barrier to nursing. In addition, an infant may have other complications such as a lip tie to further complicate the matter. The first months of life are crucial to the development of a newborn and when they have difficulty nursing, parents may feel hopeless.

Hospital staff may offer some suggestions, even clipping and releasing the tongue tie itself with a quick snip. However, this may not always be effective enough to allow a newborn to properly nurse from their mother. I found myself in this exact same situation as my wife and I struggled as new parents to learn the ins and outs of parenting and ensuring proper nutrition for our new baby. The hospital we stayed at used a more conservative ‘wait-and-see’ approach. While we were hopeful for things to work out, it turns out breastfeeding was not the sole issue that sessions of lactation consultation could solve. We tried many things as well: nipple shields, different positions, switching breasts, etc. but it did not seem to help.

Some Options

This is not to say that lactation and breastfeeding consultations are useless, they can be very helpful especially for new parents. Note also that breastfeeding should NOT be painful. However, if the underlying problem is a tongue tie that requires additional interventions, lactation consultants may not be enough to overcome the barriers to proper nursing.

Perspective

One thing to note is that a tongue-tie is not the end of the world. There are always options. Parents can opt to supplement with formula. And that is okay. However, like most parents, especially moms, being able to breastfeed is a motivating and goal that can be fulfilling and a life-long dream to many.

Common Resources

If you look on Facebook support groups for breastfeeding and even specifically for tongue ties, you will often see a pattern of approaches to tongue ties for breastfeeding. I call this the Trifecta for Tongue Ties. This trifecta is a combination and team approach that involves the collaboration of different specialties to address, train, and overcome the tongue to promote proper nutrition, bonding, health, and much more. Newborns also receive a lot of antibodies from breastfeeding from their Mom and in a time when COVID-19 vaccines are not recommended for newborns, this can be reassuring for many parents as some form of immune protection.

Study: A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19

Trifecta Part 1 – Dental Consultation

“Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie.”[1]Ghaheri, B. A., Cole, M., Fausel, S. C., Chuop, M., & Mace, J. C. (2017). Breastfeeding improvement following tongue‐tie and lip‐tie release: A prospective cohort study. The Laryngoscope, … Reference List

Find a recommendation for a dentist who specializes in tongue ties. Not only that, but find one who has been doing it for a while. While all dentists are properly trained and licensed, not all of them may have the experience they need to work with your little one to use tools such as Laser to release their tongue-tie. There is a small amount of risk here as there is a laser being used. We went this route for our newborn.

If you live in Northern California, the dentist to see is Dr. Shervin K. Yazdi in Castro Valley. He comes highly recommended and we used him ourselves with great success.

If you are not in this area, go on breastfeeding groups in your area and find recommendations from other parents who have used a dentist who specializes in tongue ties for children. Do some research on laser for tongue ties to get some background knowledge before going in for your consultation.

If a tongue-tie release is appropriate for your newborn, then afterward, you will have some homework to do. Post-tongue-tie release homework often involves doing exercises. They are called exercises, but really, you just put pressure on the post-surgical area to ensure proper healing and promote maximum function. Follow your dentist’s exercises to a T as this is often proven to work based on the dentist’s intervention. Even if your newborn is improving with a release alone, continue to do the exercises as long as recommended because a wound can revert back.

Trifecta Part 2 – Lactation Consultation and Sessions

“Occupational therapists can analyze a level of activity or task that is suboptimal and develop a plan to improve performance. But surgery alone does not guarantee performance of the activity; for example, infants often have difficulty in the transition from breast milk or formula to textured foods and solids.”[2]Ligh, R. Q. Strategies for Treating Tongue Tie.

Many occupational therapists are lactation consultants and certified. While you do not need to specifically see an OT who is a lactation consultant, it can be very beneficial because OTs focus on function and can promote the therapeutic activity of breastfeeding between the dyad. OTs can provide a holistic, family-centered approach based on the family’s habits, strengths, routine, environment, culture, and more.

“Occupational therapists are well positioned to assist individuals, organizations, and populations in establishing habits and routines supportive of continued breastfeeding while lessening environmental and contextual barriers.” – American Occupational Therapy Association 

Not only can OTs address breastfeeding themselves, but they can tend to the anxieties and worries of the parents (including your partner) in this potentially stressful time. OTs may also address issues such as sensory defensiveness in your child and promote improved bonding when breastfeeding for it to be a therapeutic experience. Many OTs can provide this service in your home or over telehealth. Your insurance may cover this service from OTs.

Trifecta Part 3 – Chiropractic and Body Work

“Often compensatory behaviors lead to premature weaning, as they can be inefficient and physically and emotionally injurious to the mother, thus hope of reclamation becomes less certain. Chiropractic intervention, when applied skillfully and in collaboration with the lactation consultant can support full competency in feeding and offer the infant the opportunity to reclaim his full human potential.”[3]Tow, J. E. N. N. I. F. E. R., & Vallone, S. A. (2009). Development of an integrative relationship in the care of the breastfeeding newborn: lactation consultant and chiropractor. J Clin Chiropr … Reference List

The birthing process is one of the many miracles of life. It can also be very demanding for both parents as well as the newborn. During labor, the baby may experience physical and mental trauma such as lowered oxygen levels, being exposed to medications, being stuck in a certain position such as breech for a prolonged period, etc. Not only that, but babies spend a lot of their time in a tiny space that is the womb.

Many babies (as well as parents themselves) may benefit from chiropractic interventions and bodywork. Don’t be alarmed. When it comes to newborns, it is not what you think. The chiropractor is not putting them on the table and ‘cracking bones’, so to speak. In fact, they are very very very gentle. To work with this sensitive population, it is reassuring that chiropractors need special training and hours specializing in pediatrics. This intervention can help to correct alignments in the spine as well as work with soft tissues to alleviate issues that may inhibit therapeutic breastfeeding.

Conclusion

Consider using a team approach with the trifecta for tongue ties: dentist and post-surgical exercise, breastfeeding consultation with an occupational therapist, and bodywork from a qualified chiropractor. Often, one major discouraging barrier to breastfeeding a baby with or who has had a tongue tie is pain. Nipple pain. Breastfeeding should NOT be painful and if it is, consider addressing each of the three trifectas again to alleviate pain.

Throughout this journey, remember to breathe, be patient with each other, and enjoy this precious time with your little one. They are learning something new and getting used to this activity and it may take some more time for some than others. Absolutely do not compare your child to another one with a tongue tie. Just like how babies reach their milestones at different times or may even skip some, breastfeeding is the same.

Stay positive and also consider other services such as counseling, mental health, physical therapy, or soft tissue bodywork as alternative options. Don’t forget, your pediatrician may also provide a lot of insight into this subject and guide you along the way.

 

References

References
1 Ghaheri, B. A., Cole, M., Fausel, S. C., Chuop, M., & Mace, J. C. (2017). Breastfeeding improvement following tongue‐tie and lip‐tie release: A prospective cohort study. The Laryngoscope, 127(5), 1217-1223.
2 Ligh, R. Q. Strategies for Treating Tongue Tie.
3 Tow, J. E. N. N. I. F. E. R., & Vallone, S. A. (2009). Development of an integrative relationship in the care of the breastfeeding newborn: lactation consultant and chiropractor. J Clin Chiropr Pediatr, 10(1), 626-632.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.