Signs of a Tongue-Tie in Newborns: When to Talk to an Occupational Therapist
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Have you been hearing about tongue ties, but don’t really know what that is? Is it a big deal or isn’t it? And what do you do about it anyway? Read on to get clear about tongue ties, what they are and what to do about it!
What Is a Tongue Tie?
A tongue-tie is a type of oral restriction, which can occur at any of the 7 frenula in the mouth: under the tongue, the upper lip, the lower lip, the upper cheeks and the lower cheeks. Yes, there are 7 frenula in the mouth and we need them!
The frenula are connective tissue (i.e. fascia) that connect the tongue, lips and cheeks to the jaws. The tongue is the most common oral restriction followed by the upper lip. Restriction of the cheeks and lower lip are less common.
So, what’s the big deal? The big deal is that limited mobility of the tongue, the lips or the cheeks will affect the way your baby can feed now and in the future. This is true for both breastfeeding and bottle feeding.
In addition, human development builds on itself. That means that what is happening developmentally with your baby now will influence the skills that come next. If feeding is hard now, that will lead to challenges with solid food feeding in the future and often speech and language skills as well.
Diagnosis of an oral restriction requires both a visual assessment of the anatomy AND a functional assessment of the mouth (i.e. how do the tongue, lips and cheeks move). If someone has only looked at the tissue and is declaring it a “tie,” beware! An accurate diagnosis is important and is accomplished by a skilled provider with a license to work in a baby’s mouth (ex: occupational therapist, speech therapist, dentist, ENT, nurse practitioner or pediatrician).
Early detection is ideal so that you can alleviate challenges your baby is facing now and to ensure that your baby’s developmental trajectory is as optimal as it can be going into the future. So, how do you know if your baby might have an oral restriction?
Common Signs of a Tongue Tie in Infants
There is what I call a constellation of symptoms that are associated with having an oral restriction. Because that frenulum is made of fascia and our fascia runs through the whole body, when it’s restricted in any one part it can cause trouble in other parts of the body too. Here are some of the most common symptoms for baby:
Gassiness and/or reflux
Slow or limited weight gain
Difficulty latching or staying latched
Falling asleep when feeding
Feeding more frequently than every 2 hours after the newborn phase
Significant restriction in the body such as head turning preferences or head shaping differences
Generally uncomfortable and fussy or “colicy”
Clicking and/or coughing/choking when feeding
Irregular and/or painful bowel movements
Because babies with oral restrictions have difficulty with feeding, there are also common signs of oral restriction that are experienced by the breastfeeding parent:
Flattened or lipstick shaped nipples after a feed
Pain experience during or after feeds
Mastitiis
Consistent engorgement
Nipple thrush
Cracked or creased nipples
If you are noticing these symptoms in your baby or yourself, the next step is to get an accurate diagnosis by a qualified provider who is trained in diagnosing and addressing oral restrictions.
Best Practice: What to Do if Your Baby Has a Tongue Tie
People often think of getting a frenectomy as “fixing” the tongue tie problem. And there is often a feeling of immediacy to rush and do the release as soon as possible. However… best practice for addressing oral restrictions includes a variety of providers and does not treat a tongue tie as an emergency. In only rare cases does a baby need a frenectomy immediately, like when the feeding challenges are so great that getting any amount of sustenance is extremely difficult.
So, I like to think of a “solution pie” when I talk to families about how to address oral restrictions. This means that there isn’t only 1 solution, but many solutions (like pieces of a pie) that are needed to provide individualized care AND to provide the family with the best support. This includes types of intervention, as well as, education for the family and identifying the ideal timing for release. Generally, the pieces of the pie include oral motor intervention, lactation, a release provider and body work.
Oral motor intervention – This is going to be your occupational therapists and speech therapists. Oral motor intervention is where you get to teach your baby how to use their tongue, lips and cheeks more effectively. Learning new motor patterns is essential and this doesn’t automatically happen from the release alone! Baby has been using compensations very wisely to get the job done, but the only way to learn how to do things differently is to practice, practice, practice. OTs and speech therapists have the strategies to facilitate this learning with your baby, teach you how to keep things progressing at home and to problem solve any challenges that arise.
Lactation – A lactation provider that is trained and skilled in the specialty of oral restrictions will have the know-how and savvy to guide your feeding journey and support you and baby as best as possible. This is the provider families often go to first when having feeding challenges. Therefore, the lactation provider is also essential for offering families excellent education and guidance on what to do next when oral restrictions are the cause of the feeding issues.
Release provider – The release provider is the person who performs the frenectomy or frenotomy. This is often a dentist or ENT. This provider should spend time evaluating and educating you and understanding your baby’s specific challenges. A great release provider will also value the other pieces of the solution pie by either referring you to additional services or collaborating with your current providers.
Body work – This category includes a variety of services that work with the body’s natural healing mechanisms, like craniosacral therapy, chiropractic and Musgatova Neurodevelopmental Reflex Integration (MNRI). Individuals benefit from one or a variety of these services to bolster the nervous system and to facilitate a state of healing and ease in the body.
Each of these providers should be seen, to varying degrees, both pre and post frenectomy. This is to support you where you and baby are at now, to prepare your baby for release, and to monitor the healing process and enhance optimal skill development after the release.
Why Occupational Therapy Can Help
A pediatric occupational therapist who specializes in feeding and oral restrictions is an invaluable piece to the “solution pie.” As OTs, we look at and treat the whole body. For example, we are going to look at how posture and motor milestones are also being affected by the challenges in the mouth. Human development starts with oral motor skills, so challenges there will inherently lead to challenges with other skills.
So, how do OTs assess oral motor development?
We are going to look at the postural and oral reflexes of the body, as well as, how your baby is able to move the tongue and what your baby is doing when feeding.
What does all of that mean, exactly? We are going to check skill by skill and reflex by reflex. We are also going to watch your baby feed and feel your baby’s suck. All of this information tells us where exactly your baby needs support to bolster their feeding ability.
In addition, since we are working with the whole body, we will address any other areas that need support. This may be tummy time skills, head rotation, posture, sensory integration, regulation and more.
When to reach out for support?
You should reach out for support as soon as you have concerns and questions. I offer a free consultation call just for this purpose. This way you can ask your questions and get my feedback to help you determine what to do, if anything. Many other providers offer the same service, so the best thing to do is start somewhere, ask questions and follow your intuition.
How Happy Healthy Therapy Can Support You
At Happy & Healthy Therapy I offer OT sessions for infants from birth to the crawling stage for feeding and whole body therapy. I predominantly serve babies with oral restrictions and I incorporate craniosacral therapy and MNRI into my work. The work that I do is gentle and not forced. I am working to facilitate and not manipulate. And therapy is individualized to your baby and your family goals.
The first session is evaluative where I gather information on your and your baby’s journey, assess your baby’s skills and provide my feedback and recommendations. From there, follow up visits are focused on the interventions that will improve your baby’s skills and achieve your family goals.
If you’re noticing signs of a tongue tie in your newborn, don’t wait—reach out to Happy & Healthy Therapy to schedule an evaluation and get support tailored to your baby’s needs.
