Successfully Addressing Oral Ties

We went through the ringer with our own kids years ago and stumbled through this process of addressing oral ties. I often wish we had known with our first child over 10 years ago, what we know now. But our experience led us into our passion and knowledge of the body and the place we are today in the care we provide to our in person patients. I’ll share briefly our experience with our first two children and then what we now suggest for tackling this overwhelming topic.

LET OUR STRUGGLES GUIDE YOU.

When my oldest child was born, I knew NOTHING about tongue ties. I was dead set in my intention to breastfeed thanks to reading Ina May’s Guide to Breastfeeding. I was 100% determined and credit my grit to her wisdom.

Breastfeeding my oldest was difficult. I remembering crying often, because the pain was unbearable. My midwife, bless her, didn’t know enough about ties to refer to anyone and I fumbled through the first week of feeding him. But trusting my gut, I made an appointment with another midwife in the area who was confident enough to snip the anterior portion of his frenum with a scissors (a practice done by midwives for generations). This gave me a significant amount of relief with feeding.

He was what I call a “marathon nurser”. 45 minutes was a SHORT nursing session for him. I now know that he was NEVER efficient at transferring milk when at the breast. He was skating along, just hanging out at the boob waiting for my let down and thankfully I had MORE than enough milk for him, but this created a different common problem we see with babies.

He wasn’t regulating his milk intake so he also spit up BUCKETS of milk every day. I distinctly remember holding him up to puke over the side of the rocker onto the floor on more than one occasion. Burp rags were always at the ready and if they weren’t I would be wearing spit up that day. Who am I kidding? I was wearing it either way.

He was never content for long. He grunted in his sleep and seemed uncomfortable most of the time. But I only had him to worry about. No other kids to chase around, so I could hold him for naps and we made it through the early months. I thought everything we were experiencing was normal.

At 9 months old little man had a pretty massive gap between his front teeth and I could see plaque on those two front toofers. I found out he had a BIG ‘ole lip tie under there. We found a local dentist via reccomendations from mom groups on facebook. It seemed everyone took their kids to this provider for tongue and lip releases. He took a quick visual look at our baby and basically said “Yes. thats a lip and a tongue tie. If you want to do it right now, today, we can waive the consult fee!”

So we allowed this dude to use a CO2 laser to release our son’s ties right there in the room. It was hard. I wasn’t ready for it. I had no grid of what to expect for healing and no idea what to do for baby afterwards. They talked us through what stretches we needed to do, but couldn’t demonstrate on him as he just had the procedure done. Not to mention, I was fairly traumatized by witnessing the release and trying to comfort my son afterwards that I couldn’t absorb any information.

We ended up coming back for a re-check a week later and this highly recommended provider told us there was “reattachment” under the tongue. He then proceeded to open the wound up manually with his fingers. There was never a recommendation or referral made for chiropractic, bodywork, an IBCLC or anything.

Looking back I would have done so much differently.

With my second child, I had learned some. He was born at home, but birth was a ROLLERCOASTER. He was born extremely fast and I was terrified. I didn’t parciticpate in his birth. Birth happened to me. If I was supposed to be riding the waves on top of the water, if felt more like I was tumbling and getting pummeled under those waves. Poor kid seemed to be the saddest baby on earth. He came out screaming and it seemed like he never stopped. If he wasn’t sleeping or nursing he was screaming.

I remember in the early days looking at him and legitimately thinking, “I’m pretty sure you won’t ever smile” and I was seriously convinced that was the truth.

When breastfeeding was excruciating, we quickly found a different provider 3 hours away. We made a 3 hour drive to see this dentist. There was a bodyworker in the office who worked with him releasing fascial strain before the procedure and afterwards as well. This helpful woman advised us that he would need MORE help than she could give in one day. We ended up driving back and forth from our home to their office for therapy several times.

At about 2.5-3 months old I experienced a round of mastitis that I will never forget. We brought him back and found that the wound had not healed as open as they would’ve hope, but they advised we find a local person for fascial bodywork before we tried a second release. I am SO grateful for that advice.

After several months of bodywork and slow progress, we felt prepared and underwent a second release procedure. By 7-8 months of age we had what seemed like a different kid. Who actually did smile.

This experience was the entry into fascia for me and the impact this overlooked system has on the body. I’ll tell more of that story some other time. For now, I’ll skip ahead to what we learned and what we now advise for our patients. These are the steps we took with our 3rd and 4th babies when they were born.

7 Steps to Successfully

Address Oral Ties

This is meant to serve as a guide, not medical advice.

Although we just spent the first section talking about our experience with our babies… this guide can be applied for anyone of ANY age. I want to simplify the process & give direction for you to make your own health decisions. With so many opinions, parents feel overwhelmed or lost as they simply want the best for their child. From the story above you know that I can relate, but first let’s get one thing straight…

RELEASING A TONGUE TIE IS RARELY AN EMERGENCY

Oral ties are a complex problem requiring a lot of focused attention for any age and especially for infants. Even when each step is completed correctly, you still may need to address oral function with these tongue tied babies later in life. 
To clarify, oral ties can occur in 7 places in the mouth. So when we are talking about oral ties, we are including tongue, lip, & buccal oral tethers.

Oral ties can affect any age. Many rush to release those fibers via surgery saying “the younger the better”. We disagree. Surgery (even minor) without a plan, a team of professionals to help or knowledge of aftercare is a recipe for a disaster. Oral Ties require focused attention for any age, but again IT IS RARELY AN EMERGENCY! Even in the event that an infant is not feeding/ losing weight, don’t skip steps & get a support team. Adults & children can address oral function later in life.

1. Functional Evaluation

This is much more than a quick look in the mouth and the appearance of a frenum does not mean the person has a tie! This can be done at a tongue tie knowledgable provider who is trained to assess function. It is not advised for the this step to be done with the tongue tie release provider! For infants, a lot of times functional evaluations are preformed by a private practice IBCLC who has done EXTRA training to be able to assess all areas of oral function.  

For older children and adults this step is likely with a myofunctional therapist, orofascial myologist or tongue tie specific Speech Language Pathologist. Ask what training they have in assessing oral function.

Please note: not all lactation professionals, pediatricians, chiropractors, or dentists know or are trained to fully asses oral function. At the assessment the provider will determine the areas of restriction, make note of compensation patterns and provide recommendations on what you can do to help improve function. 

2. Gather a Team of Professionals

You’re going to need a team approach to prepping for any potential release procedure. Depending on the age of the individual it may include an IBCLC, bodyworker (we highly recommend fascial work specifically), SLP, Chiropractor, OMT, PT, OT or others tongue tie knowledgable pros. You need to vet these professionals carefully. It might take some digging to assemble the right team to support you for the successful outcome you need! For younger babies, a knowledgeable IBCLC is a MUST. It doesn’t matter if this is your 1st or 7th child, breast or bottle fed…. GET LACTATION SUPPORT!!!

3. PRE- Habilitation

You’re going to want to address much of the strain and tension that the tongue tie has caused so the wound has the best chance of healing in the proper open position rather than closing down on itself or “reattaching”. You also want the nervous system to be clear and calm going into a release. If an individual is in a state of fight or flight (sympathetic overdrive) before a surgery, it’s definitely going to have a negative impact on the outcome. 

Fascial release therapy, is key to helping clear the soft tissue web of tension that will impede proper healing. This will also help regulate the autonomic nervous system. 

Pre-hab activities at home can include specialized exercises in the areas of oral weakness. Older children and adults will likely work with a myofunctional therapist, orofascial myologist, or other tongue tie savvy professional for these exercises. Young infants will also have oral exercises to do to supporting and gain as much oral function for feeding as possible before a release.

4. Re-assess Function

After weeks or even MONTHS of pre-habilitation, ask your team of providers to reasses oral function to determine if a surgical procedure is indicated. Remember FUNCTION is key, not just APPEARANCE! If function has improved enough and this can be maintained, a surgery may be UNNECESSARY!

5. Determine Timing for release & Prep for Aftercare

You’re going to work with your providers to determine the optimal timing of release. This is TRICKY STUFF. Consider your home life, work schedules, vacation plans, childcare, illness, not to mention most importantly… the body’s readiness! The body needs to be as free of strain and tension as possible BEFORE a release procedure. Again, RELEASING A TONGUE TIE IS RARELY AN EMERGENCY!

Along with proper timing for the release you need to be prepared for wound care and pain relief measures after the procedure. You want to understand, practice and be fully confident of your responsibilities after the procedures to help the incision heal correctly. Ask your team, “What exercises will I need to do after the release”. Practice those exercises AHEAD of the procedure.

If you’re child (especially an infant) is having the release, work with them ahead of any procedure so they are used to your hands inside their mouth!!! This will help reduce trauma all around. Not having practiced ahead of the release, can lead to trouble getting the exercises done correctly and fully afterwards. After the release those tissues may also be very tender and sensitive. You will want to be confident and accurate with any tongue or lip lifts you need to do to keep the tissues open during the healing process. You don’t want to be underprepared for the aftercare and wound management post-procedure.

 Aftercare recommendations will vary from provider to provider. For our patients we find gentle wound management to provide best outcome. We don’t rub directly on the wound as that can cause an excessive amount of scare tissue to form. Ask your team about gentle wound management techniques. 

6. Release Tissues with Preferred Provider

After reassessment of function and  determining the optimal timing for release, you will carefully choose a provider to do the release. You want a skilled recommended provider who is going to do a complete release of the oral tethers. Your team will likely have recommendations for you on who is best for your area. You also may consider traveling for this step of the process to see a better provider than whoever is closest.

Whether this step is taken with a dentist, ENT, pediatrician, midwife, or other professional, a great preferred tongue tie release provider will understand the importance of a team approach to addressing a tongue tie and encourage you to not to rush the process and work with a bodyworker, chiropractor, myofunctional therapists to gain full oral function. 

The TOOL used to release the tie is not as important as the SKILL and TRAINING of the provider. Scissors, laser, or other techniques can be used successfully. Each tool has its pros and cons. Do your research. Talk to your team to make the decision of what technique and provider is best to perform an oral release procedure. 

7. Follow up with Your Team

Post procedure you’re going to keep working with your team of professionals throughout the healing process. Initially the first few weeks are imperative while the wound is new. Because you are well practiced ahead of time, you should already feel comfortable and confident in the post procedure exercises and wound care.

Stay in touch with your team of professionals as those tissues can continue to change and remodel for as long as 6 months after release. Your team should work with you to gain as much function as possible!! They are likely very invested in the outcome as well because they have been in your corner since the start of the process. 

A Note for Families,

I’m thinking especially of families with infants, it's important for YOU to receive care during this time. You are undoubtedly connected to your child. Any anxiety or stress WILL AFFECT the outcome. Don’t make decisions out of fear. First establish peace; then determine your steps.

Here’s a few ideas: Seek fascial bodywork for yourself. See a counselor or therapist for emotional work. Check into trauma therapies such as EMDR. Get outside for morning sun, take off your shoes and walk in the dirt and grass. Practice breathwork.

The data about how children reflect or mirror the strain and emotions of their parents is astounding.

Toddlers and Preschoolers are a tricky age group when addressing oral ties. For one, there is a severe lack of professionals trained to work with this age group. Depending on the level of compliance for the kiddo, you may have to slow the process waaaaay down and/ or revisit the issue at an older age.

Tune in to your parental intuition on this. It will likely become clear whether or not your child will tolerate and participate in the process or if holding off for a time would be best.

We hope you find this guide helpful and our personal story encouraging. If you have further thoughts or questions, we always would love to chat. Reach out and let us know if you found this post valuable!