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Tongue Ties Need Teamwork

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I've been receiving questions from moms lately about tongue ties, oral dysfunction and how to explain it all to their partners. If you're like most families I'm seeing, I mostly see the mom as she's the one taking the kids to ALL. THE. THINGS. --airway-focused dentist, dentists trained specifically in frenectomies and frenuloplasty (commonly called revisions), myofunctional therapy, lactation, chiro and/or PT and Osteopath and OTs. If I'm being completely honest, it's a lot. Especially if your partner doesn't necessarily understand the why behind it all. So here's the why…in hopes it helps get everyone on the same page and builds a stronger support team during these hard times. 

Why do oral dysfunctions and tongue ties happen?

Honestly, if I knew this I would be a millionaire. Unfortunately at this time we don't have a clear cut answer. We are just in the beginning stages of research to help us understand the why/how it happens. I hope in the next 10-20 years we will have a better understanding of why it happens but until then, we have a few really great speculations that make sense.

Typically the tongue starts to develop by weeks 5-7 and the frenulum separates around weeks 10-12 in utero but in kids with tongue ties it hasn't separated (technically, it hasn't gone through apoptosis or cell death). Some believe it is related to the genetic MTHFR mutation while some people like the brilliant Dr. Steven Lin who believe it is related to Vitamin A deficiency. https://www.drstevenlin.com/tongue-tied-genetic/  There is also some research to suggest that excessive folic acid (rather than folate or 5-methyltetrahydrofolate) may lead to increased tongue ties. 

While we don't know why just yet, it's important to focus on what we CAN change for the future rather than questioning what we did (or didn't do) in the past. And that's where the next section comes into play…it's about "all the things" you might be doing for a tongue tie. I also want to take a second to remind you that each kiddo is different so please don't think you need to do everything and add more. I'm simply talking about your options and why they might be best for you and your kid. Also, each provider’s training is different…just because one chiro or PT or dentist is trained in tongue ties does not mean all of them are trained! It’s important to look around and find the most qualified team in your area to help you and your kiddo.

Breastfeeding and Tongue Ties

This is where an IBCLC and myofunctional therapist excel when it comes to tongue ties. Some of the most common reasons a baby is brought in for evaluation is nipple pain, poor latch, slow weight gain (some babies are able to grow well due to oversupply and a fast letdown), recurring clogged ducts and mastitis. When the tongue can't freely move it prevents the tongue from fully cupping the nipple and the baby can end up gnawing or gumming the breast rather than sucking. 

To say that tongue ties can affect breastfeeding is an understatement. In these cases I love having both an IBCLC and myofunctional therapist looking at the mom and baby together. Sometimes it's something as simple as the IBCLC changing the position the baby is being held while feeding (bring baby to breath rather than dropping breast down to baby) and sometimes the baby needs specific jaw or tongue exercises to help relax specific tongue or cheek muscles and strengthen others which the myofunctional therapist can determine.

Local IBCLCs: Lisa Zimmerman, Jill Aspinwall, Beth Bejnarowicz, Heather Dvorak

Local Myofunctional Therapists: Simply Communication in Roselle (all are fabulous, Michelle specializes in newborns and young children)


Gassy Babies and Tongue Ties (Breastfed & Bottle Fed Babies Too!)

Reflux, colic and gas, oh my. This is one of the top three reasons I see little ones in my office. I'm going to throw it out there that babies shouldn't "fart like daddy" or "burp louder than a grown human" and they really shouldn't be decorating your walls or clean laundry baskets (*cough* true story) with constant spit-up. Have you searched for the perfect formula that won’t make your baby spit up or maybe you’ve cut everything out from dairy to chocolate (and all the things that bring joy to your life) hoping it would make your baby less gassy and fussy.

Babies with reflux, colic and gas frequently have something called aerophagia which is a complicated way of saying they take in too much air. And what goes in must come out…whether it's in the form of spit up, farts, burps or even constant hiccups.  If your child is "on the highest dose of reflux medicine" or "none of the reflux meds help" that may be because it isn't an acid issue but actually an air intake issue. Babies frequently take in too much air (aerophagia) when they can't get a good latch. If you look at the baby while they eat (breast or bottle) you shouldn't see gaps at the corner of the mouth but instead you should see a nice full latch circling the entire nipple/bottle. This is another area where Myofunctional Therapists excel because they are trained to look at and listen to the jaw, mouth and tongue and can help assess if they are all moving and swallowing correctly. 

Now, sit back a second and think of a time that you ate wayyyyy too much food and you feel like you’re going to explode. Think of the bloating, the gas, the abdominal pressure building. You're constantly shifting in your normally comfy chair trying to find a comfortable spot and you can't seem to find it. That's how your baby is feeling when they take in too much air. No matter how much they wiggle and move they can't seem to get comfy. Chiropractors, Doctors of Osteopathy and Physical Therapists are trained to help relieve the tension that comes along with that increased air intake. 

Local chiropractors trained in TOTs: Dr. Lauren Keller (Bloomingdale), Dr. Jessica Leighton (Naperville), Dr. Gabriella Ludeman (Bolingbrook)

Tense Babies, Plagiocephaly, Torticollis, Motor Delays and Tongue Ties

First a few vocab words… torticollis is the shortening of a muscle called the sternocleidomastoid (SCM for short) which causes a baby to turn their head to one side and tilt to the other. Plagiocephaly is the flattening of the bones of the skull. This is a "chicken or the egg" scenario because for the most part we don't know what came first. Torticollis can make it harder for a baby to move making Plagiocephaly more pronounced but plagiocephaly can increase a flat spot making it harder to turn their head. Either way, when torticollis and plagiocephaly are involved, it's important to check for a tongue tie as it may delay progress. 

If you're wondering how the three are connected, take your hand and place it on one side of your neck under your ear and pull down towards the center of your neck. Did you notice how your neck naturally moved to compensate for the pull on your neck? Now try to turn your head. It’s not easy, is it? That's the same pull your child is feeling when they have torticollis and it can prevent them from moving through milestones with ease. This is most commonly noticed when a baby isn’t rolling from back to belly by 4.5 months.

Have you ever looked at your baby and thought, "whoa, you're so strong for your age" or said "they were lifting their head up the day they were born" or "My baby rolled when they were only weeks old" or "my baby loves to do little sit-ups" or maybe you comment on your sweet little one’s six-pack abs? Here's the catch, what we usually think is brute strength is actually tension. Through fascia our tongue is connected to everything- the diaphragm, the pelvic floor and even your toes. If there's tension in the jaw and tongue then there might be tension in one of those areas as well. It's important to relieve that tension so the baby can freely move without restriction.

Chiropractors and Physical Therapists are trained to help relieve the tension through stretches, strengthening exerci ses and even positional changes to help relieve the general tension that many babies have when they have a tongue tie. 

Speech and Tongue Ties

Articulation problems, phonological disorders and lisps are all reasons people might consider evaluating for tongue ties. There's some research suggesting that improved mobility can improve speech.  I'll admit that the research isn't there (yet) so speech improvements with frenectomies are mostly anecdotal at this time. With that being said, I will never forget sitting across from my Dad 3 days after my 3.5 year old had a functional frenuplasty. For probably the third time in my life I saw him cry as he smiled at me and said, "I can finally understand her." I will wholeheartedly admit I am biased on this part because I have seen firsthand the drastic change in speech that is possible for some kids. If you suspect your child's speech delay may be related to a tongue tie, a speech pathologist trained in myofunctional therapy is the gold standard. 

Local Speech Language Pathologists trained in tongue ties: Simply Communication 

Sleep Apnea/Restless Sleep and Tongue Ties

Alternatively this section could be called Bedwetting and Waking to Go Pee and Tongue Ties

Have you ever found yourself asking if your child wrestled an alligator in their sleep because the sheets are so twisted? Or maybe you absolutely love how your baby sleeps on their belly with their butt in the air. Or worse, you want to know why your kid wakes up almost every single sleep cycle all night long. You and your partner are to the point of exhaustion. Your stomach hurts and you want to cry because this kid just doesn't sleep and you've “tried everything” and it hasn't worked. 

Starting even at the newborn stage, if a baby has a tongue tie that isn’t mobile enough to let them put the tongue to the roof of the mouth, this can cause sleep apnea and restlessness. If you ever look in your baby’s mouth, what’s going on with their tongue? Is it suctioned to the roof of their mouth (yay) or is it down where their bottom teeth will grow in at or constantly sticking out between their lips? Try to lie on your back and let your tongue drop to the floor of your mouth and pull it back. It doesn’t feel good, right? When you do this your brain will most likely send warning signs to move your tongue back to where it should be to stop you from limiting your airway. Tongue ties and low resting tongue posture can cause sleep apnea by allowing the tongue to slip down and back and narrowing the airway. This commonly happens when they sleep on their backs.

On a personal note…think about how you sleep. Do you constantly thrash around and struggle to sleep? Or maybe you “get enough hours of sleep but constantly feel exhausted”. Even as adults this can be a sign of a tongue tie and sleep apnea and the inability to get enough air while we sleep.

If your baby is young then myofunctional therapy is the first place to go! If your child is older, an airway focused dentist along with myofunctional therapy is a great option. The dentist can run a CBCT which is a scan that looks at your kid’s sinuses, nasal structure (do they have a deviated septum), tonsils and adenoids as well as their airway and palate. If they find your child's "mouth is too small" to fit the tongue they may offer expansion to widen the palate which creates more space in the sinuses, allows for nasal breathing and opens the airway. 

Remember that alternate title? If your child is frequently waking up and unable to get restful sleep, they may have bedwetting issues at an older age or they "wake up to go pee" a lot. This is because when we sleep our bodies create something called antidiuretic hormones to make us pee less by making the urine more concentrated. If your kid isn't sleeping, their body won't be able to release this hormone and they are more likely to wet the bed or wake up and need to use the bathroom in the middle of the night.

Local airway focused dentists for kids: Dr. Julie Davis in Park Ridge, Dr. Courtney Dankoh in Downers Grove, Erica Zolnierczyk in Orland Park, Dr. George Rivera in Oakbrook Terrace, Dr. Kevin Boyd in Chicago

Local airway focused dentists for adults: Dr. Michael Marcus

For local peds ENT: Dr. Jonathan Sherman at Advocate 

For local adult ENT: Dr.Michael Hutz at RUSH

For peds pelvic floor: Dr. Lauren Keller (me)

For adult pelvic floor: Dr. Lauren Keller (me), Leena Bird in Naperville, Kate Uttech


Sensory kiddos, ADHD, Emotional Dysregulation and Tongue Ties

Is your kiddo a sensory-seeking, high-energy, oh-my-gosh they never slow down kinda kid? Earlier we talked about sleep and it's important to know that sleep also helps us restore the body, improves healing, and allows us to process trauma and create emotional stories. When kids don't get enough sleep it's common for them to be overly tired and appear wired. 

Sit back for a second and think of a time that you didn't get enough sleep. It may have been studying for a test or worrying about something in life. How did you feel the next day?  we can be exhausted but adrenaline will keep us going. If this happens a lot (like during finals week in college), we can start to feel the lack of sleep and stress build within us. Kids are no different. They are constantly wired as if they are in a fight-or-flight situation and unable to calm down. There's some research to suggest that kids that can't sleep well can have ADHD symptoms, increased anxiety and tend to have emotional regulation issues. This is where OTs come into play as they excel at all things sensory input and emotional regulation. 

Local OTs: The Balanced Kid in Naperville and Westmont

How are tongue ties diagnosed and who performs them?

Many of the providers listed above can diagnose a tongue tie. If you're not local, here's a great resource from Dr. Ghaheri on how evaluations should be performed.

https://www.drghaheri.com/blog/2014/2/15/how-to-examine-a-baby-for-tongue-tie-or-lip-tie?fbclid=IwAR2nWQueup9cmOYp6JxFHMx5XRRbBTqm32tKFruciYX2J8R76HXQh-R8Rx8 

The important thing to remember is that EVERYBODY is born with a frenulum, what makes a tongue tie a tongue tie is how the tongue moves…or actually how it does NOT move. I wish that bodywork, nutrition, tongue positioning and dental work could correct all tongue ties. Unfortunately that isn't realistic for ~12% of kids and a frenectomy is needed to allow the tissue to freely move. When it comes to the actual frenectomy, you want someone who regularly does frenectomies and has taken extra classes on doing it. Not simply someone who "can" do a frenectomy. This is important because we don’t want to simply snip the frenulum but we want to make sure that whether scissors or laser are utilized, the provider is making sure that range of motion is being returned to the tongue and lip.

Local Frenectomy and Frenuplasty Provider: Dr. Milton Geivelis


I know this was long but I hope it helps you find comfort in knowing that you are not alone and you are doing what is best for little one….even if right now you feel like you’re just surviving doing all of the things, you will soon be thriving. That’s what the team is there for…to help you and your little one go from surviving to thriving.

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