Updated: Nov 8, 2021
Ankyloglossia is a STRUCTURAL impairment that consists of a shortened lingual frenulum. The body of the tongue appears thinned and the borders of the tongue are elevated. The front center edge of the tongue may have a heart shaped indentation. There is a functional impact when the tongue tip cannot contact the upper surface of the mouth when the jaw is nearly closed.
So what does this mean?
The FUNCTIONAL impact of the lingual frenulum is what matters, not necessarily the appearance.
Release of tongue and lip ties is an elective surgery, parents make the decision based on the information they are presented with. Families should be educated on their options to make the best decision.
1. Do nothing
If a family decides to do nothing, it is still important to be educated around how this could potentially impact the child’s future speaking, eating and sleeping. This information can be determined through an Oral Motor Assessment.
2. Oral Motor Therapy (with an OT or SLP)
Without a revision an OT or SLP can provide oral motor therapy to maximize a child’s function with available lip and tongue range of motion. There is a possibility that a baby or child may hit a “plateau” in progress without revision depending on how much the restriction is impacting function.The best way to determine if pursuing a revision is necessary is to complete a re-evaluation/assessment to note the progress made and if plateau is occurring. It is necessary to have ongoing monitoring of the child’s oral motor function until the therapist feels the child has developed adequate strength/re-train the muscle.
3. Pursue a revision.
For best outcomes work with an occupational therapist/speech language pathologists and lactation support. Therapy is necessary following the procedure.
The 'diamond' shape that results after a revision
A frenotomy is a low risk procedure, but it is NOT a “quick fix,” especially in cases of infants and children with complex issues surrounding feeding and speech development.
Oral motor interventions are an important part of oral motor skill development with both types of tongue ties. It will be necessary to help strengthen new areas of the mouth that have not been activated. After a surgery the tongue develops more movement (range of motion) but it does not necessarily mean that your infant or child will know how to use their new free tongue. A child is more likely to use their tongue exactly the same way as they did before the surgery.
Your therapist will most likely work on full body alignment, since oral movements are refined motor movements and they are distal to the pelvis and trunk. Trunk alignment must be obtained in order to gain in the next practice. Jaw structure and neck elongation are other oral structures that must be in the correct alignment for eating as well.
Why does tongue movement matter?
Our hard palate is easily moldable when we are infants. Why does this matter? Well the tongue helps shape our palate and if the tongue is restricted or not resting in the ideal resting position it will shape the palate differently. A hard palate that is shaped ‘too high’ or ‘too wide’ can impact the child in many different ways, including eating, breathing and sleeping.
The tongue position also impacts the ability of the airway to stay open, if the airway does not develop properly due to the tongue position issues like snoring, sleep apnea, teeth grinding, constant wake ups, hard to settle (without feeding/pacifier/thumb) and mouth breathing. This improper airway development is a potential cause of SIDS. It impacts alertness and focus during the day and consistent deep sleep at night. The tongue also needs full movement to help chew efficiently and swallow safely, along with clearing food from the teeth and lips.
The Breastfeeding Dyad:
The breastfeeding infant’s symptoms are JUST AS IMPORTANT as the mother’s symptoms. Most often women are told that if baby is gaining weight that is all that matters. But your symptoms as a mother matter too! Breastfeeding SHOULD NOT be painful. Painful breastfeeding is an indicator that more is going on; it could be issues with latch, a tongue tie, a functional issue, an issue with overactive let down, etc. An oral motor therapist and lactation consultant can help identify the issue and provide tools and strategies to resolve the concerns.
One of the most important newborn and new caregiver tasks is early feeding. Not only does the task nourish the baby but it also promotes mother-infant bonding, self-regulation skills and early communication skills for the infant. Breastfeeding should not be a constant difficult task. Many parents have expressed that feeding difficulties have caused them stress, anxiety and feelings of guilt. Early intervention is vital to establish, increase, and maintain a mother’s supply.
An occupational therapist and lactation consultant are able to help problem solve breastfeeding difficulties. An occupational therapist, lactation consultant, speech language pathologist, ear, nose and throat doctor or pediatric dentist who specializes in tongue-tie all are able to help address a true tongue tie.
Occupational Therapy Role includes:
Assessing oral motor patterns, swallow function, feeding function, developmental skills and sensory systems to determine what seems to be causing or contributing to the feeding issues
Providing recommendations for developmentally supportive positioning or activities to avoid additional delays, potentially correct the feeding issue, and/or support the new tongue movements needed post-clipping, if clipping is indicated
Assessing and intervention if there are other facial, neck, trunk or hip muscles that appear tight or are limiting the baby’s function
Identifying tongue-tie and connecting families with the appropriate professional to help clip it if this appears needed
Discussing findings with families and making a specific plan tailored to their needs, values, and priorities
Discussing with the child’s pediatrician and whoever will be consulted to clip the tongue if needed
Providing pre- and post-clipping tongue exercises to help build new patterns and maintain the range of motion gained by clipping
Helping parents identify an appropriate bottle/nipple choice if bottle feeding is desired or if it is needed for a period of time to address weight gain issues
Addressing the disrupted bonding between parent and baby or referring to the appropriate professional if more intensive therapy is needed
Education on breastfeeding – habits, positioning, tools, exercises
Supportive interventions for breastfeeding – pumping, hand expression, bottles, pacifier selection
Comfort for mom and baby – position and pillow support (e.g., My Brest Friend)
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
Referrals to craniosacral chiropractic/bodywork, dentists, SLP, and other resources
Pain management for baby
Psycho-social support for frustration, stress, depression of parents
Early Warning Signs can include:
Frequent nipple infections or thrush
A declining or poorly established milk supply
Sore cracked nipples
Insufficient milk supply
Fusses at some point during the feeding
Loses seal (“falls off”) on the breast or bottle frequently
Is not gaining weight well
Is very cranky/gassy/uncomfortable after feeds
Spills a lot of milk from the mouth while eating
Seems to cough a lot while breastfeeding or bottle feeding
Takes a long time to complete a breast or bottle feed and never really seems satisfied
Difficulty sleeping, especially at night
Baby may fuss or arch away from the breast when it is presented
Tongue can look like it has a heart shaped tip when trying to extend
Tongue can look square or flat
Baby cannot poke tongue out beyond bottom gums or lip
The tongue humps up in the middle instead of plunging forward
Tongue cannot move freely to the left or right of mouth
Baby often makes a clicking or smacking sound while trying to eat
We know how scary feeding difficulties can be for infants and babies. It can be very overwhelming to find out that your baby may have a tongue tie or functional issues. We see the value in having a team to support you on your feeding journey! Infants are amazingly adaptable and when you have the right support the challenges can be overcome.
Family Foundations Therapy CEO/Founder & Lead Occupational Therapist is experienced as an Oral Motor Therapist. We can be part of your team and help solve the feeding concerns that you are having. Email us at email@example.com to begin the discussion of how we can help you and your family.
***Occupational Therapy services are covered by most healthcare insurance plans****
Janelle Daku, Women’s Health and Pediatric Occupational Therapist
What our customers are saying about our Lead Occupational Therapist:
"I reached out to Janelle for assistance with my 3 month old baby who was born with a posterior tongue tie. The tongue had been released but we were still experiencing some difficulties with low facial muscle tone and tightness in his body. Janelle gathered a thorough history of my concerns and observations and gave me a few options to have my baby assessed by her in person. I really appreciated the option of in home assessment especially due to the pandemic. Her in home assessment was also very thorough and I was incredibly impressed that the oral and feeding assessment was consistent with what I have seen recommended by those who specialize in tethered oral tissues. That alone gave me great confidence in her as it has previously been challenging to find adequate help with therapy post tongue tie release. She provided me a plan that was easy to follow and not overwhelming and I have already seen great improvement with consistency. Janelle was extremely supportive and relatable; I felt as though she was also there to support me in my goals for my baby. Her communication is excellent and she is extremely knowledgeable."