Why tongue ties occur

With a tongue tie, a baby is not able to suck with the full potential of their tongue. As they get older, breastfeeding

Instead of tongue moving forward, the tongue moves down and back. Hence gumming. Pain.

Also with it back, there is increased space bw tongue and palate. Aerophagia, gassiness. Gag = posterior tongue can’t protect the airway.

Colic = higher likelihood of posterior tongue tie

Sleep apnea = mouth open, mouth open w/wo snoring, noisy breathing = disordered breathing while sleep

Anterior:

Posterior: bowling, cupping, can’t elevate. 50% were dxd to have refulx. Release and then reassess at 6 weeks time.

• Changes associated with ongoing

  • Palate shape more narrow,

  • Nasal passage smaller

  • Mouth breathing tendancy

  • Improper swallowing function

  • Can have a set back mandible.

• 1330 babies, observational study

  • 99% set back mandibles

  • 95% open mouth at rest

  • 93% narrow and rounded palate

  • Hypersensitive gag reflex

  • www.littlebirddental.ca

Could your baby have a tongue tie?

https://littlebirddental.ca/newborn-6-months/ assessment tool for babies less than 6m.

All restrictive fibres need to be released. No differe

sucrose 2ml 2min before. vibration pillow. hemostat clamp for 5sec, then scissor release. then functional blunt dissection with finger lifting.

Tongue Tie Patients

Not all tongue ties will need to be released, so it will be left to the discretion of Dr. Trenholm as to whether or not a tongue tie release will be recommended.

If a tie is released, it is best to be prepared to feed right after the procedure is done as breast milk will help soothe the baby, as well as help with healing.

Normal Tongue Mechanics

Here is a good video that allows, in slow motion, you to see the wave-like motion of tongue mechanics that are used during breastfeeding.

The infant in this video is not tongue-tied. So, several inferences can be made when looking at this sucking motion for breastfeeding. Initially, a baby will start to root around (looking around with head quickly with an open mouth) until the nipple reaches the mouth. At this point, the baby will engulf the nipple and aerola (pink part around the nipple) into the mouth. This will position the end of the nipple close to or at the soft palate in the mouth.

Then the first phase of the wave is to extend the tongue out of the mouth and flick up so that the tissue behind the nipple that contains the milk for the next suction motion is located. The flick will trap the milk from flowing backward.

Then wave-like motion will push it back towards the nipple. At this point, the middle part of the tongue will elevate and create suction in the mouth thereby drawing the milk out of the nipple. Research has proven that it isn't a pure peristalsis movement (wave-like) that results in the milk coming out of the nipple. It is suction. And that suction is caused by the compression of the tongue up against the roof of the mouth and then drawing it down.

Similar to the suction you would get if you closed your lips and put your tongue up against the roof of your mouth and then you try to lower your tongue to the bottom of the mouth.

With an anterior tongue tie, the tongue cannot fully extend out of the mouth to engage the aerola and trap milk in there, so the trapping is done by the lower gum line. This results in nipple trauma as there is a "chewing" motion that is repeated over and over. Usually anterior tongue-ties are obvious right off the bat after a baby is born.

Posterior tongue ties not picked up as well after delivery, and the effects may not show up for 6-8 weeks when a baby switches from passive feeding (like milk can just flow into the mouth with minimal effort) to active feeding. They work hard, for long periods of time, to get milk out, and they can't keep up with the caloric demands that their body needs to grow and function. So you may see a plateau in their weight. Symptoms of a posterior tongue tie include a clicking sensation when feeding, aerophagia (noisy feeding as they are sucking in a lot of air), milk spillage out the corners of the mouth (due to a poor latch), excessive spit-up (as they have a lot of air in the stomach at the same time ... it has to go somewhere!), irritible babies as they have a lot of gas in their gut, and weight plateauing as mentioned.

So, if you are suspicious that this is affecting your baby, we encourage you to visit a lactation consultant and your physician. If they are not sure if your baby has a tongue-tie, or they think your baby is tongue-tied, then a referral to a local specialist is warranted to see if they have one or not, and whether or not a release is required.

How a tongue tie release is done

After a thorough assessment by the physican performing the procedure (Dr. Trenholm in this case), the tongue is elevated using a finger and then the tongue tie is stretched. Using a fine pair of sharp scissors, the tongue tie is carefully released ensuring that the surrounding tissues are not damaged (salivary ducts and surrounding blood vessels).

With anterior tongue ties there usually is no blood or very little blood when released. However, when a posterior tongue tie is released there tends to be a bit more blood as there are some small blood vessels there, but these always stop bleeding on their own. This is one of the reasons why we ask moms to breast feed after the procedure is done.

There are no nerves in this area, so you do not need to worry that this is hurting your baby. They probably will cry during the procedure, but that is mainly due to the fact that the doctor will be forcing the tongue up towards the roof of the mouth.

TONGUE STRETCHES:

Please watch this video as it explain how to position your baby, and then how to properly place your fingers in the mouth to perform the stretch.

Focus on getting your index fingers mentally glued together - this forces you to stay in the middle, right on top of the diamond. As you push into the diamond and then lift the tongue up, the top half of the diamond will ideally come away from the bottom half of the diamond. It is attention to separating the fold across the diamond that results in a successful post-operative stretching regimen.

Peform the stretch twice a day for 5 seconds.

no gap betewen fingers, as far back as they can go, and then lift and hold.

SUCKING EXERCISES

It's important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. The following exercises are simple and can be done to improve suck quality. I would start these on the 3rd day following the procedure, and spend 30-45 seconds on each exercise prior to the wound stretches (no need to do these sucking exercises during your nighttime stretch).

1. Slowly rub the lower gumline from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.

2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.

3. Let your child suck your finger and apply gentle pressure to the palate. Once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.

4. With one index finger inside the baby's cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

STARTING SEVERAL DAYS AFTER THE PROCEDURE, THE WOUND(S) WILL LOOK WHITE AND/OR YELLOW AND WILL LOOK VERY SIMILAR TO PUS. 

This is a completely normal inflammatory response. Do not let your child's regular doctor, lactation consultant, friend who thinks they're an expert, or anyone else make the determination for you. If you think an infection exists, give our office a call.

Follow up

Most patients do not need any follow up with Dr. Trenholm.

However, it is essential that you follow up with your lactation consultant after the procedure as soon as possible to ensure optimal results.

If you have any questions, or if the baby has an unexplained fever or has pain that is not controllable, please contact our office or your primary care provider.