First of all, let's define tongue tie.
We all have a string of fascia, or connective tissue, under our tongues called a frenulum (and we actually have 7 frenula in the mouth, but in this post we will focus on the tongue). This fascia attaches on the underside of the tongue, and inserts into the floor of the mouth. When this tissue restricts the movement of the tongue, it is considered a tongue tie. The medical term is ankyloglosia. There are two types: anterior (at the tip and generally easier to diagnose) and posterior.
My pediatrician says baby can stick their tongue out, so therefore it's not a tongue tie. Is this true?
False. Babies may be able to stick out their tongue, while still not having the mobility to use it during functional tasks, like feeding. Babies require a functional assessment to be diagnosed. This is completed by a lactation consultant or feeding specialist (speech or occupational therapist). During a functional assessment, the provider will gather background information, observe a feeding, and assess baby's oral motor skills and whole body for indications.
Here are some tasks you can do at home to screen your baby:
The Murphy Maneuver (aka a finger sweep)
Run your pinky finger along the lower gum ridge all the way back. Once at the site where molars will erupt, slide your finger down under the tongue. Next, sweep it across the floor of the mouth from one side to the other.
What did you feel? Was it smooth and supple, or did you hit a speed bump? If you felt tension or had to "jump the fence" to get across the floor of the mouth, then a tongue tie may be contributing to feeding challenges.
Assess Tongue Appearance
Observe baby's mouth at rest. Is it open or closed? Does the tongue rest on the palate or low on the floor of the mouth? Does the tongue elevate when crying? Is it bowl or heart-shaped? We want the tongue to elevate, suctioned to the palate at rest, with lips together. Any bowl-shape or heart-shaped tongue indicates a restriction.
Symptoms that may indicate a tongue tie:
Shallow latch
Inability to maintain a latch
Painful breastfeeding
Misshapen or damaged nipples
Clicking while eating
Excessive gas or spit-up
Fussy or colicky
Choking/coughing
Milk leaking from mouth
Lip blisters
White coated tongue
Chomping on breast/bottle
Frequently feeding and never satisfied
Long feeding sessions
Falling asleep during breast/bottle feeding
Hates tummy time
Difficulty accepting a pacifier
Picky about bottles
My baby has all the things, now what?
Now it's time to find a provider who is knowledgeable in tongue ties and can help you achieve your feeding goals. The team includes a feeding specialist + bodywork professional + release provider. Your team could include the following providers:
Feeding Specialist:
Speech-Language Pathologist
Occupational Therapist
International Board Certified Lactation Consultant (IBCLC)
Bodywork Provider:
Osteopath
Chiropractor
Cranial Sacral Therapist
Physical Therapist
Occupational Therapist
Release Provider:
Dentist
ENT
Note that not all professionals named will be knowledgeable in tongue ties. It depends on the training of that individual. Be sure to check their website for credentials, search the internet for highly rated providers in your area, or ask for a referral. Providers who are educated in this space will have a team to refer to. It is best to start with a bodyworker or feeding specialist first.
Why wouldn't I just go straight to a release provider if I have already screened baby at home?
It is ideal to initiate feeding therapy first to begin something called "neuromusclular reeducation". This is not the same thing as stretches. It is oral and whole body exercises targeting tongue function. Rarely does a release alone resolve feeding issues, and a baseline also helps us understand other contributing factors to feeding challenges. Tongue ties also create tension in the head, neck, and even down into the pelvic floor. This can cause head turn preference or torticollis, digestive issues, colic, etc. These issues are resolved through bodywork. Having bodywork before a release improves the likelihood of a complete release, and decreases the risk of reattachment. It also resolves the listed complications caused by tension, and helps baby be in a more calm and regulated state.
Nourish Therapy is Spokane's feeding specialist. We started this practice specifically to fill a need we saw in the community. Carissa is a Speech-Language Pathologist, Certified Lactation Counselor, with extensive training in tongue ties, and hours of experience helping families with babies who struggle to feed. She collaborates with bodyworkers and release providers throughout the Spokane community to help families navigate the process. Not in Spokane? That's okay. We provide virtual consultation to help families worldwide navigate the process. If we can't help you, we can find someone local who can. Reach out today for a free phone consultation if you have questions or concerns .
Nourish Therapy (509) 508-0725
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