Table of Contents for all blog posts
It takes a village to help a baby with ties
TL/DR
Get this easy to read but also very thorough book (Fit to Be Tied - a Visual Reference for Parents)
Join the NY and NJ tongue tie Facebook group
Follow Bobby Ghaheri on Instagram
Follow Tongue Tied Experts on Instagram or YouTube
Skip my overview (next) to get to the other resources below (articles, podcasts, videos, books, etc)
Overview
As information about ties becomes more well-known, there are many families asking if their baby has ties. Ties are tight connective tissues (called a frenulum, or frenum) in the mouth - they can be under the tongue (tongue tie), lips (lip ties), or cheeks (buccal ties). Ties cause oral tension, and make it difficult for a baby to feed effectively (and can also cause other issues later in life). I often think of feeding difficulties as an “early warning system”. If a baby can not use their oral motions properly to nurse or bottle feed (and this is so much more than just being able to physically get the liquid down and gain weight - more on that below) - then the chance that other issues may occur later in life is higher.
The first step in “unwinding” this process is a full functional evaluation (note - this post is not a substitute for that evaluation!). An IBCLC (International Board Certified Lactation Consultant) or SLP (Speech Language Pathologist) with extensive oral/body tension training are excellent practitioners to work with for this evaluation - which is a thorough assessment of:
Baby’s latch to breast and/or bottle
How the baby processes suckling-swallowing (breast or bottle)
Baby’s oral and body range of motion, muscle tone, symmetry
How this affects your experience - pain, milk intake, challenges with milk supply, how often to pump and bottle feed (and balancing it all!), baby’s comfort during and after feedings, and much more!
Many people join local Tongue Tie Facebook groups (see below for some) - and these can be great places to get support and to find suggestions for IBCLCs, SLPs, PTs, (etc) in your area. Keep in mind, though, that many people will share pictures of their baby’s mouths on these groups. This can be helpful but it’s so important to know that a tie, or any kind of oral tension/dysfunction, can not be properly evaluated through a picture or video! Only a thorough functional evaluation can truly determine the source of your issues.
As part of the info on this page, I’ve written a lot more about the most up-to-date approach for unraveling the topic of ties and oral/body tension. If you have a few minutes - bear with me and continue reading. If you’d like to skip the next section and go to resources (articles, videos, books, etc) click this link and it will take you to the bottom of this post where I’ve listed them.
Does my baby have Ties?
A baby with ties (or oral/body tension) may have a variety of symptoms. And, parents are often working overtime to keep the baby satisfied and growing, to ease the baby’s tummy upsets, maintain their milk supply, and deal with many other issues.
Symptoms of ties may include any of the following:
a painful/tight latch
or the opposite - a latch that feels too light (breast or bottle is always falling out out of babies mouth, or milk is leaking/spilling))
breast/nipple damage
frequent plugged ducts/mastitis
endless nursing sessions that don’t satisfy the baby
fatigue or constantly falling asleep at the while feeding (breast or bottle)
clicking, gulping, sputtering or choking (breast or bottle)
reflux-like symptoms (from air intake)
baby cannot hold a pacifier
baby refuses bottles
tense/asymmetric body or head positions
asymmetric head shape, or cranial molding from birth that never resolves
snoring/airway issues/open mouth breathing
lip blisters
general fussiness, trouble sleeping
and so much more!
(Of course many of these issues occur for reasons other than ties and oral/body tension/asymmetry, but this is a list of very common ones that we see)
Sometimes babies are gaining and taking in milk - but sometimes they may still have oral dysfunction. For example some babies get milk easily from their parent’s fast flow or a fast-flowing bottle nipple. In this case it seems like all is well, but then if milk supply starts to decline (which often occurs if baby’s latch is less-effective), then latch/feeding issues become more obvious - because now the baby has to work harder for the milk. And, the same can occur with bottle feeding - the baby may start to get fussier and fussier, and/or start to reject bottles.
Some babies have a good latch for a few minutes but then start to narrow, chomp, fall asleep (breast or bottle), etc. Ties and oral tension can be like doing exercise with a resistance band - you can start off easily, but then get tired from the resistance. Sometimes babies will start to use the wrong muscles to make up for this fatigue and compensate with their lips, cheeks, jaws (etc) - this can cause latch pain, air intake (breast or bottle), lip blisters, fussiness, and so many other issues.
In the early weeks/months, all babies need to “unwind” or “de-uterize” after pregnancy and birth (the uterus is a tight place and birth is a bumpy ride!). That means that sometimes oral tension is not from ties but from tight/asymmetric muscles or connective tissues, post-birth head molding, oral motion dysfunction, immature nervous system, and much more. Because of this, the topic of oral tension is very complex!
So when a baby has oral/body tension, I think of it as a “which came first, the chicken or the egg” scenario - are tight muscles (anywhere near the mouth, face, or neck) causing the muscles under and around the tongue, lips and cheeks to appear/feel tight or asymmetric and the head/body posture/shape to lean more one way? Or, are tight connective tissues (ties) under the tongue, lip or cheeks pulling on muscles in the face, neck/shoulders, head, and rest of the body? Either scenario makes it harder for a baby to feed effectively and because the whole body is connected, we want to tease out if it might be one/both (ties vs tight muscles), or a baby needing some time, practice, and “unwinding”. This is where bodywork and oral exercises come in (click those links to see much more info that I’ve written on both of these topics, and also see more on this next)
What if I suspect my baby has ties or tight oral/body tissues?
When frenulum are truly tight and causing functional issues - that is the definition of a tie. But because other bodily forces can cause trouble on their own, or even make a tie worse - my first recommendations is usually time, practice with feeding skills (breast or bottle), oral exercises and bodywork (exercises and massage to help loosen up tight/asymmetric muscles). There are many ideas you can do home, and there are many professionals that can help - many in NJ and PA are listed here - and then we re-check how things are progressing.
If muscular/body tension, asymmetry or nervous system function are the root problem, then bodywork and oral exercises should improve feeding/oral function. If there are ties along with the muscular tension, then relieving the muscular tension first and aiding overall oral range of motion is still the preferred first choice - because bodywork will “pre-loosen” the baby - aiding in the diagnosis, tie-release procedure, and healing from the procedure. As well as aiding the baby re-learning to use their newly freed tongue after the procedure. For this reason it’s important to not rush to a tongue-tie release - most babies (and their parents!) need some preparation prior to a release - we call this “optimal timing of release” and it gives you time to prepare the baby physically, neurologically, and time to prep you (the person who needs to help the baby) for this process too!
An IBCLC highly trained in ties, and oral/body tension/asymmetry can not “officially” diagnose a tie (we are also not allowed to tell you that you have a broken leg even if a bone is sticking out!). But, a tie-savvy IBCLC has a lot of experience assessing oral function and helping you to determine the more likely cause of your feeding issues, and guide your next steps.
When it becomes clear that the baby needs an evaluation to rule in/out ties, and perhaps have the procedure to release them - for that I have a very specific list of doctors that I refer to - there are too many doctors dismiss ties, or call them “small”, or say that it’s fine because the baby is gaining (which ignores that they may have oral dysfunction). On the opposite end there are too many doctors who will release any frenulum (even ones that may not actually be ties). And, especially unfortunately - too many that do a poor procedure. The people on my list are very highly vetted from my and my collegues’ experiences. But, again it is crucial that you have a functional evaluation before jumping to any procedures. This page and my next blog post - Ties, Part II, discuss why.
But, before you go on to Part II - Here are resources to help you learn more about ties and oral/body tension.
I have broken the info into different categories - support groups, articles, videos, books, podcasts, Instagram pages. Don’t feel like you need to look at everything here! Think of this a a “library” - pick your learning style to start, and/or choose a few from each category. My top choices have *** next to them
*** Facebook Tongue Tie groups - very informative and supportive!
NY and NJ Tongue Tie Support Group. There are other area-specific groups on Facebook as well - if you are not from NY or NJ, search for your area.
Tongue Tie Support Group - a great group to connect with people all over the world, and as a starting place to help you find a specific group near you.
Articles and other writings about ties:
*** Very informative and short overview of ties by Dr. Chelsea Pinto DDS
*** Articles by Bobby Ghaheri (ties specialist in Portland, Oregon):
Types of Tongue Ties (anterior to posterior ties)
Why baby’s weight gain is not the only marker of successful feeding
Choosing your providers - does laser vs scissor matter? Quick answer is no! The skill of the provider matters the most. This article also has questions you can ask your provider to vet them.
Why parent’s symptoms are just as important as baby’s symptoms
Why the healthcare system often falls short on the topic of ties
Why compensations (lip curling, cheek suction, strong jaw motions and more) can be problematic (even if a baby is gaining weight).
And, there are many more articles by Bobby Ghaheri here, including up-to-date research studies and more.
*** How Bodywork and Ties interrelate - “Is Your Baby a Tether-Berg or a Tether-Floe” by Michale Chatham, RN, BSN, IBCLC, OMT makes a fantastic analogy - that the tension from a tie can be like an iceberg (90% under the surface) or like an ice floe (all on the surface). Bodywork helps relieve tension, and it’s wonderful for all babies - but for a “Tetherberg” baby, it’s essential
Article by Breastfeeding USA - great overview.
Research by Scott Siegel (Oral and Maxillofacial Physician/Ties specialist in NYC) demonstrating that reflux and ties are related.
Tongue-Ties and Sleep Issues - by Richard Baxter, discusses the relationship between ties and high palates, snoring, sleep apnea and more.
And, another article describing a correlation between ties and a high palate (this one is more focused on lip and buccal (cheek) ties), by Daniel Lopez, DO
As you do your research, you may see many unfamiliar phrases and acronyms. Robyn Merkel-Walsh, an SLP in Northern NJ, has created a very informative “cheat sheet” with explanations for phrases and other topics that you may encounter when researching the topic of ties.
Videos
Tongue Tie Experts YouTube Channel - amazing interviews with Bodyworkers, IBCLCs, Tie-release providers, SLPs and more! Here are a few specific ones from that channel with interview with NY and NJ based practitioners:
*** Scott Siegel (Oralmaxillo facial surgeon) interview about tie evaluation and procedure
*** Jackie Hines (Physical Therapist/Cranial Sacral Therapist) interview about bodywork
*** Michelle Ariante and Rebeca Four (IBCLCs) interview about lactation and how it all fits in with feeding, ties, bodywork, etc.
Lisa Paladino, RN, IBCLC who does the above interviews, also sells a very thorough course called the “Comprehensive Guide to Tongue Tie for Parents”, including 5 video modules, info download and more.
Very thorough video series by Richard Baxter (author of “Tongue Tied” book listed above - background on ties, videos of tie releases, caring after tie-release procedure (frenotomy) and more
The Broken Eating Mechanism - Part I, Part II - videos (part II is an interview with an SLP and ENT) discussing how tongue tie and other oral dysfunctions relate to speech, eating, sleep disorders, ADHD, anxiety, and more.
Airway and TMJ - how open mouth breathing can impact palate, tonsils, airway, jaw, teeth, posture, and more
Books
*** “Tongue Tied” - by Richard Baxter, DMD and a multi-disciplinary team (IBCLC, SLPs, Chiropractor, OT, Dietitian). This excellent book covers ties through all stages of life - babies through adults - breastfeeding, bottle feeding, eating solid foods, dental issues, speech, sleep issues, and so much more.
*** “Fit to Be Tied - a Visual Reference for Parents” - by Renee Beebe, MeD, IBCLC, Excellent and easy to read book with many pictures for visual referece.
“SOS 4 TOTs” - by Lawrence Kotlow, DDS - addresses how tongue/lip ties affect breastfeeding, speech, dental development and overall pediatric health.
The next books are for adults considering their own oral health and possible ties
“Jaws: The Story of a Hidden Epidemic” - by Sandra Kahn (orthodontist) and Paul R. Ehrlich (evolutionist) - addresses reasons behind why our jaws and other mouth structures have become more restricted/crowded over time.
“Breathe: The New Science of a Lost Art” by James Nestor - how oral health and much more matters for healthy breathing, and a healthy life.
“Gasp!: Airway Health - the Hidden Path to Wellness” by Michael Gelb and Howard Hinden - how sleep-disordered breathing relates to poorly structured oral health and functional airways.
“Six-Foot Tiger, Three-Foot Cage” - by Felix Liao, DDS - addresses how lifelong issues can arise from issues with mouth structures.
Podcasts - these are weblinks but of course you can also find these on any podcast app
*** The Untethered Podcast - by Hallie Burkin, MA, CCC-SLP, COM. Many informative episodes on all aspects of ties throughout life - including feeding, speech, airway, sleeping issues and more
The Breastfeeding Talk Podcast episode on ties
The Boob Group Podcast episode on ties
The Badass Breastfeeder Podcast - many episodes on ties
Babies in Common Podcast - several episodes on ties
Podcast from the American Academy of Otolaryngology with an interview with Bobby Ghaheri relating to his tongue-tie research studies
Instagram Pages
@drghaheri
@tonguetiebabies
@tonguetieexperts
@tummytimemethod
@teamtonguetie
@brooklynmyo
@lactationsolutionsofprinceton (that’s my page! I follow and repost many pages that relate to ties)
<—— At breast/chest supplementing ———-—— Ties, Part II ——-->