Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More

By Richard Baxter DMD MS et al
Tongue tie, also known as ankyloglossia as well as tethered oral tissue (TOT), is a condition in which a string of tissue under the tongue is so thick that it restricts normal tongue movement. This restriction can cause problems with breastfeeding, eating and speaking in babies and children but, if untreated, can also lead to sleep apnea, neck pain, shoulder pain, migraines and/or problems with speech, picky eating and swallowing in teenagers and adults. This book covers not only traditional tongue ties but also lip ties and buccal ties. It is geared towards both parents and practitioners. In addition, it is extremely comprehensive in that it discusses tongue ties from multiple perspectives: pediatric dentists, lactation consultants, speech and language pathologists, feeding specialists, myofunctional therapists, chiropractors and neurodevelopment bodywork practitioners. The book provides information on the latest research and even discusses the link between the MTHFR genetic defect and tongue ties. This is the one book you will need to become more knowledgeable on this little-understood defect that can have far-ranging impacts on both health and quality of life.

The book states that 4-10% of people have a tongue tie but estimates that this percentage may actually be higher due to mis- or non-diagnosis. While the book is not a substitute for professional training or diagnosis, it is an excellent starting point for practitioners wanting to learn more about how and why to diagnose and for parents wishing to know if a tongue tie could be causative in their child’s breastfeeding problem, picky eating, acid reflux, speech issues, ADHD and/or Obstructive Sleep Apnea.

Although there is an abundance of photographic examples in the book to help prove a point, please be aware that pictures alone are not enough to diagnose a tongue tie. A physical exam must be performed to assess function or lack of function.

Common Health and Development Issues Associated with Tongue Ties

For each of the following issues, the book provides commentary backed up by peer-reviewed medical research as well as photos that illustrate a point in some cases. It will likely be eye opening to the reader to learn that such a broad range of short-term and long-term health and quality-of-life issues might be nipped in the bud by releasing a tongue tie. Be aware that most doctors and dentists are not taught about this in their medical schools, so if you are a parent looking for help, you might be dismissed or told to “watch and wait”. Instead, if problems persist, consider seeking a second opinion from a tongue-tie-knowledgeable practitioner.

Breastfeeding Problems

The pendulum swing towards more natural health interventions in the last few decades has caused breastfeeding to become more popular. With this trend comes a slew of new mothers who’ve discovered that their newborn baby has problems with breastfeeding. Often these babies are labeled as “lazy nursers”, but the truth is that they may have a tongue tie that that prevents them from latching on well. Frustrated mothers may give up on nursing because of the pain associated with feeding such babies, and the problem is compounded by the fact that many children’s health providers such as pediatricians may not know enough about tongue ties to say that these tethered oral tissues could be the primary problem.

A tongue tie is a common culprit of breastfeeding problems, and this is the developmental stage where it is most likely to be suspected and diagnosed. Common signs of a suspected tongue tie in babies can be:

  • Painful nursing for mother
  • Poor breast drainage for mother
  • Poor milk supply for mother
  • Mastitis for mother
  • Poor latch for baby
  • Poor seal for baby
  • Losing milk out of the corner of the mouth for baby
  • Gagging while feeding for baby
  • Lazy nursing for baby
  • Falling asleep while nursing for baby
  • Clicking or smacking noises for baby when feeding
  • Excessive spitting up for baby
  • Mouth breathing for baby
  • Stuffy nose for baby
  • Poor weight gain for baby
  • High-arched palate in baby

An evaluation by an International Board Certified Lactation Consultant (IBCLC) is an important first step, although these providers aren’t allowed to officially diagnose.

Because breastfeeding is a foundational oral skill, a baby who has breastfeeding problems is more likely to develop other problems down the road such as picky eating, speech and language issues, and facial/airway development problems such as Obstructive Sleep Apnea, so it is important to take the issue seriously and not to dismiss it.

Acid Reflux

What may be surprising to many is that a tongue tie can often cause acid reflux in nursing babies. If a tongue tie is present, a baby cannot properly latch and seal when nursing and thus takes in air while nursing. This extra air can induce what is called aerophagia-induced reflux. A medical research study of this issue of 1,000 infants showed that 52.6% had improvement in reflux symptoms so much so that they no longer needed acid-reflux medication after their tongue ties were released. In addition, another 19.1% improved but still needed medication.

Given that stomach acid is vital to health because it kills pathogens, deconstructs proteins into amino acids and cleaves vitamin B12 from food, a simple tongue-tie release can have far-reaching impacts on a baby’s immunological and neurological development. Babies who struggle with reflux, spitting up, gagging, colic or choking while nursing should be checked for a tongue tie by a qualified practitioner.

Picky Eating

It’s normal and common for babies and toddlers to avoid new foods and have just a few favorites. If these preferences extend beyond the toddler years, there may be other factors at play for your child’s picky eating, such as a tongue tie; sensory processing issues that cause hypersensitivity to tastes, smells, appearances or textures; hypotonia (low muscle tone) and/or nutritional deficiencies such as zinc. It’s not uncommmon for all of these issues to be at play, especially for a child with a neurodevelopmental disorder such as autism or ADHD.

A tied tongue makes it difficult for chewing, moving food around the mouth and swallowing. If your child consistently has any of the following issues when eating solid foods, consider a tongue-tie evaluation:

  • Gagging
  • Choking
  • “Chipmunk cheeks” (stuffing food into cheek pockets)
  • Slow eating
  • Taking a long time to eat
  • Difficulty eating tougher-to-chew foods such as meat
  • Preference for soft foods, “white” foods, processed foods and/or dissolvable foods
  • Poor weight gain

Research is beginning to show that a tongue-tie release in conjunction with appropriate therapies mentioned below may resolve some or all of these issues.

Speech and Language Problems

It stands to reason that if a tongue tie can hamper proper function for eating, the same can be said about speech and language problems, as the tongue is crucial for the fine-motor skill of speech. Although most speech and language pathologists (SLP) are not educated about the effects of tongue ties on speech, there are a few peer-reviewed research articles dating back to 2002 about the subject, which the book reviews. A study by Walls et al in 2014 showed that children who had their tongue ties released at birth had better speech outcomes three years later than those who didn’t.

Facial/Airway Development Problems

Restricted movement of the tongue can lead to improper growth and development of the dental arches and facial/airway development. A tongue tie usually means that the tongue is not stimlating the upper palate to grow and broaden, which can lead to narrower sinus and airway passages as well as a narrower jaw with more crowded teeth. This may not sound like a big deal, but it is. Narrower sinus and airway passages could lead to more risk of sinus infections, less oxygen to the brain (many children with ADHD have tongue ties and narrow airway passages) and Obstructive Sleep Apnea.

Tongue Ties and MTHFR

The effects of the MTHFR genetic mutation on midline issues such as cleft palate are becoming more well known as practitioners become more knowledgeable about the epigenetic effects of environmental and lifestyle issues on our health. In the case of MTHFR, synthetic folic acid supplementation (shown as “folic acid” on a food or supplement label) can have negative health consequences to a person with this mutation as they are not able to methylate, and thus detoxify, properly. If you or child has such a defect, be sure to work with a functional, holisitics or integrative practitioner that can help you replace these synthetic versions with methylated forms of vitamins B6, B9 and B12, as well as other supplements that allow for better methylation.

Although tongue tie is a midline issue, there is very little research on the effect of MTHFR on tongue tie except for this one study that showed a positive association between a mother’s folic acid consumption before conception and her baby’s likelihood of having a tongue tie. Thankfully, the book addresses this topic and reminds us that just because a person has an MTHFR genetic mutation doesn’t mean that they will absolutely have a tongue tie. Diet, environment and lifestyle choices matter in the potential expression of these mutations.

Treatment of Tongue Ties

The book makes a solid case that a tongue-tie release should not be the end of the story. Instead, it advocates for a whole-body approach and team of professionals such as a:

  • Pediatric dentist who is knowledgeable about tongue ties (many aren’t)
  • Lactation consultant if child is still nursing
  • Myofascial/myofunctional practitioner
  • Chiropractor
  • Bodywork practitioner such as a craniosacral therapist and/or reflex integration therapist
  • Speech and language pathologist if indicated
  • Feeding specialist if indicated

Conclusion

All in all, this is the one book you’ll need to learn more about diagnosing and treating tongue ties and other types of tethered oral tissues whether you are a parent or a practitioner. It is written from the different perspectives of the many types of practitioners that are involved in treating a tongue tie from a whole-body perspective. The book contains numerous photos to illustrate certain points, and the multiple chapters discussing up-to-date medical literature are outstanding. In addition, there are lists of resources and research articles at the end of the book. The only drawback to the book is that it doesn’t have an index, which can be so helpful for someone wanting to do a quick subject lookup.

About the Authors

Richard Baxter DMD MS is a board-certified pediatric dentist and board-certified laser surgeon who is the founder and owner of Shelby Pediatric Dentistry and Alabama Tongue-Tie Center, where he uses the CO2 laser to release oral restrictions that are causing nursing, speech, dental, sleep and feeding issues. He had a tongue-tie himself, and his twin girls were treated for tongue and lip-tie at birth, so for him, this field is a personal one. Dr. Baxter also participates in many overseas dental mission trips and is currently working on several projects related to tongue-ties involving research and education.

Megan Musso MA CCC-SLP is a certified and licensed Speech-Language Pathologist and the founder and owner of Magnolia Pediatric Therapy in Lake Charles, Louisiana. She graduated with her bachelor’s and master’s degrees from Louisiana State University and has since pursued her passion for pediatric feeding and early intervention. Megan’s experiences working with the pediatric population include treating feeding disorders in infants and children with tethered oral tissues, medically fragile infants, adolescents with special needs, and normally developing children with oral aversion or picky eating.

Lauren Hughes MS CCC-SLP is a certified Speech-Language Pathologist and owner of Expressions Pediatric Therapy in Birmingham, AL. She received her master’s degree from the University of Southern Mississippi and has pursued training to further her understanding of feeding, oral motor, speech, and language disorders to provide the best quality services for her clients.

Lisa Lahey RN IBCLC OMT has worked for 22 years in maternal child health as a nurse and lactation consultant in labor and delivery, postpartum, newborn nursery, NICU, and perinatal education. An IBCLC for 19 years, Lisa has a special interest and expertise in tongue ties. Lisa’s private practice; Advanced Breastfeeding Care provides home visits or office consults for complex feeding issues as well as joyful breastfeeding. Lisa also provides myofunctional therapy to babies, children, and adults in an orthodontic office. Lisa’s strengths are her assessment skills, teaching oral exercises, offering complementary therapies with compassion, and taking clinical photos that she uses to teach parents and professionals when teaching classes. Lisa is involved with many professional groups, a board member of IATP, and volunteers time to admin a tie support group.

Paula Fabbie RDH BS COM is a board-certified orofacial myologist who consults, letctures, and writes articles on orofacial myofunctional disorders (OMDs) and how they impact overall health and sleep. She offers a unique perspective on time-proven oral rest posture principles combined with evidence-based science to assist her patients in achieving myofunctional goals and functional breathing.

Marty Lovvorn DC is the lead Gonstead doctor and founder of Precision Chiropractic of Alabama. He is passionate about serving others and helping them achieve improved health through specific chiropractic care. With extensive studies in bio-mechanics, exercise science, health research, pregnancy and pediatric development, this allows him to serve a vast population ranging from newborn infants to elderly. Dr. Marty is a graduate of Auburn University (B.S.) and Life University (D.C), and he is dedicated to specializing in the world renowned Gonstead Technique through advanced trainings and certification. He serves as an adjunct faculty advisor through several chiropractic colleges, mentoring future chiropractors and traveling nationwide to speak at chiropractic conferences. Dr Marty was recognized as the Greater Shelby County Chamber healthcare professional of the year in 2017. 

Michelle Emanuel OTR/L NBCR CST CIMI RYT200 has 25 years experience as a neonatal/pediatric occupational therapist, national board-certified reflexologist, certified craniosacral therapist, certified infant massage instructor, and a registered yoga teacher specializing in the precrawling infant. For 17 years, she worked at Cincinnati Children’s Hospital Medical Center, in both inpatient/NICU and outpatient/development realms. During this time, Michelle developed the TummyTime! Method (TTM) to help parents and babies overcome challenges and love tummy time. Michelle also developed BabyMyo, a novel curriculum of oral habilitation involving optimal strength, endurance, range of motion, sensory processing, motor patterns, reflexes, oral and pharyngeal phases of breastfeeding and bottlefeeding for the newborn to precrawling baby. She also educates, certifies, and mentors professionals to become certified in TTM. For the past few years, Michelle has beein in full-time private practice, evaluating and treating babies with cranial nerve dysfunction, tethered oral tissues and precrawling baby oral motor/developmental concerns. She is on the teaching staff of the Academy of Orofacial Myofunctional Therapy. You can find out more about her at www.tummytimemethod.com

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