Tongue Ties: A Speech Pathologist's Perspective
There are many reasons that newborns have difficulty with feeding in the first several weeks and months of life. Feeding is a complicated process that involves 26 muscles and 6 cranial nerves. Infants begin sucking between the 18-24th weeks in utero and swallowing is observed consistently by 22-24 weeks. What does this mean? Their feeding pattern is developed and engrained months before they are born.
Common issues we have observed in the newborn population include overall disorganization (having difficulty regulating states such as alert, calm, drowsy) which impacts feeding, oral motor incoordination (difficulty coordinating use of the lips, tongue, and cheeks to suck and swallow), disorganized suck-swallow-breathe pattern with frequent coughing/sputtering, and true issues with tongue mobility resulting in difficulty with the breast or bottle.
As speech pathologists/certified lactation counselors, it is less common that we see mobility issues and more often see progress with more traditional intervention approaches such as supporting state regulation and organization, suck training, modifying feeding products and schedules, positioning, providing external pacing and cheek/jaw support, and involvement of a physical therapist, chiropractor or craniosacral therapist to ensure that all muscles of the neck and jaw are symmetrical.
We are also fortunate that we have also seen several children before or immediately after their tongue tie release and have been able to educate the parents that they should NOT expect immediate and lasting improvement from the procedure alone. As previously mentioned, a fetus begins sucking as early as 18 weeks into the pregnancy. Even if the tongue tie is released during the first week of life, there is still a need for intervention to re-teach the sucking pattern in the correct way. That does occur for some infants with little support; others, it can be a longer and especially frustrating process if parents went into the procedure with the expectation that results would be instantaneous. From our experience, mothers typically see improvement in the first few feedings at the breast after the procedure and then regression is observed if no other strategies are not in place to support the new sucking pattern. The infant returns to their “old ways” of feeding and need support and time to acquire the new motor skills we are expecting.
Another important thing to remember if you do have an infant who undergoes a lip or tongue tie release and massage to the site is recommended; be cautious and make sure to provide other enjoyable experiences throughout the day such as facial massage or pleasant stimulation to the gums and lips. Infants are quick to anticipate the pain that comes with these stretches and can develop oral aversions, especially if they undergo 2-3 procedures. It is really important to work with a provider to help improve the child’s sucking patterns because that in itself can be therapy and help to stretch the frenulum to keep if from reattaching.
Tongue tie is a hot topic and we do believe that some infants benefit from release of a tight frenulum that is functionally impacting sucking skills with the breast or bottle, however there are also several other issues to rule out prior to deciding on this course of treatment.
