Let’s talk Tongue Ties

Let’s talk Tongue Ties

As well as seeing mums at the Best Start clinic, Eve also runs a weekly Oral Function Assessment Clinic at IKIDS paediatric Dental Surgery.

Dr Johnston is a Specialist Paediatric Dental Surgeon, and is the ONLY provider in WA who offers Laser frenotomy that works directly with an IBCLC, and primarily releases oral tethering to support the outcome of infant feeding. This is a fantastic partnership to ensure babies are having surgery for the RIGHT reason – to improve feeding.

Since the function of the tongue is paramount when assessing for tongue tie, a full assessment is vital to clearly identify structural AND functional issues that may restrict optimal mobility and movement of the tongue, therefore causing challenges with breast or bottle feeding.

Eve assesses hundreds of babies who come to see whether a frenotomy (tongue tie release) may be necessary. She performs a visual assessment, a physical suck assessment, takes a history about birth and feeding, and observes a feed. Only then can she provide unbiased, ethical advice; and provide you with all of the options, one of which may be frenotomy.

“Ties” are a hot topic and there is increased awareness surrounding the possible effects they have on breastfeeding. There are however so many other reasons babies do not function well when feeding and these have to be fully explored prior to identifying a tongue tie.



Tongue Tie

Tongue tie released

Here are some things to know about tongue ties

Tongue ties have been around for a long time!

They are not new, they are not a fad, and they definitely can cause feeding issues.

A lingual frenulum is not a tongue tie

A frenulum (the little membrane under the tongue) is a normal part of anatomy, and can be felt in most people’s mouths. Some people have long, stretchy ones, others have short, thick, inelastic ones! Some are anterior, others are posterior. Does this mean that every frenulum must be removed? The short answer is no.

A frenulum is only a frenulum until it is deemed to be compromising function!

Online forums are not the place to get a diagnosis

Nowadays mums have access to so much information online – forums, Facebook pages, Instagram, support groups…the list goes on!

Whilst these resources can be fantastic, there is also a lot of misinformation out there, and lots of people giving advice who are not specialists/professionals/experts in the area of interest.

Often these pages have their own agenda, have a limited ‘provider list,’ which is comprised of a select few professionals, chosen by the group admin.

They do not show transparency or give women informed choice, and often have misleading testimonials about how the procedure worked like magic! The procedure is not a “quick fix” and is not expected to work like magic.

It is also important to note that photographs are not a reliable source to diagnose a tongue tie as it’s not what the frenulum looks like, but what effect it has on tongue function.

A full functional assessment is required.

International Board Certified Lactation Consultants (IBCLCs) specialize, and have expert knowledge in infant feeding, but this is often still not enough. There is extra training that needs to be completed to gain a deep understanding of oral anatomy and structure, and the correct assessment tools used to screen for tongue tie.

IBCLCs are not able to offer a diagnosis, but rather support women who have feeding challenges by excluding all possible contributing factors. One of these may be a restricted frenulum. They can then provide you with options available to improve feeding.

Speech Therapists also have expertise in tongue function and for a baby who is formula feeding or an older child, they may be the appropriate health professional to liaise with for support.

Dentists are the practitioners who release tongue tie by laser frenotomy, however, their expertise is in dentistry and oral surgery, not infant feeding or suck function, therefore they are not the appropriate service to use when initially approaching feeding issues.

Paediatricians are divided in the tongue tie world! Many believe that a tongue tie does not affect the infant’s ability to breastfeed, others will make a diagnosis through a visual assessment, but certainly, most do not physically examine the inside of the mouth or watch a baby feed. This is a huge red flag!

Bodyworkers (chiropractors, osteopaths and physiotherapists) treat babies for a range of issues. They are able to assess for, and release tension the face, palate, jaw, neck and midline, which may contribute to poor suck function or tone, but they are not specialists in infant feeding, therefore are not the providers who should recommend frenotomy for feeding issues. However, they play an integral role in infant health and with a collaborative approach when working with babies who display tension, digestive issues, poor tone, and a disorganised suck, often bodywork can release enough tension to improve tongue function without surgical intervention.

Many babies that are affected by tongue-tie display these symptoms:

  • Fussy at the breast
  • Unsettled
  • Shallow latch
  • Pulls off frequently
  • Makes a clicking sound whilst feeding
  • Dribbles milk out of their mouth due to a poor seal
  • Coughs/splutter/choke at the breast
  • Hiccups often
  • Regurgitates milk frequently
  • Won’t hold a dummy in their mouth
  • Has a preference to turn their head to one side
  • Has facial asymmetry

Maternal symptoms:

  • Discomfort and misshaping of the nipples
  • Engorgement / blocked ducts / mastitis
  • Supply reducing over time

But … There are also many other reasons these symptoms can occur:

  • Position of baby in utero
  • Gestation of baby at birth
  • Type of birth
  • Birth trauma
  • Antibiotics in labour / after birth
  • Poor gut health
  • Colic symptoms
  • Reflux
  • Torticollis
  • Low oral/facial tone
  • Uneven palate
  • Congenital abnormalities
  • Micrognathia (recessed jaw)
  • Over supply
  • Breast issues – insufficient glandular tissue / breast reduction
  • Nipple size / shape

This is why it is so important to have a full feeding assessment by an IBCLC if your baby is displaying any of the “tongue tie” symptoms.

Many professionals classify ‘oral ties’ differently. The IBCLC’s at Best Start perform an oral function assessment, observe a feed and take a pregnancy, birth and feeding history to exclude other factors that may be contributing to feeding issues. We also use a diagnostic screening assessment tool for identifying functional issues.

We have done many hours of extra training and courses to keep ourselves up to date with education to provide the best support possible to help you and your baby enjoy breastfeeding.

We believe a collaborative approach to infant and maternal health promotes the best outcome for feeding challenges, and work closely with many other health providers in the community to ensure you are well supported.

You can book in directly with any of the team for an oral function assessment, or Eve Coote is at IKIDS Paediatric Dental Surgery on Thursday mornings. Please note if there are more complex feeding issues, we always recommend an initial assessment at the Best Start clinic with one of our IBCLC’s, as this is a more in-depth assessment over 1 ½ hours.

An oral function assessment is more suited to women who have already had IBCLC/CHN input and a “tongue tie” has been suspected or identified as the cause of the feeding issues.