Tongue-tie and lip-tie issues affect up to one in three babies and are often genetic. Stemming from connected tissue that limits the mobility of the tongue or lip, ties can impact an infant’s latch during bottle or breastfeeding and can also affect speech and even sleep patterns later in life, says Cara Riek, co-founder of Arizona Breastfeeding Medicine and Wellness in Scottsdale.
Riek is an international board-certified lactation consultant who holds a doctor of nursing practice degree — the highest degree a nurse can earn — from Arizona State University. She became passionate about helping mothers after her own difficulties with breastfeeding, and now works to educate healthcare providers about breastfeeding issues. She also performs laser procedures to correct lip- and tongue-ties in infants, children and adults.
How common is tongue-tie and/or lip-tie in infants?
A 2018 research study published in “Speech, Language, Hearing Sciences Education Journal” cites the incidence of tongue-tie as high as 32.5 percent in infants. As a professional, I feel like this is a fairly accurate assessment that one-third of babies are born with a tie that ultimately needs correction.
Is it always a genetic condition?
I do believe that there is a huge genetic component to ties. I also think there are epigenetic/environmental circumstances that contribute to ties. We do know that the tie is formed in the first six weeks of gestation. Certainly more research is needed in this area as many providers agree that we are seeing more ties but are not entirely sure why.
Anytime a child has a lisp, is it the result of a tongue- or lip-tie issue?
Often, in the case of a lisp, a tongue-tie is a big part of the issue. The tongue is not sitting and moving correctly in the mouth because compensations have been made to allow for intelligible speech. Again, it is important to have an assessment by a skilled provider to rule out any other causes.
Are newborns routinely checked for tongue- and lip-ties upon delivery at a hospital or birth center?
Ties often are not checked for in the hospital. Many birth centers in our community do look for ties at birth. It is hard to assess the full functionality of a tongue within the first few days of life. Some ties are obvious and need correction right away. Other ties are not as obvious and are difficult to assess before milk comes in. It is very important that families have ties assessed by a skilled professional to fully assess tongue movement and make sure the issue is not related to other underlying issues (such as muscle tightness or torticollis).
Can tongue- and lip-ties be corrected immediately after birth?
If a tie is significant enough, it can be corrected at birth. Often, it is better to wait for the milk supply to come in and then seek help from a professional who specializes in tie release. Our office is really good about getting babies in ASAP who have noted ties, as we want to establish breastfeeding with minimal complications for mom or baby.
Is there an optimal age to have this procedure done?
Research tells us that correcting ties in the first 10 days of life leads to breastfeeding (and bottle feeding) success. The sooner we can identify a true tie and correct it, with proper support for bodywork and feeding, we get the best results. The longer we wait, the more compensations form, potentially resulting in a longer time to see improvement.
Are there any down sides to having this procedure done?
I tell all my patients that this is a medical procedure. All medical procedures come with potential risks, though we rarely experience them. Tongue- and lip-tie procedures require exercises and stretches afterwards (and sometimes before) to insure proper healing. The exercises can be difficult and do cause babies to be in discomfort over the first few weeks.
Most people think of tongue- and lip-tie causing problems with breastfeeding, but there are lots of issues it can create for babies and kids — and even adults?
Ties cause issues across the lifespan. For infants, we can see issues with both breast and bottle feeding. As a baby gets older, we can see issues with starting solid food, such as gagging and food aversions. In toddlers and young children, undiagnosed/untreated ties can result in speech issues, pediatric sleep apnea and bed wetting (for potty-trained children). Older children and adults can experience TMJ issues [jaw pain], sleep apnea, headaches, neck aches and sometime GI [gastrointestinal] issues.
One mom told us that because her child was not experiencing serious breastfeeding problems, her pediatrician saw the procedure as unnecessary. What should parents consider before ruling it out?
The first doctrine of medicine is “First do no harm.” When we are assessing for ties, it is important to look at the entire picture. Often we find that while a baby may be gaining weight well with breastfeeding, there are other underlying issues, such as reflux, colic and possible feeding discomfort for mom. If breastfeeding is truly going well, and there are no issues for mom and baby, then waiting to do a procedure may be the best choice. I advocate that parents seek help from a provider that specializes in diagnosing and treating ties to come up with an appropriate care plan that works for mom and baby. This may mean treating the tie, or this may mean taking a wait-and-see approach.
What kind of follow-up care is needed after the procedure?
When treating ties, I advocate for a team approach: family, release provider, international board-certified lactation consultant (IBCLC) (or speech language pathologist/oral myofunctional therapist if treating a child or adult), and body worker (chiropractor, craniosacral therapist and/or physical therapist). Families must commit to doing the exercises, IBCLCs help with feeding and positioning, and a bodyworker helps with making sure the bones and muscles are properly aligned and free of tension to allow for normal biological movement. Six weeks of exercises help strengthen and tone the tongue to allow for proper healing of the procedure.
A Mom’s perspective
Kate Reed, a marketing consultant for Raising Arizona Kids, had her son’s tongue-tie corrected via a laser procedure at Arizona Breastfeeding Medicine and Wellness Center this spring. Reed agonized over the decision to have the procedure and wanted to talk about the process to help other moms. Here’s what Reed shared:
How did you know your son Grayson had a tongue-tie?
We found out about an hour after his birth, during his newborn check at the birth center. The midwife noted “severe lip- and tongue-tie.” So, I was well aware before we saw problems. We noticed his issues within the first week, but by 5 months, when he already had two teeth, we knew we needed to have it corrected. I was concerned about tooth and palate development and speech issues — limited tongue movement means he could have a lisp or struggle with speech.
Most babies with lip- or tongue-ties have low weight gain due to latching issues, or moms have severe pain while nursing. This wasn’t the case for us. Grayson is an efficient eater, so he gained weight fine. However, he wouldn’t take a pacifier, struggled with a bottle and had issues with reflux and gas because he was getting too much air from a poor latch while feeding. He also seemed frustrated while nursing. His upper lip was always tucked under, and he got frequent lip blisters.
What made you decide to have the procedure done?
Reading about future issues he might have — teeth development, speech issues, even sleep apnea, neck/shoulder tension and potential focus issues in older kids — convinced me to have it done. One local specialist recommended delaying it because Grayson had no weight-gain issues, he is generally well-adapted and I was not experiencing breast pain. Our pediatrician saw surgery as the last option. I asked every mom I could about their experience, and they all said, “Get it done!” I know a lot of moms stop nursing because they assume their body and their baby aren’t “compatible,” when they might have a similar issue — which is so sad if they really wanted to breastfeed.
A tongue-and/or lip-tie is corrected by cutting the tissue. What are the different ways you can get this done?
The best way to have it done is via laser. Our doctor used a CO2 laser, although there is a water laser as well. They started with a shot to numb him, then the laser was maybe 45 seconds, then they took pictures and handed him back to me.
In researching this, you found out pediatricians, breastfeeding specialists and even dentists can do this procedure?
There are pediatrician offices, breastfeeding centers and pediatric dentists that specialize in lip- and tongue-ties.
What was it like having the procedure done?
It’s always terrible to see your baby in pain, and all I wanted to do was hold him. The procedure was short, though, and they handed him back to me the second they were done. He wanted to nurse immediately!
You mentioned you have to “stretch the wounds” so they don’t fuse back?
This is one of the reasons I wish we had done it earlier. At 6 months old, he can fight me (and bite)! I have to lay my legs on his arms and squeeze my thighs to hold his head still. There are a few different stretches you have to do every four to six hours (we space four hours during the day, six hours at night if he’s sleeping). You have to do these stretches for four to six weeks to prevent reattaching.
What advice would you give other parents?
Use your gut and do your research. Deep down, I knew we needed to have the procedure done. I talked about it over and over again for six months — always talking myself out of it because (some) medical professionals saw it as a last option. Cara Reik (who did the procedure) made me realize even the most mild of symptoms were still not normal. Grayson compensated and made nursing work for him, but it wasn’t correct. Now, because we allowed it to go on for this long, he has a high palate we need to correct.
In researching this for Grayson, you noticed your older son Jackson, 6, has a lip-tie. Are you considering the procedure at his age?
Some of Jackson’s issues — snoring, congestion, high energy due to lack of quality sleep, wouldn’t take bottles or pacifiers as a baby, constant headaches, lisp/speech issues — are likely related to this. We are considering having this procedure done with him as well, but there are two to four weeks of prep work, and then chiropractic care after the procedure because of the tension release. While I dread the stretching with him, I wonder if it will benefit him as he grows up.
Is the procedure expensive, and are there follow-ups?
Ours cost $300. Other places quoted $500 and up. Insurance often covers this, so parents should check their plans. We have one follow-up to make sure it’s not reattaching, otherwise I think you would only have further appointments for chiropractic care (they recommend at least once after the procedure for babies) or lactation appointments. If you had difficulty nursing, you’d need to teach baby how to nurse correctly.