Tongue & Lip Tie may be a term you’re not familiar with at all, or maybe you’ve been having trouble with breastfeeding and your Lactation Consultant assesses your infant’s latch, witnesses their behavior while nursing and concludes your baby has a tongue or lip tie which is impacting their ability to feed.  Either way, what is the next step for you and your little one? We sat down with Dr. Johal, Holistic Dentist specializing in Infant and childhood dental and airway development and Taya Griffin, International Board Certified Lactation Consultant to chat about what to do next. 

1.What is a tongue or lip tie?

Dr. Johal –  A tongue tie is a condition in which an unusually short, thick or tight band of tissue tethers the bottom of the tongue to the floor of the mouth. This can constrain not only the tongue, but mouth, neck, and connected muscles as well. A lip tie is when there is tissue connecting the upper lip to the upper gum restricting the mouth’s mobility.   I usually say, it’s not the structure I’m concerned with, it’s the function. Sticking out the tongue for an infant tells us they can probably lick ice cream, but that will not help with nursing because the tongue needs to elevate up against the palate to properly express milk.

2.What are the symptoms of a tongue tie in nursing and bottle fed babies?

Taya Griffin, IBCLC –  The most common symptom that draws mothers to book a virtual, in home or clinic visit is painful nipples.  Mothers will feel significant discomfort and have damaged and misshapen nipples while nursing. Another symptom of oral ties is the inability of the baby to efficiently remove milk from the breast.  Babies may be labelled “lazy”, will have frequent feeds, long feeds and may not be taking in enough milk.  This can lead to lowered supply and the need for supplementation.  Breasts that are not well drained by the tongue-tied baby may experience blocked ducts, milk blebs and possibly mastitis.  Sometimes when the baby is feeding they cannot create a full seal at the breast meaning they will take in air and leak milk while they are drinking.  Babies may also make a tell-tale clicking sound at the breast and may have blisters on their upper and lower lips.   Babies who are bottle fed may also lose milk outside of their mouth and have a hard time drinking well from the bottle.  Additional symptoms include gas, reflux and unrestful sleep

3.How did you both get interested in tongue ties?

Dr.Johal –  Breastfeeding was a horrible experience for me. I tried for 6 months with my oldest and only lasted 3 months with my youngest. I knew something was wrong, but all the professionals told me there was nothing wrong — and was even told, “the babies are large and you’re tiny”. I was not enjoying my breastfeeding experience.  When I wasn’t breastfeeding, I was pumping.  As a dentist, I should have known more. I started learning about tongue ties a few years after having my children, and came home crying because I learnt that both of my children were tongue tied. From that moment, I knew I had to help other mothers struggling with breastfeeding.  I love my job and see patients of all ages at my clinic Family Dental Centre and Tongue & Lip Tie Centre, in Guelph. 

Taya Griffin, IBCLC – I studied at the Newman Breastfeeding Clinic (now International Breastfeeding Centre). A world class learning ground, I could not have had a better foundation in lactation education.  We witnessed many incredible results after the release of oral ties alongside solid breastfeeding support.    Subsequently, it turned out both of my little girls required a tongue tie release within the first 5 days of their life.  I have since participated in many more conferences and masterclasses around  tongue tie and oral rehabilitation. I now work at Kidcrew Lactation Clinic in Midtown Toronto where, every week, we assess for and release tongue ties in babies who are having trouble nursing.  I also see mothers virtually and at home.  I couldn’t love my job more!  

4. Will my primary health care provider assess for a tongue tie? 

Taya Griffin, IBCLC – Unfortunately, unless your health care practitioner (doctor, midwife, dentist) has had a personal experience with or taken a special interest in nursing and oral ties then they may know very little about how to assess for and address tongue ties.  There is very little education on oral ties in the traditional medical stream.  A level of skepticism exists until they begin to see the results of how a release can help the breastfeeding dyad.  

Dr. Johal – As a dentist, we were taught very limited knowledge about tongue ties and the long-term effects. There is more research emerging in support of the benefits of getting a tongue tie released in infants. Interestingly, in Brazil it is standard practice that tongue ties are screened for in newborns before leaving the hospital, and they have seen a substantial decrease in nursing issues. I am hoping this becomes standard practice everywhere! If you feel that your baby is tongue tied, advocate for them to be assessed by your health care practitioner or find someone who is educated on the topic to do an assessment. 

5. Do I need to get my baby’s tongue tie released?  If I do, where do I go?  

Taya Griffin, IBCLC – Parents need never release a tongue tie if they do not feel comfortable with the procedure. The key is to look at infant feeding goals, work with a skilled professional and to go with one’s gut.   If the decision is to release the tongue, the key is to work with a pediatrician or dentist that is highly experienced in the procedure.  The tool that is used, scissors or laser, really does not matter.  Rather it is the skill and experience of the provider.  In the case of breastfeeding challenges, it is vitally important that an IBCLC be present for the release for immediate breastfeeding support. Alternatively, connecting with an IBCLC as soon as possible is crucial. 

Dr. Johal – If a tongue tie is present, it should be addressed. I release tongue ties in older children and adults.  I see the long-term effects of tongue tie such as poor posture, speech impairment, small airway, sleep disordered breathing  facial development and malocclusion.  When looking for a professional to release a tongue tie, it is important to find someone professionally trained and who has experience with the procedure. In  my office, I use a Co2 laser with no needles, and no bleeding.   In addition, the procedure involves a thorough assessment to ensure that there are no other underlying issues. Most of my infant patients do not need pain medication after the procedure and heal very quickly.

6. Are there any guarantees that a tongue tie will solve all issues?

Taya Griffin, IBCLC – Just releasing a tongue tie for nursing issues without consulting a lactation consultant is not recommended.  Working on latching, feeding management and other nursing challenges will mean better results post tongue tie release.   It is also important to remember that when a baby has an oral tie they are generally tight in other areas of their body.  Despite a tongue tie release they may continue to hold onto their tightness and dysfunction.  Best practices would be to have baby see a bodywork practitioner such as an osteopath, pediatric chiropractor or cranial sacral therapist.  Ideally this would happen both before and after the tongue tie release.  Adding tummy time and rhythmic movement is important. Avoiding swaddling babies also gives them ample opportunity to move their body which is very important.   

Dr. Johal – I completely agree with Taya! A collaborative approach is the best for the baby and mom.  Some babies will need to see a body work practitioner in addition to a lactation consultant.  While not  all results are immediate, some mom’s will feel and see the difference when they feed immediately after the release!  Along with all the other benefits, a tongue tie release can affect the shape of the baby’s head. We have gotten some amazing results working with physical therapists, osteopaths, chiropractors, and cranial sacral therapists to help with baby’s head shapes. The bodywork will help loosen tightness all over the body from head to toe, especially in our torticollis babies, where the baby tilts their head more to one side. 

Taya Griffin, IBCLC – In conclusion,  if you find that things are not going well with your nursing experience it is important to seek out help.   If you do not feel that you are getting the answers you need and you are still in pain, your baby is still not getting enough at the breast then seek out additional help. Achieving your infant feeding goal IS possible.    Both Dr.Johal and I are available to answer any questions or concerns you may have. You can book virtual consultations via Well.ca from the comfort of your own home.  Happy Nursing!

Taya Griffin is an International Board Certified Lactation Consultant, practicing in the Toronto area. Looking for support on your Breastfeeding journey? Virtually connect with Taya through Well.ca Services!

Dr. Mandeep Johal is a Holistic Dentist.  She practices at her clinic Family Dental Centre and Tongue & Lip Tie Centre, and can virtually connect with you through Well.ca Services. Try a discovery call today!