In part 1, we looked at what a tongue tie is, how the tongue moves, signs of a tongue tie to look out for, how a tongue tie may impact function and development, and who to see for assessment and diagnosis of a tongue tie.
Now that we know more about the impacts of a tongue tie, we need to look at who can help you with managing a tongue tie and what options are available for conservative management and surgical intervention.
Management Options: Conservative and Surgical
Conservative Management
Conservative management often includes multiple healthcare practitioners, this collaborative approach will help build confidence in your decision-making around your baby’s health.
- Lactation Consultant- International Board Certified Lactation Consultant: These specialists can offer support and strategies to improve breastfeeding success, even with a mild tongue-tie. Techniques like positioning and latch assistance can make a big difference.
- Paediatric Chiropractor: Chiropractors, like our team at Australian Children’s Chiropractic Centre, take a holistic approach to oral function. We identify neurological and muscular imbalances orally, and throughout the body (especially in the head and neck) that could be co-contributors to oral dysfunction. Conservative management includes optimizing muscle and nerve function through the mouth, assessing cranial bone function and ensuring proper cranial development, and building muscle tone throughout the body.
- Speech Therapist: If speech development is delayed due to a tongue-tie, a speech therapist can provide exercises and strategies to improve sound production.
Surgical Management
- Frenotomy or Frenectomy: These are minor procedures performed by a pediatrician, dentist, or oral surgeon to release the tight oral tissue. They are usually quick and can be done with medical scissors or a laser. You may also hear this called a “tongue-tie release” or “tongue-tie revision”.
Prior to any surgical management, it is crucial to be under the care of an IBCLC to understand what support your baby needs when preparing for surgery. At ACCC, we work closely with IBCLC’s, dentists, and GP’s to assist in optimizing oral function, as well as making sure we have balance in nerves and muscles. Following a tongue-tie release procedure, aftercare is necessary for optimal healing and preventing reattachment. Your pediatrician or dentist will provide specific instructions, but generally, they may recommend:
- Gentle stretching: Using a clean finger, gently massage and stretch the area under the tongue or lip several times a day (every 4-6hrs) to prevent the frenulum from tightening again.
- Feeding: Offer frequent feeds to encourage sucking and maintain milk supply. Breastfeeding can usually resume right away, while bottle-fed babies may need a slower flow nipple initially.
- Monitoring: Keep an eye on your baby's feeding behaviour and weight gain. Follow-up appointments with your healthcare team will ensure proper healing and address any concerns.
What Does the Tongue Look Like After a Tongue-Tie is Release?
After frenotomy or frenectomy, you will typically see a small triangle or diamond-shaped white patch under your baby’s tongue or lip. This is where the tissue has been released or removed. The stretches mentioned above help keep the wound separated while healing, this stops the tissues from reattaching or healing together. After the procedure, full healing usually takes 2-3 weeks, however, this is dependent on the method used for release (scissors or laser), how much tethering was present, and your individual baby’s healing. Though the wound may take a couple of weeks to heal, there is often a change in tongue function quite quickly after the procedure.
Tongue-Tie Management in Older Children
As we discussed in Part 1, there are potential impacts from oral tethering that go beyond feeding. If a tongue-tie is missed while your child is under 1 year old, the management may look a little different. Paediatric chiropractors and speech therapists can still help with optimising oral function for your child, and there are options for silicone toys or teethers to help with jaw and palate development. Surgical intervention is still an option, though this option is only available once your child is 5 years old. This allows your child to participate in appropriate pre- and post-surgical exercises and for the safe use of anesthesia for the procedure.
Monitoring and Follow-Up
Whether you choose conservative measures or surgery, monitoring your baby's feeding patterns, weight gain, and development is crucial. Follow-up appointments with your paediatrician, lactation consultant, and chiropractor can ensure your baby is thriving and recovering well.
The Importance of Individualized Care
The decision to intervene with a tongue tie depends on how significant the tethering is and the impact on your child's feeding and development, as well as the feeding experience for both mum and baby. Working with healthcare professionals who understand your child's individual needs and your goals is important.
What Are The Next Steps?
If you have questions or concerns about your baby’s function and development in regards to feeding and oral function, book a call to chat with one of our fabulous chiropractors at ACCC. We can discuss options for care and management, as well as provide support to navigate who to include in your healthcare team.
Book a free call online with our Chiropractic Care Team today.
Additional Resources:
- American Academy of Pediatrics: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Where-We-Stand-Breastfeeding.aspx
- La Leche League International: https://llli.org/
- American Speech-Language-Hearing Association: https://www.asha.org/
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