Tongue 👅 Tie, Lip 👄Tie and TOTs

Tethered Oral Tissues (TOTs)

Tethered oral tissues? Tongue tie? Lip tie? - what is it? Is it really that big of a deal? And why does it seem like every other mom you meet is talking about it?

Tongue tie, or ankyloglossia, is a common condition that if untreated will remain for life. That sounds scary. It doesn’t need to be. It means that the tongue is tied, or stuck, more firmly to the floor of the mouth, limiting tongue movement and range-of-motion. This can be slight, one can stick their tongue out a little but not touch the roof of the mouth, or severe, where one can’t lift the tongue at all and it impedes ANY eating or swallowing. Most Pediatricians unfortunately aren’t trained to recognize or treat TT. Many even tell their patients “the baby isn’t tongue-tied” after a IBCLC already made the assessment and recommendation. The big problem isn’t that the pediatrician disagrees with the exam, it’s that the Pedi tells the parents there isn’t a problem. If Mom says there is a problem- if breastfeeding hurts, baby is super spitty or somehow the breastfeeding experience isn’t good- then there is a problem! So what to do?

First, if in doubt find an expert! An IBCLC has much more experience with breastfeeding and tongue tie than a Pediatrician who needs to cover all 18 years of possibilities. An IBCLC specializes in just feeding issues. Or find a pediatric dentist who specializes in TT. Not all do.

How to know if there is a problem? First start with the baby. If you can’t sweep your finger under the baby’s tongue without being stopped by the frenulum (that thing in the middle) that’s a problem. And the same applies to the baby’s lips (more on lip tie in a minute). Does the baby have trouble latching on the breast? Getting deep enough and staying on? Can the baby suck on your finger and keep good suction? What about bottle feeding- does the baby loose suction on the bottle and dribble out a lot of food? Is the baby seem extra gassy and fussy? Do you hear any clicking when the bay is sucking or feeding?

Then look at mom. Is the nipple still round after a feeding- not flatten, squished or have a crease on it? Are the nipples really painful and sore, maybe even cracked and bleeding? Does mom cringe at the thought of putting baby to breast and curl her toes during latch (sorry mama)?

The tongue isn’t the only part that can be tied. Lip ties can be very difficult as well because it makes it very difficult for baby to maintain suction on the breast or bottle. So you get an extra messy and consequently gassy baby. You should be able to sweep your finger across baby’s gums under the lips without being stopped.

What does all of this mean? It means that you need an expert. Anytime things are out of your expertise, whether it’s a broken computer, leaky faucet or a medical concern, you need to find an expert. So, for tongue and lip ties look for an IBCLC in your area who is trained and experienced with them. The LC should be able to give you a contact or two for a pediatric dentist who specializes in tongue and lip ties as well. Get help. Feeding doesn’t have to hurt! And it is much better to deal with this now, or know if it needs to be dealt with, then when the baby is 4 and having food/texture issues, recurrent ear infections, and other possible complications from untreated TT/LT. It’s always easier now before a problem becomes huge.

I have a whole page devoted to TOTs because this is one of my main specialities. Unfortunately I see a LOT of TOTs, but that means I have a lot of experience helping families assess for and deal with TOTs. Make an appointment today so we can see if TOTs is a problem for you and your baby.