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Treatment of lip & tongue ties in young babies

 
Procedures for lip and tongue ties have increased recently, but are they necessary or a passing fad? Find out more about lip and tongue ties in young babies, why they need to be treated and how are they treated.
Procedures for lip and tongue ties have increased recently, but are they necessary or a passing fad?

From what I have read and observed, the treatment of lip and tongue ties is a valid choice for babies who show obvious physical ties or present with breastfeeding difficulties that can be attributed to them.

We are hearing more about lip and tongue ties too, and that is a positive thing as maternity providers become increasingly aware of the impact they can have in breastfeeding and other oral problems.

I have found that the experiences of mothers tell us that procedures for lip and tongue ties are invaluable too. Helping them to continue breastfeeding and to resolve issues they might be having such as pain, nipple damage and poor supply.

So what are lip and tongue ties, why do they need to be treated and how are they treated?
 

Lip ties & tongue ties in young babies

 

What are lip & tongue ties?


Tongue ties can be seen in around 10 % of babies and occurs when the membrane between the tongue and the floor of the mouth is too tight or too short, restricting the movement of the tongue or being able to extend it out of the mouth.

Without treatment a tongue tie can mean things we take for granted like licking our lips or an ice cream would not be possible, as the tongue is not free to move naturally.

Lip ties are where the upper lip is attached to the gum by a thin membrane called the labial frenum. In cases where this membrane is too tight or short, lip movements can be affected.

Left untreated a lip tie may go on to effect dental development in some, leading to a gap between the two front teeth.

Lip and tongue ties are commonly found together in babies as the oral development prenatally is by a similar process.

There can also be a hereditary factor where a parent also had one or both of these ties present.
 

Why do lip & tongue ties need to be treated


For a baby to latch to the breast, the tongue and lips are very involved.

Babies need to be able to open their mouth widely enough to allow their tongue to protrude forward, past the gum ridge and then take a big mouthful of the breast.

This ensures that:
 
  • The milk sinuses are massaged by movements of the baby’s tongue and by pressure from the lower alveolar ridge causing the release of milk which is ejected through the nipple.
 
  • Peristaltic movement of the tongue, (rippling, from the front of the tongue to the back), strokes the breast, draws out and maintains the flow of milk.
 
  • These movements of the tongue also stimulate the nipple to elongate, so that it is pointing down the baby’s throat, and directing milk towards stomach.

When a tongue tie is causing problems with breastfeeding, the baby often does not open their mouth widely, and so cannot latch on to the breast at the correct angle. Instead they may latch onto the nipple, and ‘gum’ or chew it, causing severe pain and eventually, nipple damage, sometimes followed by infection or mastitis.

The rippling tongue movement may not occur, or it may occur only on one side of the tongue, so that the nipple does not elongate. This means milk may not be directed correctly for swallowing causing coughing, gagging, choking, or vomiting. Since the latch is not correctly positioned, the sinuses where milk is stored are not stimulated to release milk.

A baby with a tongue or lip tie may be unable to make a good seal around the breast with their lips, resulting in milk dribbling from their mouth and noisy sucking. Interestingly this can be seen in the latch of either a breast or bottle-fed baby.

Untreated lip and tongue ties do lead to breastfeeding problems for some babies, they may be unable to latch and suck well due to their oral restrictions which can lead to ineffective milk transfer, weight gain issues, air being swallowed and excessive crying.

Some also will have a sucking blister form on their lip. Untreated, future dental issues can occur with the growth and development of the palate, overcrowding and risk of tooth decay.

Studies have identified lip and tongue ties can contribute to some forms of speech impediment, reflux, snoring and sleep apnoea.
 

How are lip & tongue ties treated?


Commonly lip and tongue ties are picked up in the newborn phase by the mother, midwife or lactation consultant, as the tie may be visually obvious or suspected if breastfeeding difficulties are present.

The lip or tongue tie is assessed and parents can decide if they will proceed to have it freed with either surgical scissors and a snip by a midwife or lactation consultant, or by laser in a procedure called a frenectomy performed by a specialised dentist in a clinic.


Post procedure care


The clinic parents are given education around the wound healing, and exercises or stretches that are carried over about 4 weeks, 4-6 times a day to prevent any re-attachment.

These are simple to do, however may cause some oral discomfort for the baby during the stretch.

Carrying out exercises around nappy change time, instead of before a breast fed will reduce the risk of a negative association or aversion being formed by the baby to the breast.

A week after the procedure, I have found that mums often comment that latching was easier and more effective, and that they were more confident now about continuing to breastfeed.

Source: This article was kindly written for us by Janferie Dewar, Baby and Beyond Consultant and Registered Nurse .
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