Evaluation of Infants
In normal human anatomy there are ligaments that connect the upper lip to the upper jaw bone (maxilla) and connect the tongue to the muscles forming the floor of the mouth. These ligaments can be light, thin in nature, allowing for normal lip movements and tongue extension, or they can be heavy, thick connections impeding lip and tongue function.
Symptoms in the baby (and mother) that may indicate impairment of function from infant tongue and lip ties include:
- Maternal pain during breastfeeding
- Flattened, cracked, bleeding nipples
- Mastitis (infection in the breast commonly arising from poor nursing technique)
- Baby leaking milk from sides of mouth during feeding
- Baby making clicking noises during nursing
- Baby feeling tired out after nursing, due to strain from overusing muscles during feeding
- Presence of lip callous at midline of upper lip
- Excessive gassiness, reflux
- Choking or gagging during nursing
- Frequent ear infections, mucous accumulating at corners of eyes
- Failure to thrive, poor weight gain due to inability to nurse effectively
On autopsy, many babies who were lost to SIDS, demonstrated food (milk/ formula) in airway, possibly due to inability to swallow and clear milk effectively, and this may have been related to a tongue which could not lift up fully to swallow completely.
Many times, the above symptoms result in early reduction in milk production and/ or maternal frustration with breastfeeding, leading to early cessation of nursing and reliance on formula to feed the baby. Babies falling asleep and the breast and not eating efficiently, result in the mother feeling that she cannot do anything during the day beside feed her child, especially in our modern times where maternal attentions are divided among so many responsibilities.
For the baby, sucking in air during nursing can result in baby feeling gassy, which can be painful, leading to the common label of “cholic”, or excessive spit-up, reflux, resulting in pediatricians prescribing common acid reducing medications like Zantac, Pepcid, etc. When baby is not gaining weight at the appropriate rate, pediatricians may recommend supplementing nursing with formula. Formula is expensive, but more importantly it will never provide the complete nutrition of breast milk. Mother’s milk contains antibodies (cells and proteins which protect an infant from infection in the first months of life), more easily digestible proteins and sugars and fats which are important for proper growth and neurological development.
In addition, there is the intangible, priceless benefit of enhancing the mother infant bond through successful nursing.
If you are a mother to a newborn and you are experiencing any of the above signs and symptoms, please consult an International Board Certified Lactation Consultant for help with breast feeding and ask if there is a lip and or tongue tie problem which could be contributing to difficulties with the latch and nursing. If so, Dr. Stubbs can be a part of the diagnostic process and help design a treatment plan not only including tongue and lip tie release, but also enlisting the help of infant massage therapists and/ or physical therapists who help with the relaxation of muscle tension resulting from tightly bound, restricted tissues.
Evaluation in Toddlers and Children
Many infants are able to overcome difficulties in feeding from tongue and lip ties, and will gain weight and grow appropriately in the first year of life, but then other problems develop which may be the result of an undiagnosed oral and airway dysfunction from undiagnosed tongue and lip ties.
Signs of oral and airway dysfunction may include but are not limited to:
- Child having difficulty using sippy cup or straw
- Child having difficulty eating with a spoon
- Difficulty extending the tongue to touch lips or the roof of the mouth (palate)
- Difficulty licking an ice cream cone
- Child easily chokes, gags, reflux
- Sensory issues with food, picky eater; textures of food limit child tastes/ diet
- Early childhood caries
- Slow or delayed speech, difficulty in pronouncing hard consonants like p, b, m, f, t, d, s, z, n, r, k; have a lisp
- Dark circles, shadows in lower eye lids, previously diagnosed with “allergic rhinitis”
- Mouth breathing
- Issues with posture
- Display sleep disturbances like snoring, grinding of teeth, head arched back while sleeping, night terrors, bed wetting
- Diagnosis of ADD, ADHD, Sleep Apnea
A restricted tongue (a tongue tie) can affect the further development of the airway as the child grows. Accessory muscles around an attached tongue can develop in such a way as to compensate for activities the free moving tongue would ordinarily be able to do but in its tied state cannot. This compensation from accessory muscle often results in shortening of cervical (neck) muscles and a stooped, head-forward posture.
In orofacial development, a restricted tongue is often correlated with a high palatal vault, which encroaches on the air way space a restricting air flow through the nose and nasal passages. Often such individuals have a long face, and chronically mouth breathing. In children, restrictions in air way space can manifest itself in poor sleep patterns resulting in ADD, ADHD. Often children with tongue tie present with dental malocclusions (poorly positioned teeth, crowded teeth). Chronic mouth breathing is also related to heavy plaque (bacteria) build up on teeth and formation of caries.
A freely moving, normally attached tongue allows influences in the development of a broader palate, wider nasal floor, which in turn allow for better air flow and nasal breathing. Humans, by design, are meant to breathe through our noses!
If you, as a parent or caregiver of child, note any of the above symptoms, please see Dr. Stubbs for a consultation and evaluation. Dr. Stubbs can help diagnose and treat tongue and lip ties. She may also make a referral to a physical therapist, or massage therapist to help with follow up exercises for the patient to go through to retrain muscles, re-learn breathing through the nose for better overall health.