The day after my son was born the pediatrician came in. I said “I think he has a tongue tie” and my mom says “what’s that?” The pediatrician explained it to her and she asked if she had one and lifted her tongue. I then learned that ties are hereditary. So what would having a tongue tie mean for an adult? Or a child? Is it worth revising later on?
As your supply regulates your baby needs to place the demand on the body to produce the milk by efficiently suckling and transferring from the breast. Up until that 2-3 month mark, it’s quite possible your baby has been riding on a strong supply and overactive letdown. This is especially true if you’ve been pumping in addition to nursing at the breast/chest. They don’t need to work much for that milk, so you may not have seen issues with weight gain and may not have had any pain or damage. If your baby’s gain starts to slow, or if you start to experience issues at the breast after, it is not too late to have baby checked for oral restrictions. In fact, some symptoms don’t show up until much later than this!
We know we need the tongue to properly breathe, speak, and swallow, but there are uses beyond that. The tongue cleanses the teeth and palate after a meal, removing the larger food particles from the mouth. If it cannot move to do this, you may have dental decay, cavities, or gingivitis. A receding gum-line is also linked to ties. The placement of the tongue in the mouth when at rest also has ties (no pun intended…well kind of because lol) to what we LOOK like. If your tongue doesn’t rest properly in the mouth you may find yourself tensing your jaw to hold your mouth closed. This extra tension in your face changes your overall appearance, and can cause premature wrinkles. I am forever amazed by the before and after images of adults who had ties corrected (visit The Tongue Tied Adults Support Group on Facebook to see!).
When the frenulum forms too tightly, so does the fascia in the head, neck, shoulders, and trunk. Do you get tension headaches? Migraines? Stiff neck? That could be due to this tightness. Ties are also linked to clenching the jaw and grinding teeth, especially at night. This, too, would contribute to headaches and upper body tightness. There are more symptoms, and you do not need to check all of the boxes to have it looked at and diagnosed. It just depends on how much the symptoms you do have are impacting your life.
I have heard people make comments that tongue ties are a “new thing” and that they’re over diagnosed. You may be surprised to learn that revising tight frenulums was first proposed in Greek medicine. In the 1800’s midwives would use a sharp fingernail to sever the tie at birth and doctors, if present, would use their instruments (2009 S. Karger AG, Basel). There is even reference to severing a tie in the Bible (‘‘And the string of his tongue was loosened and he spake plain’’ Mark 7:35). So why does it feel new now?
When World War II started and the men went to war, the women had to go to work. This led to the widespread use of formula for infants. Many infants with ties can bottle feed without as much difficulty, so during the years of the war ties were not recognized the way they are now. When manufacturing companies learned what a money maker formula is they started to push advertising. There were no advertising regulations back then so the advertisements were very persuading and would say that breastmilk alone is not enough for a developing baby. Doctors started recommending formula over breastmilk, and it even got to the point in the 60s and 70s where women were given a shot of Bromocriptine right after birth to dry up their supply before it even had a chance to fully come in. This huge swing from breastfeeding to formula feeding played a large part in tongue and lip ties falling out of the conversation around infant health. It wasn’t until the mid 80s that breastfeeding rates were rising more and peaked in 1984 at about a 60% initiation rate, but began to decline again. There were many, many years where breastfeeding was just not done, and if a person tried to breastfeed and had issues they weren’t given the help needed to correct them.
So now the initiation rate of breastfeeding in the hospital is about 84% and with this comes A LOT more conversation. We also now have social media and lactation support groups which we obviously did not have in the 40s and 50s when breastfeeding initiation rates were dropping. There is also a lot more research being done about breastfeeding and more education available to both families and providers. It is not a matter of tongue ties being a “new” thing. They’re talked about more now because we’re trying to breastfeed our children more now. We hear about them more now because we have the ability to communicate and reach out for help. Revisions are being done more because we know the possible long term effects of them.
This leads us to the last question. How do you know if you should have the revision done or not? This one falls to you, the parent. You do your research (learn more at these links listed here), you assess the symptoms. Any time a tie is suspected I strongly encourage reaching out to your lactation consultant and consulting with a preferred provider in your area to assess the tie. Lean on your support team, think about what you have learned, and lean into that gut instinct to decide which is the right way to go for your family. There are pros and cons to both decisions, and I feel it is a personal one.
Some important questions to review with your care team:
Is the tie anterior, posterior, and level of restriction (graded level 1-4)?
What are the identified symptoms, and how much are they impacting our goals and overall health and wellness?
Which method of revision is recommended?
If we wait to revise, is the process, recovery different at age 3? 10? 15? (Some find toddler age is a more difficult age to revise because they need to hold very still for the revision, and that may be difficult for them especially if they’re weary of the doctor/dentist, so thinking about issues the tie may cause at that age may weigh into the decision about when to do it.)
You also want to ask about their experience. I like this blog post for some more information on this. Pediatric dentists and ENT’s who are doing tie revisions for breastfed infants should be asking who your lactation consultant is, and your lactation professional should know who you saw. This is important for the continuum of care so they-with your permission- can communicate with each other to ensure your care if cohesive and complete.
Research around ties and breastfeeding in general has a long way to go, but the strides being made in recent years are doing wonders for our ability to nurture our children and care for their overall health. Please comment below or reach out if you have any questions about what’s written here or about your own situation.