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TONGUE-TIE REVISION: CONFOUNDING FACTORS AND SUPPORTIVE MEASURES

The mother baby dyad is where we evaluate function, not the oral cavity. How do we support the nursing dyad, support healing and normalize function?

Compensatory feeding even at the breast is not a sufficient goal to support health and healing and so many babies struggle unnecessarily through early life in this manner. Moms often know something isn’t right but they may not know how to fix it. An infant who fails to compensate effectively is at risk for starvation, detachment, poor growth and development, risk to immunity and well-being.

An infant who compensates is at risk of compensatory behaviors and integrated neurological patterning is less than ideal. Full function and competency can only be restored when baby is exclusively breastfeeding functionally.

When baby is compensating, we must intervene. An example of compensation is a baby with sunken cheeks and high suction. That is not right. Due to a poor latch, the baby has to work harder, suction harder to get milk. Compensations may weaken physiology, emotional well-being, etc. Compensations require a large amount of energy and baby may end up falling asleep at the breast frustrated and unsatisfied. Optimizing compensations misses the big picture and they sadly become the infant’s barometer.

Healthy breastfeeding is vital for the development of attachment behavior and early social development. When mom is frustrated and feels like she is not spending time with baby but is spending time with the pump, we have to intervene. We are born for normal term breastfeeding and babies will breastfeed a lot longer. We are designed for oral competency, but exquisitely capable of compensation.

What are the keys to normalizing function in the tongue-tied baby? We must start with a thorough assessment. The revision must be such that the baby has the potential for full, unrestricted function. The baby must be evaluated for colic, reflux and pain. Does the baby have torticollis? Is the baby healing properly and is there reattachment of the wound? We must ask about the birth history. Was there any trauma? Is the mother concerned about anything specific? How is mom’s nutrition?

A holistic approach to restore oral function is preferable and normalizing function should be the goals in our multi-disciplinary approach. This integrative philosophy may include bodywork, increasing range of motion and releasing body/ facial strain. Using the exercises in a playful way makes it fun for baby and mom or dad. The floor of the mouth and base of the tongue must bereleased. Outcomes can be optimized when bodywork and oral work exercises begin prior to revisions. This gives the baby an opportunity to be more receptive post-procedure, as they are a continuation of what they are familiar with. It is imperative to help baby to understand that the floor of the mouth and the tongue are separate units. Oral work can help separate these units and help to build new pathways.

To accomplish healing holistically, we must create an environment that supports well-being and avoids medicines if possible. Virtually all medicines deplete vital nutrients and potentially results in undesirable side effects. For example, acetaminophen depletes glutathione and significantly increases the incidence of asthma. We must stay on top of the pain and anticipate the post-procedure pain response, usually 5-6 hours later. We must offer moral and emotional support, communication, bodywork, strive for a functional latch, practice oral exercises and use homeopathy (Arnica, ozonated olive oil, cell salts, herbs, coconut oil).

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