Lip & Tongue Ties

Dr. Aaronson has received specialized training in the proper diagnosis and treatment of babies, children, teens, and adults with lip, tongue, and buccal (cheek) ties. As a member of the International Affiliation of Tongue-tie Professionals (IATP), she is up-to-date with the latest research and techniques relating to treating ties. Our hygienist, Karen, is a lactation counselor and is always happy to answer questions and help with nursing both before and after treatment.

 
 

Forms and Information

 

Please fill out the following health history form prior to your appointment. 

Our goal is to get all tongue- and lip-tie consultations seen within 1-2 business days,  since this is often a frustrating, painful, and/or medically concerning issue for both parents and children. Consultations are free, and we set aside time on the day of the consultation appointment if treatment is needed and parents are ready to proceed. 

More information is available on our website dedicated to tongue ties, www.bostontonguetie.com.

Ages 0-1

for lip/tongue tie eval

Ages 1+

for lip/tongue tie eval

The following forms will be given out at your appointment, but feel free to download if needed:

 

What is a tongue tie?

 

The medical term for the condition known as tongue-tie is ankyloglossia. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted. Tongue-tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 0.2% and 2% of babies are born with tight frenulums. In most cases, the frenulum recedes on its own during the first year, and causes no problems with feeding or speech development. A lot depends on the degree of the tongue-tie: if the points of attachment are on the very tip of the tongue and the top ridge of the bottom gum, feeding and speech are more likely to be affected than if the frenulum is attached further back.

A lip tie occurs when the frenulum that attaches the upper and/or lower lip to the gums on the upper jaw bone. Sometimes the frenulum can wrap all the way around the gums and attach on the palate. The degree of attachment does not always correlate with decreased function - the need for treatment is based solely on symptoms, not thickness of the frenulum or where it attaches.

 

How do I know if my baby is tongue/lip tied? 

Look at your baby and stick out your tongue. Even tiny babies will imitate you. If he or she is unable to extend their tongue fully, or if it has a heart shaped appearance on the tip, then you should have your baby evaluated by a lactation consultant or dentist. You can also try putting your finger in their mouth (pad side up) until the baby starts sucking. See if the tongue extends over the gum line to cup the bottom of your finger. If not, you may want to have them checked.

To check your baby's lip, lift the upper lip as high as it will comfortably extend. If the lip can easily lift up to the nostrils, it is unlikely to interfere with proper flanging/sealing on the breast. 

 

How can a tongue or lip tie affect my child’s development? 

Severe tongue-tie can cause problems with speech. The most common letters affected are R, S, G, K, L, Z, D, CH, TH, and SH, but other sounds are also difficult. While some kids can make these sounds in isolation, stringing the sounds together during speech can be very difficult. In addition to forming specific sounds, tongue-tie may also make it hard for a child to lick an ice cream cone, stick out his tongue, play a wind instrument, or French kiss. While these may not seem like important skills to you as a new mother, someday they may be very important to your child! Dental development may also be affected, with severe tongue-tie sometimes causing the lower front teeth to pull inward towards the tongue. Furthermore, tongue and lip ties may lead to dental decay, as a tight upper lip may make it .

Lip ties may make it difficult to properly clean the top of the front teeth. If a lip is tethered tightly to the upper gums, access may be difficult and may also cause pain while brushing. A tight lip frenum may also be more prone to tearing if the child falls and bangs his or her mouth. 

 

Tongue and Lip Ties and Breastfeeding 

In order to extract milk from the breast, the baby needs to move their tongue forward to cup the nipple and areola, drawing it back in their mouth and pressing the tissue against the roof of the mouth, which allows the milk to move into the mouth. The tongue plays an important role in breastfeeding, and if the baby’s frenulum is so short that their tongue can’t extend over the lower gum, they may end up compressing the breast tissue between their gums while they nurse, which can cause nipple soreness or damage.

Tongue-tie can cause feeding difficulties such as low weight gain and constant fussiness in the baby. Nursing mothers may experience nipple trauma (the pain doesn’t go away no matter what position is used), plugged ducts, and mastitis. In addition to problems with nipple soreness and weight gain, some other signs that the baby may be having problems nursing effectively include breaking suction often during feedings, and making a clicking sound while nursing.

Since these symptoms can also be caused by other problems, it’s a good idea to be evaluated by a knowledgeable health care provider to rule out causes other than tongue-tie. Tongue-tie should definitely be considered a possibility if breastfeeding doesn’t improve even after other measures such as adjustments in positioning have been tried.

Normal breastfeeding motion is best achieved when the baby can widely open their mouth. This wide opening is best achieved when the baby is able to flange the upper lip outward, allowing the mucous membrane portion of the lip (rather than the dry outer portion) to contact the breast. This allows for a better seal, which is the first step in generating the negative pressure for breastfeeding. When an upper lip tie tethers the lip downward, that flanging is impeded. This results in a limited mouth opening and forces the baby to adopt a more shallow position on the breast, leading to a multitude of problems. This video from Fauquier ENT shows how important the mobility of the tongue is during breastfeeding.

 

How is a tongue tie fixed? 

 

If it is determined that tongue-tie is causing breastfeeding difficulties, there is a simple procedure called a “frenectomy” that can quickly correct the problem. In a quick and relatively painless in-office procedure, the doctor uses a laser to release the attached frenulum and allow the tongue full range of motion. It takes less than 10 seconds, and because the frenulum contains almost no blood, there is usually no bleeding during the procedure. The baby usually stops crying as soon as they are picked up and held. The baby is put on the breast immediately following the procedure. Anesthesia and stitches are not necessary. The baby cries more because he is being restrained for a few seconds than he does because of pain. Comparing the procedure to ear piercing is a good analogy. Both involve a second or two of discomfort and a very small risk of infection, but are overall very safe and simple procedures.

If you believe your baby may have a lip or tongue tie, please call our office to schedule a no-charge consultation. If we confirm the presence of a tie and treatment is desired, we are usually able to treat the same day if the parent wishes. Please call our office at 781-431-9999 with any questions and for more information.

 

Post Operative Stretching 

 

Dr. Ghaheri has a wonderful video that shows how to properly stretch the tongue after revision:

Frequently Asked Questions

Q: My baby is fussy after the procedure. Can I give her medication?

A: You may give your child Tylenol every 4-6 hours. Refer to  this chart to know how much to give. Do not give your child more than 5 doses in 24 hours. Infants under 6 month of age should never be given Ibuprofen (Motrin/Advil), and babies under 1 year of age should not be given topical anesthetics or teething gel (Orajel, Benzocaine, etc.) You may also want to try giving your baby some frozen breast milk (in slush form, no large chunks) to help soothe the irritated area.

Q: I notice a yellowish goo on my baby's incision site. Is it infected?

A: Immediately after the procedure, you will be able to see a diamond shaped wound. This diamond indicates that the tie was fully released.  It is important to prevent the top and bottom of the triangle from reattaching to each other, which would result in a short, tight frenulum and little to no change. Our goal is for the sides to heal together and form a new frenulum that is longer and gives the tongue or lip more mobility. Over the next couple of days, the diamonds will turn white, yellow and greenish; this is what a wound that is healing in the mouth looks like.  

 

Q: My baby is drooling more than usual. Is this normal?

A: It is common for babies to drool more after a tongue tie revision. This is because their tongue has not yet learned how to properly position itself in the mouth to hold saliva. As your baby relearns how to nurse with their newfound mobility, they will also learn to swallow saliva as it pools in the mouth rather than letting it dribble out.

Q: I am still having trouble nursing. What should I do?

A: Call your lactation consultant. She will help you and your baby relearn how to latch and nurse effectively. While most mothers notice an immediate change in their baby's latch, it can sometimes take more time and effort to get to where nursing is pain free and baby is getting enough milk. 

Q: I just did the stretches and there is some blood. What happened?

A: As the frenum begins to heal in its new position, sometimes the edges of the wound will reattach in their original position. Proper stretching will break open any of these new connections and will encourage the wound to continue to heal in an open position. If, during the stretching, you break open the reattached areas (which is what you want to do!) you may see a few spots of blood. This is to be expected and is a sign that you are stretching the area properly. With proper stretching, you will not do any damage to the lip or tongue, despite the presence of blood.

Here are some resources you may find helpful if your baby may have a lip or tongue tie:

Dr. Bobby Ghaheri's Webpage: http://drghaheri.squarespace.com/

Facebook Group: New England Lip & Tongue Tie Support Group (admin approval required)

Facebook Group: Tongue Tie Babies Support Group 

Facebook Group: Tongue Tie Lip Tie Babies Support Group

KellyMom: Breastfeeding a Baby with Tongue-Tie or Lip-Tie