Is your baby having trouble nursing, or having trouble transitioning to solid food?
A tongue-tie, also known as TOTs (tethered oral tissue), is when the “string” or band of tissue connecting the tongue to the mouth is either too short, thick, or tight.
Interesting fact: there are 7 areas in which a tie can occur. Upper and lower lip x2, upper and lower cheeks x4, and tongue). This post is specific to the tongue, however it is common that lip and tongue ties co-occur.
Some tongue ties can be very obvious to the untrained eye. When seeing a child speaking, you may notice that the tongue may look different, with a string clearly holding down the front of the tongue. Because the attachment comes all the way to the tip of the tongue, it is more easily diagnosed and treated. However, other tongue ties may be posterior or sub-mucossal, which means beneath the visible layer of the tongue and oftentimes go undiagnosed by pediatricians, ENTs and other untrained professionals.
Not every tongue tie looks the same and neither will the symptoms present be identical. Some tongue ties may impact nursing, eating and speech. For another, it may not impact speech at all.
Common symptoms:
Babies: Difficulty latching and/or sucking, colicky, reflux, gas, poor weight gain.
Children: Speech issues, difficulty transitioning to solids, difficulty with textures, chewing or swallowing, digestive issues, unable to clear food from teeth, breathing and sleep issues, bedwetting, teeth grinding.
Adults: Head and neck pain, clenching, grinding, orthodontic relapse, unresolved speech issues.
Treatment options: A tongue-tie release, which may be called a frenectomy, is a simple surgical procedure which takes a couple of minutes. Today, laser is commonly used by pediatric dentists to release TOTs.
Some people wonder can we “stretch” a frenum (the string)? The research suggests that the tongue-tie tendon can’t be stretched.
Common concerns: My child got their tongue “clipped” but it didn’t help. Not surprising.
A) The release was simply not enough. It was “clipped” or not completely released by a well-trained provider.
B) The child was never given any skills as to how to use the muscle. The release may have been complete but there was no muscle training. The tongue can physically move more, but the child has no idea how to functionally move it accordingly for chewing, swallowing, clearing food from teeth, etc… Working with a trained speech therapist or myofunctional therapist is key to seeing successful results. The release providers I work with will make sure there is a provider working alongside to give the skills over before the release, so that they can implement them immediately post-release.
I commonly hear, “My pediatrician or ENT said my child is not tongue-tied.” Unfortunately, there is a lack of education in this area. In these cases, the child almost always has a less obvious submucossal type of tongue-tie. The same symptoms may be present, but the tongue tie looks less obvious and therefore often missed by trusted medical providers.
Not every tongue tie will have obvious symptoms; this article is only meant to bring awareness. Does every tongue tie need a release? It comes down to function. How is it affecting you or your child? Dr. Richard Baxter, Author of the book “Tongue-Tied”, sums up the vast array of tongue and lip-tie effects perfectly: “A tongue-tie can be the hidden reason behind nursing difficulties in babies, feeding problems in toddlers, speech issues in children, and even migraines or neck pain in adults.” That little string under the tongue can impact so much.
Editor’s Note; Readers can leave recommendations of providers in their city who have helped them diagnose, treat, or release a tongue-tie.
we used the pediatric otorhinolaryngist in Hackensack UMC to snip my baby’s tongue tie when he was 3 days old. It was a painless procedure that he slept through.
My pediatrician di it for me in his office when my baby was 6 days old- when you catch it early, it’s much easier to take care of it.
On the way home from the hospital my midwife clipped my baby’s tongue tie in the office. Best decision I made. Nursing was so painful in the hospital.
Wow this post came just in time. My baby is 6 months old & lactation Consultant discovered tongue tie now… Can anyone share some tips & guidance on releasing tie for infant.
Lactation consultant at Wic in
Lakewood is amazing she found it in my 3 month old ans dr Sherman Dds did the procedure
Where is doctor Sherman located? Do u have his number
My oldest had difficulty nursing and a lactation consultant diagnosed him with tongue tie. I went to two ENTs who told me that it is very mild and I shouldn’t cut it. My nursing problems were driving me crazy so I cut it anyway and the next day I saw a huge change!!!!!
Thanks so the great information! As an SLP I’m seeing a few kids with tongue tie having poor breathe support. They have mumbly speech, “swallow” ends of sentences. They have difficulty taking deep breathes or sustaining phonation for more than 5-6 seconds. Are these symptoms commonly seen with kids who are tongue tied?
Hi fellow SLP!
There are 2 components to what you’re describing. The low lying restricted tongue often results in mouth breathing, which is not as efficient in breath support for breathing and speech. Additionally, jaw, tongue and lip weakness as a result of the tongue tie (think open mouth, low lying tongue, weak lip use) will impact clarity of speech. This is an example numerous issues coming into play as a result of a tongue tie.
this sounds more like an issue with enlarged adenoids
This is so so important. My daughter ended up on a feeding tube because of a tongue tie an ENT who supposedly specializes in ties said she didn't have. Seven years later I am still hearing stories like ours. Thank you thank you thank you for sharing this.
http://Www.Drghaheri.com is a great resource! My first baby screamed for six months. Bh by my fourth someone told me about posterior tongue tie which is much harder to see but really impacts nursing. Most pediatricians ignore it and say it’s nothing. I finally found a pediatric dentist who did the laser cut and it helped after two days!
My daughter was also posterior tongue tied
It took about a week after for her to latch on properly. Bh no issues after that.
I used Dr Rickert in NYU
She got it snipped at 2 weeks.
My eldest child, who just turned 37 was born tongue tied, as was my eldest sister. It seems that there is definitely an inherit link with the tongue-tied issue. The clinic pediatrician diagnosed this issue, not a hospital doctor. My son did not have his tongue snipped until he was nearly five years old. He did need Speech Therapy for less than a year. What amazes me is that even after So many years, the medical community is not well educated with this problem. Much luck to all of the other parents and children who are still dealing with tongue tied offspring in a less-informed medical community.
Im wondering why you snipped it at age 5? My 6 year old was never snipped but he nursed fine. But may be the cause of his lisp? Is it worth it to release at this point?
How did they do a release on a 5 year old? does that need anesthesia?
You can do that with laser. Dr Scott Siegel is amazing!
It is truly a shame that there is not enough awareness about a condition that is way more common than we think. So much frustration and misery could be avoided by a little education and action. I truly believe babies should be checked by someone competent (most pediatricians cannot recognize a posterior tongue tie)for this condition at birth as it is not specifically discernible to the naked eye. For sure many ‘colicky’ ‘screaming’ ‘bad’ babies ..simply suffer from an inability to suck properly due to their tongue tie. ..you know those babies who ‘just cant nurse’??..many are simply tongue tied.. I am grateful to Dr Goldsmith who has come to the rescue time and again…there is so much to figure out in those first few weeks of life.. this little bit of information could make it so much more pleasant for both mother and baby..
Correct website is simplyspeech@gmail.com
Lisa Paladino is a IBCLC and CNM in Staten Island who is well versed in TOTS and is an excellent resource for both parents and professionals. Dr. Scott Siegel in NYC is top notch for releases. In Baltimore, my daughter was released by Dr. Robert Marcus, now there is also Dr. Candace Zorn as well as the Tongue Tie Center of Baltimore. It's really important to get a functional assessment as well as proper before-care and after-care .
And in the Northern New Jersey area, Sipporah Tracer is an OT and IBCLC who is very knowledgeable about TOTs. If you like podcasts. The Untethered Podcast is an excellent resource of information on TOTs.
My first son was tongue tied. I realized right away cause he wouldnt latch on while trying to nurse him . I was told to force him to nurse first and then snip it after his bris. It was a crazy week but right after I snipped it he sucked beautifully.
Dr. Scott Seigal in Long Island is the best!!
For anyone who wants to learn more, the tongue tie Facebook group has a ton of info, learnt so much from that forum.
I had the opposite problem! The hospital lactation consultant told me that my baby is tongue tied. I freaked out, but before I did anything, I asked my pediatrician for a second opinion – my pediatrician checked my baby and said that she is totally not. She is now 5 with no pertinent issues, speech or otherwise BH. A few months after the saga, a friends of ours happened to mention that they are taking their newborn to be snipped, due to the baby’s tongue tie. We advised them to get a second opinion, and their pediatrician also said that the baby did not have the condition. Turns out, we gave birth in the same hospital, and the same lactation consultant gave us this misguided advice. Do your research!
Unfortunately pediatricians are not very knowledgeable about tongue ties. Some have even called it a social media fad. I'm not saying the lactation consultant is right and I'm glad your baby is doing well (iy'h should stay that way), but many many many families were wrongly told there was no tongue toe only later to find out there in fact was. If ENTs who are supposedly trained are missing ties right and left, I would expect pediatricians (who don't have the training) to be any better. Lactation consultants aren't always qualified to diagnose ties. What this lactation consultant should have done was advised you to go to a properly trained IBCLC or feeding therapist for an assessment and perhaps a list of symptoms to look out for. Unfortunately too many families have suffered like we did (even 7 years after my daughter was misdiagnosed) and there's very little outcry relative to the severity of the issue. The system has to change so that the babies who need the care are able to get that care. All the best!
Sorry I mean I would NOT expect pediatricians to know better.
Unfortunately pediatricians aren’t knowledgeable on this. My children went to a top pediatrician, who declared there’s no tongue tie – and he totally didn’t check or assess for it properly AT ALL, nor did he know how. Medical school doesn’t teach much at all about this. A pediatrician, dentist, or SLP cannot appropriately (or accurately) assess for oral function unless they have undertaken additional specialized training to become a certified orofacial myologist, otherwise they are not qualified to tell you that you or your baby are “fine.” Ties impact the development of the jaw and palate. By your doc’s standards, I was “fine” since I had nursed well as an infant, swallowed food normally, didn’t have speech impediments, and didn’t need braces. But I had a posterior tongue tie, lip ties, and cheek ties that were really interfering with my oral function years down the line. (Sleep, eating, speaking clearly and audibly, oral hygiene, facial pain and tension, breathing.)
For anyone in New York, there is a pediatric dentist in Albany, Dr Kotlow, who does a simple laser procedure instead of snipping. It is not painful, and he gives you exercises for the tongue that need to be done for the two weeks afterwards. It was a long drive, but it was a one-time thing, and Boruch Hashem, after that, my 5 month old, who my pediatrician said, “is probably just not a nurser” nursed beautifully until about one year. Dr. Kotlow’s website is http://www.kiddsteeth.com
So happy for you! Dr. Kotlow is one of the gurus of laser revisions. He is the reason that many other dentists are at their doing the same. The dentist who did my daughter's release learned from Dr. Kotlow! Hope all continues to go well for you!!!
I did Craniosacral therapy for my baby’s tongue tie, and it worked beautifully (2 sessions). Her tongue was noticeably looser and moving more, and she latched so much better.
Just putting it out there that this option exists (as opposed to snipping).
I also did CST because my baby wasn’t nursing well. Her tongue changed shape from just one session! It was round, fat and she couldn’t stick it out of her mouth. After the session it was looong and. skinny and nursing was much better!
I was told in the hospital with 3 of my 4 children that they were tongue tied. None of them had difficulty nursing so I didn’t do anything and so far they seem fine. Is there any reason to intervene if feeding is going well?
My 4 nephews just had their tongue ties released. They all nursed fine but had other issues while growing up. One had poor digestion with pinworms. The other couldn’t say a R properly. There’s a fantastic dr kotlow in Albany that does it and is very well known. Thinking if would help my 10 yo son with bedwetting?
I live in North London, Uk, and had my baby’s tongue tie cut by Doctor Wetzler at 3 days. Unfortunately, it reattached at two weeks (which is not uncommon, we were told) and had to have it snipped again.
Our mohel told us our son had a tongue tie! Our pediatrician didn’t. When we asked him about it he said everyone has tongue tie . We went ahead with the procedure at Dr. Sherman and so happy we did it ! Baby less cranky and less gassy after eating .
Please please please find someone to do a functional assessment if you suspect any of these issues at any age! Before clipping you should take your child to see a craniosacral PT or OT or Tots Davy SLP to strengthen their muscles so they know how to use them post release. Beth Morel at little movers PT IS AMAZING! She’s in jersey city and northern NJ. http://www.littlemoverspt.com/
THANK YOU for writing this!!! So many people think it’s “fine” to get a quickie snip done at the pediatrician or ENT (or even the local oral surgeon!). Then they wonder why their tie release “didn’t work.”
We used dr Scott seigel in Long Island to laser the tongue/lip/cheek tie. The office was super pleasant, Dr Seigel gives out his cell so you can ask him any questions! Great experience with each kid I had to do it with (2). I would recommend him in a heartbeat!
Is there anyone out in Monsey
Over the years, I’ve acquired a lot of knowledge and insight on ties through my own personal experience as an individual with ties and as a parent of tied children. Unfortunately Dr Sherman doesn’t perform good, proper releases. People who went to Sherman usually need to go get a corrective work (revision) done by providers who use better technique and are more skilled and experienced with performing properly done releases.
The tie savvy LCs and the SLP in my area who works with oral function (orofacial myology) do NOT recommend Sherman for a reason…if you’re getting a tie release, please get it done right the first time by going to someone like Dr Siegel. (You’ll thank me later!)
Also, you can’t just go to any feeding therapist or speech therapist who claims to be “tie savvy” knowledgeable on ties. That’s not enough. I asked one of the top feeding specialists in my area, who “didn’t believe” in ties and I shudder to think how my child would’ve ended up if I had listened to her advice!
Go to an SLP who’s a certified orofacial myologist, as they have undertaken the specialized training in assessing oral function and are highly qualified to be assessing whether there are restrictions and if it’s affecting oral function. If I had a dollar for every pediatrician or not tie savvy feeding specialist or SLP who claimed my kids were “fine”!
looking for tie savvy LC or SLP near lakewood to advise on my newborn’s tongue tie, any recommendations?
BEWARE! Please do not use Dr Sherman or the local ENT for releases. He has a solid track record of not performing proper releases, and many people end up needing to get his work corrected and revised by a provider who uses better, more correct technique and are more properly trained and are more experienced. There’s a reason why the real tie-savvy LCs and SLPs certified in orofacial myology (oral function) do not recommend Sherman…
Does anyone know if Dr. Ari Goldsmith is reliable for a tongue/lip/cheek tie consultation? If the procedure is necessary, we will make the trip down to Dr. Kotlow in Albany, however, we want to hear a professional’s opinion before making the trip. Is Dr. Goldsmith enough of a pro?
looking for an ibclc in/near lakewood to assess my newborn’s nursing functionality. any recommendations?