Updated: Aug 19, 2020
Breastfeeding is the norm but may not be seen as common
“The initiation of feeding at the breast is the next logical step in the continuum of an organizational process that begins before conception, follows through gestation and birth and is designed to ensure the infants potential for survival is optimized” – Jennifer Tow
The mother’s body is the baby’s habitat. There is a continuum from the womb to the world. A mother nourishes and nurtures her baby as he grows and develops in the womb and then nourishes and nurtures her baby through the first year and beyond. The baby is designed to ‘fit’ with the mother, his physiology is designed to breastfeed. One amazing way this happens is when a baby travels through the birth canal and transitions to the world; his cranial bones are shaped by the mother’s pelvis. As he begins to breastfeed those cranial bones are realigned by the act of breastfeeding.
Breastfeeding defines the physiological norm for human function. From the formation of the human microbiome to the function of airway to forming of human relationships; breastfeeding will impact the baby for his whole life.
One of the things that mothers can be aware of is the impact of the oral structure and its effect on the function of breastfeeding. Many mothers have struggled in the early day’s and months of breastfeeding and they often get many different opinions but not often much helpful information. The shared knowledge around breastfeeding has been expanding but much of what we know has been around for a long time. Technology has made sharing information and gaining information more readily available. We are learning more and more all the time about breastfeeding, breastmilk and the amazing abilities of mothers and babies.
“Nothing an infant can or cannot do makes sense, except in light of mother's body.”
- Nils Bergman
Oral restrictions not recognized as a problem by allopathic practitioners
Before the 1940s, tongue and lip ties were treated regularly by doctors and midwives. As formula companies began to heavily influence doctors, and breastfeeding rates diminished and the desire to treat ties began to decrease. Physicians, including pediatricians learn next to nothing about the mouth in relationship to breastfeeding in medical school today. Dentists also do not receive training in breastfeeding and its relations to oral structure. Many of today’s practicing physicians were taught that treatment of tongue-tie, (ankyloglossia) is an outdated concept – a relic of times past. During the last several decades of predominant bottle-feeding, tongue-tie was not seen as an issue because it did not seem to impact the bottle-fed baby in the same way.
Other than breastfeeding, tongue and lip tie can influence speech, dental hygiene and oral-facial development which can lead to narrowed airways and sleep apnea. These short or tight frenums, or frenulums, which also may include the cheek attachments–restrictions are now referred to as Tethered Oral Tissues (TOTS). These issues can be identified at birth and steps to correct it can be taken. The ability get help with lactation support is something that is very much needed but often lacking in many communities.
Some people may describe this focus on ankyloglossia and how it relates to breastfeeding as just a ‘fad’. But this doesn’t acknowledge the struggles of the mother or the baby both physically and emotionally. It minimises the frustrations felt by the dyad and does nothing to help solve the actual problem at hand.
“If a child were born with webbed fingers or toes, no one would think twice about having surgery to correct it, yet releasing the tongue, a MAJOR articulator, and the beginning of the digestive system, most doctors look the other way. WHY? The tongue has to be able to do more than protrude! It has to be able to clean your teeth. It has to be able to move FAST to articulate clearly. It has to be able to swallow appropriately”. -Betty Corylls
Instinctual imperative of a baby to breastfeed
Many times, pregnant women are asked if they “plan to breastfeed?” but the question really should be “do you plan NOT to breastfeed?”. A baby is born to breastfeed. They don’t know there is an option not to breastfeed. Through an intricate cascade of hormones and physiological action a baby will attach and feed from the breast. There are many things that can interfere with this process through pregnancy and birth.
One way we can see this normal physiology play out is through the ‘breastcrawl’. A baby will go through ‘9 instinctual stages’ after birth in order to prepare the mother and him/herself for breastfeeding.
There are several newborn reflexes that have been identified that help baby to develop and grow in the first days, weeks and months postpartum. One of these is known as the rooting reflex (triggered by touching the baby’s cheek) is familiar and obviously involved in feeding. The reflex that is triggered when you brush the top of a newborn’s foot will get baby to lift his foot and place it so this reflex may help him crawl to the breast. If you stimulate a newborn’s feet it causes him to re-latch and start sucking.
The primitive reflexes emerge to initiate a developmental process. They help to develop the neural circuit that are specific to functions in the body. The baby integrates these reflexes within the first year of life. When a baby is compensating due to a structural issue these reflexes can be inhibited.When reflexes aren’t integrated, they can cause long term issues.
Movement is an important part of a baby’s ability to integrate their reflexes. The nerves depend on movement, nutrition and hydration which help the central nervous system to develop. Repetition of movement in response to the environment around them is a very important part of helping to integrate these reflexes. Babywearing is one way to help your baby do this.
If they are not able to integrate these reflexes the sensory motor pathway has difficulty developing but a baby will compensate which requires more mental energy and focus.
Baby’s are smart and will compensate
· enables a broad palate that makes room for the tongue
· allows us to chew food
· allows for forward growth of the jaw
· enables the evolution of an adult swallow
· supports a functional airway
· supports an intact nervous system
· encourages postural stability
When a baby is compensating at breastfeeding it can lead to:
· high arched/narrow palate
· myofunctional disorders
· chronic inflammation
· retracted jaws
· immature tongue function
· low tongue rest position
· impaired airway
· preference for soft foods
· unintegrated reflexes
· impaired nervous system.
A baby will feed anyway he can. You may see:
· pulling away
· dribbling milk
· clicking, smacking
· shutting down
· preference for one side
· throwing head back/arching
· breaking the seal
· short feeds
· passive feeding
· tucking chin
· tongue thrusting/bunching
Tongue tie can impair sucking or suckling at the breast
Babies can have minor to severe difficulty coordinating their sucking, swallowing, and breathing. Symptoms can include those listed above and may also include:
· latch difficulties
· nipple pain or damage (although there may also be no pain whatsoever)
· poor milk transfer
· compromised milk supply
· inadequate weight gain
· diagnosis of failure to thrive
· fussiness at breast
· breast refusal
· poor latch
Mothers are also smart and will help baby to compensate
The long term consequences to not seeking help for the motherbaby:
· abandoning breastfeeding or exclusive breastfeeding
· using artificial nipples
· poor oral development
· sinus infection
· sleep apnea
· speech difficulties
· poor gut health
· comprised motor development
· loss of relational experience of feeding
· loss of the infant of control of feeding and of his environment
· compromised hormonal functions and an ineffective transition to adult tongue-swallow patterns
When a baby is compensation at the breast a mother may notice
· Nipple pain
· plugged ducts
· compromised milk supply
· poor milk removal
· interference with bonding
· adversarial relationship with infant/family
· loss of physiologically normal hormonal state
· loss of parenting tools
· untimely weaning
· premature return of menstrual cycle
· postpartum depression
La Leche League offers tips and suggestions to help make breastfeeding easier as you work towards getting a release done. A baby often instinctively attaches more deeply and comfortably if he can snuggle up close to his mother’s chest for periods of time. Try letting your baby lie on your body as you recline so both his chest and tummy are against you. Because gravity helps a baby keep his tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make. A mother should be supported to get lactation support before she becomes to disheartened with the challenges of breastfeeding.
“If we are concerned about the long-term consequences of not breastfeeding to the microbiome, to metabolic function, brain development, etc. why not to the impact of the airway and movement?”
A tether starts in utero
Oral development begins in utero and progresses very quickly in the first six-months of life. It is during the first year of life that health and development issues can arise due to negative changes in face, mouth, and airway structures. While many traits are inherited, parents can help their children develop the best possible face, mouth, and airway structures using appropriate feeding and oral development techniques which include appropriate oral play including things like baby-led feeding.
There are many things to consider when we think about the growth and development of a baby. The ability to breastfeed is just one of many. A holistic view of the motherbaby can help the dyad to thrive and help them be able to respond to challenges. Exposure to toxins, our diets, our lifestyles and our behaviours can also have an impact on the mother and baby as they learn about breastfeeding. We can learn and grow and change in order to thrive and be healthy.
The muscles, tendons and nerves that are connected…
There are many parts of the body connected to the mouth and that can be impacted by tongue-tie.
Vagus nerve, also known as pneumogastric nerve. It supplies nerves to the pharynx, esophagus, larynx, trachea, bronchi, heart, stomach and liver. It influences the action of swallowing, it also sends and transmits signals to our autonomous system, to help the regulate activation and control stress levels or send signals directly to our sympathetic system.
Hyoid bone.Positioning of the hyoid bone is the responsibility of the infrahyoid and suprahyoid muscles. These muscles are very important for the complete act of swallowing and action of the larynx. The four-infrahyoid muscles are referred to as “strap muscles” and are attached from the hyoid bone inferior to the clavicle, or scapula. The suprahyoid muscles are attached above the hyoid bone and infrahyoid below the hyoid with attachment to the clavicle or collar bone.
Tongue ties can have a major impact on the health and function of the jaw joint over time. The head follows the tongue, and if a person has a tongue tie, this means that the head is tilted low and forward. This posture affects the sternocleidomastoid muscle (SCM), trapezius muscle, and surrounding muscles, and can result in the following symptoms:
Neck and back pain
Headaches and migraines
The tongue is meant to be able to move freely in the mouth. There are 3 distinct actions that it must take in order to breastfeed. You can see this in a video of an ultrasound of a baby at the breast.
“You have to look at function, the way the body functions,” Joy says. “If you’re not chewing your food enough, your body is working overtime to try to digest it. It’s having the ability for the muscles to support the [oral] arches. I see so many people that have had orthodontics, after which their teeth move. They feel it’s their fault, because they didn’t wear their retainers. However, it is because the muscles are not retaining that [position], because the muscles have not adapted to the structure.”
The impact on airway and long-term health implications
“breastfeeding is a vital sign”- Michale Chatham
Babies must be able to suck, swallow, and breath. Breastfeeding allows swallowing and breathing at the same time. The development of the swallow and airway are directed by early feeding. As babies learn to talk they will lose the ability to breath and swallow. Treatment to release a tongue tie creates a wider range of mobility for the tongue, enabling it to rest on the palate. This can help a person sleep more soundly because the tongue will no longer block the airway throughout the night. While the tongue is remarkably able to compensate, and many children have no speech impediments due to tongue ties many others have.
If a tongue tie is left untreated, oral issues can follow a baby into childhood. Signs and symptoms of a tongue tie during childhood include:
· Trouble articulating sounds (- l, r, t, d, n, th, sh, and z)
· V-shaped notch at the tip of the tongue
· Inability to stick out the tongue past the upper gums
· Inability to touch the roof of the mouth
· Difficulty moving the tongue from side to side
Tongue ties have an impact on oral and facial development, which can impact the development and functions of the airway if left untreated. These symptoms are often present in adolescents or adults with tongue ties:
· Nasal breathing
· Heavy snoring
· Disproportionate grown of lower jaw
· Deficits in midface development
· Altered palate development
· Restricted movement of the tongue
Preparing for a change
“motion ignites cell function, unless you are moving, your cells are not in high function,
they are not hydrated or charged” - Dana Chen, Gina Bria
Babywearing. Postural stability is an important part of preparing for a tongue tie release. This can be done by babywearing. There are many more benefits to babywearing including less crying and easier breastfeeding.
Craniosacral therapy (CST) involves the gentle manipulation and normalization of the cranial bones. CST also involves the treatment of the underlying membranes that provide the dural structure of the cranium as well as their continuation to the sacrum as they surround and support the brain and spinal cord. Craniosacral therapy also addresses the soft tissue affecting the craniosacral system. Any imbalance of the craniosacral system can result in imbalances of the gross anatomical structures as well as producing a myriad of unwanted symptoms. The goal of CST is to bring the skeletal structure, particularly that of the cervicocranium and its underlying membranes back into balance. A general principle of this work is that as the structure is normalized, function will follow.
Dentists have a unique role in health care. The work that they do goes far beyond the teeth and gums. Oral health has ramifications throughout the persons entire system. Craniosacral therapy enhances the dentist's ability to have this profound influence. The utilization of craniosacral techniques assures a more holistic approach in dental care. Craniosacral therapy provides benefits before, during, and following dental procedures.
Chiropractic care during pregnancy is important for mom. Postpartum it is important for both baby and mom. Chiropractors can help baby stay healthy but can also help with developmental milestones, snoring, sleep apnea, feeding challenges, pooping, respiratory and digestive functions. Chiropractic care before a release can help baby get in the best alignment for the release do be optimal. A Chiropractor will assess the cranial nerves which can affect function in all parts of the body.
Lactation support is a key part of bringing all the components together.
A functional assessment by a lactation consultant helps to gather information which can be shared with a skilled provider. Breastfeeding support before and after a release will help mom and baby adjust to the changes in latching. The consultant can also look at the whole picture and work with the mom and baby on everything from nutrition to emotional support. The consultant helps mothers and baby’s before a release and afterwards to help plan and prepare the mother and baby for any challenges that may arise.
Release of the ties is only a step in the process
A release is a large part of improving breastfeeding for mother and baby. Many different symptoms are often resolved after a tongue tie release. Reflux is a common symptom of tongue tie, in one study over half of the infants diagnosed with reflux had their symptom resolved. Around 1/3 did not have reflux resolve with just the tie but there are other things that can also cause reflux including the gut health of the mother/baby. Breastfeeding issues can be significantly improved after a release and continued breastfeeding rates are improved. For some motherbaby dyad’s an improvement can be seen immediately and for others it may take days, weeks or months.
“any tongue tie causing breastfeeding problems is truly a posterior tongue tie;
a percentage of those ties also have an anterior component.
Failure to release all of the abnormal collagen fibers results in persistent tongue restriction.
When providers claim to release 80-90% of the restriction, the dyad can often see 0% improvement.”
- Dr Bobby Ghaheri
Wound care and elevations
Post release it is important for parents to be shown how to do active wound care and appropriate elevation techniques as well as body movement to help lessen the chance that further restrictions will develop. After the release parents should be sent back to their lactation consultant and when necessary baby should be referred for the appropriate bodywork in order to reduce the tightness of the structure of the head and neck.
All newborn infants should have an initial oral evaluation soon after birth especially if the mother has questions or concerns. Infants having difficulty in achieving a deep, comfortable and efficient latch onto a mother’s breast should be examined a lactation consultant within 24 to 48 hours after birth and complete an oral evaluation of oral tissues especially of the tongue and upper lip attachments. If that doesn’t happen mothers should be supported to find a lactation consultant who can answer questions and validate the mother’s concerns.
“Mothers should be given information concerning the effects of a shallow latch on her comfort and the infant’s ability to latch. Upon completion of the assessment and when there is a diagnosis of tongue and or lip ties the infant should receive treatment by a properly trained surgeon as soon as possible and then returned to the Location consultant and when indicated receive proper post surgical body work.” -Dr. Kotlow
Sources and resources
Jennifer Tow, BFA, MA, IBCLC, RLC, OMT, http://holisticibclc.blogspot.com/
Dr. Kotlow http://www.kiddsteeth.com/
Dr. Ghaheri http://www.drghaheri.com/
Alison Hazelbaker http://www.alisonhazelbaker.com/
Tongue Tie Babies Support Group https://www.facebook.com/groups/tonguetiebabies/
Speech Therapy & Tongue Tie: https://www.facebook.com/groups/speechtherapyandtonguetie/
Coalition of Speech-Language Pathologists for Tethered Oral Tissues: https://www.facebook.com/groups/500245043460710/
Tongue Tied Adults Support Group: https://www.facebook.com/groups/1494393564165999/?fref=
The Assessment and Diagnosis of the Tongue and Upper Lip Ties in Breastfeeding Lawrence Kotlow, DDS
The Symbiotic Partnership of Dentistry And Craniosacral Therapy (Part One) by Benjamin Shield, Ph.D. Kathy Leeper, MD, IBCLC
Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie) 2016 Scott A. Siegel, MD, DDS. Int’l Journal of Clinical Pediatrics
Breastfeeding Improvement Following Tongue-Tie and Lip-Tie (2016) Release: A Prospective Cohort Study. Bobak A. Ghaheri, MD; Melissa Cole, IBCLC;
Evaluation and treatment of breastfeeding difficulties associated with cervicocranial dysfunction: a chiropractic perspective By Sharon Vallone, DC, FICCP
“Breastfeeding is a whole dyad experience, taking place within a complex ecosystem, an ongoing, interdependent communication between 2 bodies, 2 minds, 2 hearts and 2 beings in a complex and nuanced dance that defines wellness for both members.” -Jennifer Tow
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