Tongue and lip ties for babies
When tongue function is restricted by a tongue tie, everyday tasks can be affected.
The function and position of the tongue is important in feeding, speaking, during sleep and breathing.
- Painful nursing
- Creased or flattened nipples
- Blistered or cut nipples
- Incomplete breast drainage
- Plugged ducts, frequent engorgement or mastitis
- Inability to nurse without a nipple shield
- Decreased milk supply
- Feeling frustrated
- Suboptimal or shallow latch
- Slow weight gain*
- Clicking or smacking noises when eating
- Dribbling milk out of mouth while feeding
- Popping on and off the breast
- Slipping shallow on breast or bottle
- Inadequate suck strength
- Slow feeds
- Frequently falling asleep before completing a feed
- Very frequent feeding and baby appearing never satiated
- Top lip curling under while nursing/bottle feeding
- Suck blisters on the lips or two-toned lips
- Milky tongue or two-toned tongue
- Choking, gagging, coughing when feeding or eating solids
- Gumming or chewing the nipple
- Difficulty using a pacifier
- Difficulty using a bottle
- Snoring, noisy breathing or mouth breathing
- Mouth staying open when sleeping or at rest
- ...and more
*Please note: Slow weight gain can be a symptom of a tie but in many cases, it is not. Your baby may have very good weight gain, but you may be experiencing some of the other symptoms listed. Please do not take good weight gain as a reason to delay getting support in resolving a potential issue. Some health care providers (while well-meaning) may tell you that as long as there is good weight gain, you should not worry about anything else! You deserve to have a pleasant, pain-free, and stress-free feeding experience and weight gain is only one of MANY markers for whether or not a child is feeding well!
If you think your baby may have a tie:
Our Squad Approach
The tongue is connected by fascia (connective tissue) to many different structures in the mouth, head, neck, shoulders, chest, back, and ultimately, the rest of the body. These structures need to function well in order for bodily processes like eating, sleeping, speaking and breathing to work properly.
It is important to think of a tongue-tie as one piece of the puzzle, and the child as the full puzzle. While your baby may indeed have a tongue-tie, it is important to address all of the pieces of the puzzle together in order to quickly and thoroughly resolve the issue. Take the case of the infant who is struggling to breastfeed, who has a tongue-tie, as well as head/neck tension from the birthing process. While we can treat the tongue-tie, it would be equally important to make sure that the family has support from an IBCLC to optimize feeding, (because a tongue- tie is not the only reason that a baby may not feed well), as well as addressing the head/neck tension by seeing a manual therapist (because this can impact tongue function and the baby’s ability to get into a comfortable position for nursing).
During your consultation with us, we will make recommendations on what other types of support you may need for your particular scenario. No two babies are the same!
Examples of different practitioners we commonly work with:
- IBCLCs (International Board Certified Lactation Consultants)
- Osteopathic Manual Practitioners
- SLPs (Speech Language Pathologists)
- Myofunctional Therapists
- Occupational Therapists
- Medical Doctors
What to expect during the consultation
At your appointment, you will be assessed by an IBCLC as well as a dentist. During the appointment, you can expect:
- A history taking, going through your baby’s birth history and current feeding circumstances to help us determine the root causes of the issues
- The IBCLC will observe a feeding (either at the breast and/or bottle) and may make adjustments or suggestions to help optimize feeding
- A functional assessment of the child’s ability to nurse/feed/use their mouth effectively
- The IBCLC and the pediatric dentist will do a full intra- and extra-oral assessment looking at the child’s face, jaw position, mouth, teeth (if any), and the child as a whole
- Together, you, the IBCLC and pediatric dentist will have a thorough discussion of options, reviewing the risks/benefits of each, focussing on the ideal timing of the release for your family, if needed.
- In some cases, a same-day release can be offered and we will assess these on a case-by-case basis. However, for some families, this may not be the case because it may not be the ideal way to address the issues at hand. For some children and families, treatment with other healthcare professionals (like IBCLCs, manual therapists, SLPs, etc.) may be recommended in conjunction with our treatment to maximize the benefits of a release.
- If a release is recommended, we will review the procedure with you in detail, including all pre- and post-operative instructions.
There is no pressure or expectation that you must do a release on the same day as your consultation. However, if this is your goal, please let us know! In striving to optimize the timing of a release, we can ensure that we give every child and family the best care possible. Ultimately, we believe in shared decision making for every family and scenario, and we aim to create a plan that takes into account your particular challenges and goals.
What to expect during the tongue/lip tie release
The procedure will take place in a treatment room while parents wait in the consultation room. This is standard protocol when operating a laser. There are 2-3 assistants in the room along with the dentist. We will prepare the baby by giving oral sucrose (sugar water) for pain relief, swaddle the baby, and then put goggles on the baby. We will take some photos of the mouth. Then, using our LightScalpel CO2 laser, we will conduct the frenectomy (tongue-/lip-tie release). Our CO2 laser allows for a very quick and smooth release, taking between 5-10 seconds per site. Afterwards, we will take some photos of the wound, and then we bring the baby back to the parents to feed and soothe the baby. Top to bottom, the whole process takes between 5-7 minutes.
After the procedure
Immediately after the procedure, we will soothe and try to feed the baby. Whether they are nursing or using a bottle, feeding and sucking will calm the baby and provide some immediate pain relief. The lactation consultant may assist you in feeding should you require it. Afterwards, we will show you how to do the post-operative stretches and then we will have you demonstrate the stretches on the baby to make sure you are comfortable with them, PDF instructions can be found here. One of the benefits of using a laser is that we are able to show you how to do the stretches efficiently and effectively before leaving our office, since there is very minimal bleeding following a laser procedure.
Any open wound will naturally contract and heal, and this results in the formation of new tissue and frenum, or “reattachment”. After a frenectomy, the goal is to prevent as much reattachment as possible so that we can maintain good mobility and function of the tongue. The goal is to have the area heal slowly, and for the new frenum that forms to be more mobile and flexible than before, allowing for ideal function.
We see all of our families 1-week and 4-weeks after the procedure to assess the wound and the healing. Additional follow-up may be recommended on a case-by-case basis.
Your child may experience some discomfort after the release. The best way to comfort a younger child/infant is to employ lots of skin-to-skin, and lots of feeding on cue, whether you are breastfeeding or bottle feeding. Some babies may require Tylenol. Ibuprofen can also be given for children 6 months of age or older. Please see our chart below for dosing instructions for Tylenol. Some people use homeopathic remedies like arnica.
We will also recommend exercises specific to your baby in order to:
a) Prepare your child for the procedure b) Ensure optimal healing of the wound after the procedure c) Show the baby that intraoral exercises can be fun and comfortable!
Frequently Asked Questions
We very frequently encounter families who have been told by multiple healthcare providers that their baby does not have a tie. In order to properly assess and diagnose a tongue tie, a thorough and functional examination should be provided by a professional specializing in tongue-/lip ties. It’s important to seek a second opinion if you/your baby have symptoms consistent with a tie even if you’ve been told that everything is fine.
We recommend limiting pacifier use after a release. The purpose of a tongue tie release is to allow the tongue to have good upward mobility, ideally having the tongue be suctioned to the palate at rest. When there is a pacifier in use, the tongue is pushed down and not able to reach the roof of the mouth because there is a physical barrier. If your baby is used to using a pacifier and you are scheduled to have a release, consider slowly decreasing the time that your baby is using the pacifier. You may use it for 5-10 minutes to calm your child or put them to sleep, removing it once the child is calm or asleep. The goal is to make sure the pacifier is not used consecutively for hours of the day.
A couple of days after the procedure, the wound will become white or creamy coloured- this is the wet scab that forms and is part of the normal healing process. It may appear yellow or orange if your child had elevated bilirubin after birth (jaundice). This white or yellow appearance can remain for a couple of weeks after the procedure.
Because we use a laser, it cauterizes the tissue in the area and normally there is very little bleeding during and after the procedure. When you get home and begin stretching, some spotting may occur, particularly if you do a stretch after a long period of time without stretching, or if you do a very deep stretch. Any bleeding should stop very quickly with some sucking as this will apply pressure on the wound. You can either let the baby suck on your finger, latch on the breast or feed on a bottle. You may also use gauze and pressure to stop any bleeding if desired.
You can call us at any time during office hours at 416-825-1818. After hours, please call the emergency phone number listed on our voicemail.
There will be minimal pain experienced during the 5-10 second procedure and some post-op discomfort can be expected within the first few days after. This can be mitigated with lots of skin to skin, feeding on cue, and pain relief medication as needed.
We have many patients in our practice who have had tongue ties released elsewhere who still have tongue ties. Unfortunately, some providers only release the front (anterior) part of the tie but do not release the back (posterior) part of the tie and this can result in persistent symptoms of tongue tie. In some cases tongue ties can heal back together without the proper post operative stretching. After a release there is always going to be new tissue (frenum) that forms in the area of the tie and without proper post operative care, the new tissue can be just as tight as the original tie was.
If you have dental insurance benefits for your baby, some or all of the fees may be covered. Everyone’s insurance coverage is different, so please contact our admin team at 416-825-1818 and we will be happy to assist you.
We always try to watch a feed as that gives us information about how your baby is functioning. Please be prepared to feed your baby during the visit.
A list of questions is always welcome. We want you to be as informed as possible!
ABSOLUTELY! We find it very helpful to have any caregivers involved in the decision making process present throughout the process.
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