5 Questions You Should Ask Your Baby’s “Tongue Tie” Provider

These are 5 major questions that you should ask your release provider when deciding to work with them to release your baby’s oral restrictions.

Question #1

What training did you undergo to learn release procedures?

This is a big one. Similar to IBCLC’s, not all release providers have the same level of training or education in assessment of oral restrictions, management of breastfeeding issues related to oral restrictions, nor do they have the same level of training when it comes to release procedures. The science around release procedures has changed over time especially with the use of new tools and assessment strategies.

The use of scissors versus a laser release is always a hot debate. In my experience, the tool does not matter so much as the skill of the provider, their follow up recommendations, and their willingness to collaborate. A scissor release with proper follow up care can, in many cases, can be as effective as a laser release with proper follow up care. There are times that a scissor may not be a sufficient method of release especially when dealing with submucosal ties. I have worked with providers who use scissors and in cases of submucosal ties they will recommend a laser release for optimal outcomes. It is important that whatever provider you chose, they are willing to recognize their own limitations, collaborate and stay up to date on best practices.

The timing of a release is important. If a release provider is recommending a release without an IBCLC assessment or counseling, it is important that you advocate for yourself and ask for IBCLC referrals first. A baby can have a tie but rushing to release that tie can result in more issues that can complicate your experience, often times waiting until all the pieces are in place before releasing the restriction and ensuring your baby is ready to be released will result in optimal outcomes.

Question #2

Do you use evidenced based grading tools to grade tongue ties and lip ties?

Grading a tie is important to assess functional improvement. If we know what the starting point is as far as function and appearance it is a clearer indicator of post release functional improvement. Any release provider should be able to tell or show you which evidence based grading tools they use when assessing tongue ties. Your IBCLC should also be using similar tools. For example, I use an evidence based grading tool that gives a score for function and appearance, along with subjective questionnaires to assess symptoms you and your baby have been experiencing. These tools are essential for proper timing of the release, to track improvement and treat patients holistically. It is one big piece of the overall assessment.

Question #3

What kind of follow up support do you provide?

Follow up support from an IBCLC is essential when dealing with oral restrictions but your release provider should also be following up with you. How else do we know our methods are effective? Important follow up points are at 1 week, 3 weeks and 3 months. Not all babies will need a 3 month follow up in person, this may be a simple phone call to see how things have progressed but these are key points post release to assess progress. At 1 week if your release provider sees any attachment they can do a deep stretch to reopen the wound and reduce the chances of having to do a second release. An IBCLC trained in proper post release care can also do this deep stretch. Your release provider should be recommending follow up with an IBCLC within 1 week of the release. After that, your IBCLC can schedule visits as needed.

Question #4

Do you collaborate with a team and how does that team function and communicate?

A team approach to treating and managing oral restrictions is ideal and leads to optimal outcomes and optimal timing of release. Many babies need body work prior to a release and after a release. Depending on the age of your baby, they may need the assistance of an SLP knowledgeable in ties to help with developmental delays as a result of the oral restrictions. Everyone on the team should be sharing reports and take into consideration each others evaluations to determine a treatment plan collaboratively. Your team usually includes a release provider, IBCLC, and body work provider. Body work providers may be craniosacral therapists and/or pediatric chiropractors, preferably specializing in neurospinal chiropractic care. If your baby is older and already delayed in taking solids or other milestones as a result of oral restrictions then the help of an SLP knowledgeable of the impact of ties on development, will be instrumental in reaching optimal outcomes more quickly.

This team should be communicating regularly throughout your baby’s care, sending reports to each other so everyone is on the same page. This is why the providers I refer to are carefully considered, I want to ensure my clients are getting the most up to date care and information. It is important for everyone to be on the same page when it comes to follow up care.

Question #5

What are your recommendations for stretching and wound healing after release?

This is another important question. A release procedure is surgery. I have worked with orthopedic/surgical patients for many years and PT/OT is almost always recommended. We know that when incisions are made, wounds heal, scar tissue forms and limited mobility is possible. Stretching that area and doing exercises to regain function is imperative. The same is true for oral muscles. Depending on the level of function prior to the release, babies have different needs. Depending on their age at the time of the release, their needs are different.

As Dr. Richard Baxter says in his book Tongue-Tied, “We need the wound to close in like curtains, not come together like blinds.”

Regularly stretching the tongue throughout the day ensures that the would heals properly. There are various exercises that parents can do to help their baby regain muscle strength and tone. IBCLC’s knowledgeable in oral restrictions can review these exercises with you, if developmentally your baby needs more help they will refer you to an SLP (Speech Language Pathologist).

With this being said, even in the best cases, with parents who are diligent about stretches and exercises, reattachment can still occur. Some babies just heal too well! However, this reattachment will be much less then if the stretches were not done. This is why close follow up in the first week is important, we know that even in optimal conditions this is always a possibility and risk, but having close follow up can reduce any complications.

Why is there not better management of tongue ties?

We had many decades of bottle feeding being the norm in the US due to the impact of marketing of breast milk substitutes. As a result we have a generation of healthcare workers who never received this generational knowledge because it was lost. Tongue ties are not new and they are not a fad. There are numerous references to oral restrictions in many historical and medical texts. With increasing breastfeeding rates we absolutely are seeing an increase in oral restriction diagnoses because more and more people are trained to assess function of oral tissues. We are beginning to relearn this lost knowledge and we owe it to parents to redevelop these skills and work together.

What I know from working with families is that their experiences are varied but all are valid. Tongue tie management and treatment is not linear but there is a set of treatments and interventions that work. There are always going to be cases that challenge us and encourage us to look at the situation differently, this is the nature of ties. Having a collaborative, team based approach with various disciplines on the team comes with the advantage of having an abundance of knowledge across many scopes of practice, this gives parents the best opportunity for life changing outcomes.