All About Ties

How do I know if my baby has a tongue or lip tie?

Tethered oral tissues (TOTs) are not simply observed, meaning you can’t just see them and determine there is a problem. You have to watch the mouth and tongue in action, ie at the breast or bottle, to assess fully. Lactation consultants talk a lot about “function,” which is how a baby’s mouth works. If a baby’s function is poor, they likely are not feeding well. If the baby’s function is good, they are likely doing just fine with feeding.

What are the symptoms of ties?

There are several symptoms of TOTs. This is by no means an exhaustive list, but here are some common signs:

• • Poor seal at breast, resulting in a ‘click’ or ‘slurp’ sound
  • Excessive gas, crying
  • Lip blisters
  • Bowl-shape or flat tongue when crying
  • Leaking milk from sides of mouth
  • Choking/sputtering at breast
  • Overactive letdown
  • Pain with breastfeeds
  • “Colic”

How are ties treated?

Typically, ties can be released by a pediatric dentist or otolaryngologist (ENT) who specializes in the procedure. The particular tool used varies, but most typically that tool is a CO2 laser or scissors.

Where do I start?

Seeing a lactation consultant who specializes in TOTs first (before making an appointment with a release provider) will give you a better understanding of your baby’s function and why they are behaving the way they are. A trained IBCLC will also give you oral function exercises. This will improve your baby’s function, as well as get them prepared for releases. They will also make referrals to preferred bodyworkers (such as a pediatric chiropractor, physical therapist, or occupational therapist) for help with the baby’s tension so that their outcomes are greatly improved. Once your lactation consultant feels the baby is ready, they will refer you to a preferred provider who then evaluates and treats the TOTs.

What happens after the ties are released?

You will follow up with your lactation consultant, your baby’s bodyworker, and potentially the release provider in the weeks following. This is to ensure appropriate wound healing and management as well as getting the baby back to breastfeeding well.