Tongue tie, lip tie, cheek ties…..all the buzz words these days it seems. Take a look at any parent/mom centered FB group and you will see countless posts about this. As an IBCLC who has seen many babies over the years, I too sometimes question “why so many?!”. Many professionals will dismiss parent concern when asked “Do you think my baby has a tie?” in the presence of a fussy, gassy, spitty baby, maybe a baby who isn’t gaining as well as they should, painful feeds for mom ( and often baby too). While the cause of these symptoms can be many things, they all warrant a deeper look.
Anatomy of the Tongue and Oral Structures
Let’s first talk about what an oral restriction IS.
Well, before we talk about what an oral restriction is, we need a little anatomy class.
Cleveland Clinic defines the tongue as “A digestive organ. Your tongue moves food around your mouth to help you chew and swallow. It also helps you make different sounds so you can speak and form words clearly. Your tongue helps keep your airway open so you can breathe properly, too.”
The tongue is made up of 8 muscles, all innervated by nerves and vasculature. The anatomical piece of concern is the lingual frenulum. When you suction your tongue to the roof of your mouth, you will see it inserting to the bottom side of your tongue and then inserting somewhere on the floor of your mouth or posterior gingiva (back side of gums). Depending on where this “band” inserts into your tongue, it may be very visible or only slightly so (called submucosal).
Assessing Oral Restrictions: Beyond Visual Examination
The problem with this structure isn’t about visibility but about how it affects tongue function. Simply seeing a picture of someone’s tongue can’t diagnose tongue tie or lip tie; a full oral assessment, including feeding evaluation for babies, is needed. While IBCLCs can’t diagnose, we’re trained to spot symptoms and conduct oral assessments to identify functional deficits and compensations.
Functional Impact of Lingual Frenulum and Maxillary Frenulum
Just like lingual frenulum tethers the tongue to the floor of the mouth, the maxillary frenulum connects the upper gingiva to the upper lip. You guessed it, function determines whether a release is warranted, although many descriptors can characterize this attachment.
Factors Contributing to the Rise in Tongue Tie Concerns
So now that we have a little anatomical foundation laid, back to the whys.
1) Breastfeeding rates have increased over the past 20 years.
According to 2022 CDC Breastfeeding Report Card, 83% of babies in the US were ever breastfed with almost 25% being exclusively breastfed through 6 months. This compares to 2007 where only 73% of babies were ever breastfed with just over 11% being exclusively breastfed through 6 months.* A mom can report pain and discomfort, whereas a bottle cannot.
2) Poor Feeding Evaluation
How many parents who chose to bottle-feed only received instruction on how to bottle-feed their baby? Or did hospital staff and/or their pediatrician observe them while giving their baby a bottle? Many babies can muddle through bottle feeds, gain weight and otherwise seem “fine” without actually eating in a functional pattern. The bottle is not going to complain if the baby is clamping, or leaking milk etc.
3) Industrialization
Katherine Reynolds Lewis wrote a fabulous article that delves into thoughts about the changing structure of our skulls, jaws, palates, and airways. Science suggests that crooked teeth, overbites, narrow jaws, and crimped nasal airways are a modern phenomenon. Skeletal remains show that just 300 years ago, humans commonly displayed straight, perfectly aligned teeth, wide jaws, flat palates, and the large nasal passages that signal habitual, healthy breathing.
Pediatric dentist Boyd in Philadelphia argues that industrialization interrupted ancestral patterns of weaning and feeding. Babies used to nurse on demand for years while also trying solid foods under adults’ watchful eyes. However, widespread adoption of bottle feeding, pacifiers, and soft processed food deprived toddlers of practice chewing and distorted the shapes of their mouths.
During proper development, the tongue moves along the roof of the mouth to push nutrients toward the esophagus, gently expanding the palate and exercising the lower jaw, lengthening and widening it over time. If a child’s jaw is too short and palate too narrow, their tongue cannot rest against the roof of the mouth and instead rests against the lower teeth. This causes them to routinely breathe through the mouth, an unhealthy habit. Then, as they lie flat to sleep, the tongue may fall back to block the throat, causing apnea. This can worsen into a vicious cycle through overuse of bottles, pacifiers, or sippy cups, misshaping the teeth and mouth. Malocclusion and its resultant sleep problems form part of the cluster known as diseases of civilization, including obesity, stress, and depression. Our modern lifestyle and environment largely cause all these conditions.
Conclusion
In conclusion, when evaluating oral function, many factors come into play. Whenever a parent expresses concerns, conducting a full feeding assessment can prove immensely helpful in addressing those concerns. The presence of an oral restriction is not necessarily implied. However, crafting a personalized feeding plan can offer insights and methods for improvement, with ongoing assessment of progress. At Bayou City Breastfeeding, we are not just experts in breastfeeding; we are also well-trained in all aspects of infant feeding!
*https://www.usbreastfeeding.org/usbc-news–blogs/a-closer-look-at-the-2022-cdc-breastfeeding-report-card
