I was recently interviewed by Sheila Coles from the Morning Edition on CBC Regina. We were discussing tongue ties, laser revision and new supports coming to Regina.
Here is a link for anyone wanting to have a listen
Some of what was higlighted in the six minute discussion I have summed up below plus expanded a small amount for clarity.
The definition of (tongue or lip) tie is restricted mobility as a result of a short and/or tight frenulum.
Restricted mobility impacts the function of the tongue. (And the tongue is a key player in breastfeeding).
The definition of a tie is a functional one used in conjunction with visual assessment. Using only appearance qualities to make a diagnosis causes professionals to miss some ties but could also lead to over-treatment.
Visual assessment alone is not adequate for diagnosis and treatment decisions. The evaluation of function must take precedence over appearance so that over treatment can be avoided. Depending on symptoms will depend on who you may need to help make an assessment. (Lactation consultant, dentist, speech pathologist, chiropractor, osteopath,etc) It can be a interdisciplinary approach from assessment to treatment.
2-12% (and perhaps higher) of the population are said to be affected by ties depending on the population under study and the definition used. There are various grades of ties identified which can impact symptoms, diagnosis and treatment. The current lack of awareness and education are often barriers to assessment & treatment.
Like everything in medicine advancements are made. Lasers have now provided us advancement in treatment of oral restrictions with benefits over scissor releases.
Scissors bleed, can be messy, cannot always reach all ties efficiently and have more of a one-time chance. Lasers do not bleed, user has more control, practioner can get back further to ensure a deep enough release and can assess as the procedure is being done. Lasers also have anesthetic properties as well as antibacterial properties.
Symptoms can be maternal and/or baby: maternal pain, nipple damage, engorgement, mastitis, thrush, low milk supply, weight loss in baby, slow weight gain in baby, failure to thrive babies, reflux, colic, digestion issues, fatigue, slow feeds, difficulty latching, gagging, choking, coughing, breast refusal, shallow latch, chin tremors, clicking noises, fretful
• Inadequate latch that interferes with milk transfer
• Insufficient milk intake and inefficient feeding due to inability to maintain and adequate tongue seal
• Nipple/breast pain and damage
• Compromised normal suck-swallow-breathe patterns
• Long feeds
• Possible weight gain compromise
• Reduced milk supply
• Early weaning
• Need to supplement
• Bottle-fed baby can also struggle
• Babies may have trouble with solid foods (reverse swallowing)
• Speech may be affected
• Orofacial development (high, narrow palate, orthodontics)
• Dental issues
• Increased salivation
• Airway integrity and apnea
Feeding and milk supply concerns can be worked on with the assistance of a Lactation Consultant. There are various tools and management techniques that can be used depending on each unique situation.
Tongue mobility is the goal of laser treatment. The secondary results, such as increased milk transfer occur only when treatment restores optimal tongue placement, movement and strength.
Function restoral is generally dependent on a team approach to care including dentists, bodyworkers (osteopathy, chiropractic) and lactation consultants.
When breastfeeding is the concern the earlier the treatment the better but that is not to say later treatment is not beneficial to other symptoms that may arise.
Tongue ties are a controversial and subjective topic currently.
The team approach will be growing in Regina soon with a local dentist coming on board to help with treatment.