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tethered oral tissues (TOTs)

Breastfeeding is extremely painful? Is this how it’s going to be?

No, honey! It doesn’t have to be!

The medical term for tongue ties is Ankyloglossia. Tongue ties restrict the tongue's range of motion To move up down and side to side. The condition is present at birth, genetic and more prevalent in males. A short, tight band of tissue called a frenulum tethers the tongue's tip to the floor of the mouth. It can affect how a child eats and speaks, and can interfere with breastfeeding.

Symptoms include difficulty sticking out the tongue past the lower front teeth or lifting it to the upper teeth, though many people believe they have no symptoms.

Oh, honey I cannot begin to list the symptoms of tongue-ties in babees but adults have them too but more of that later.

I began my journey with tongue ties just like pretty much the consensus is in this field of not receiving skilled and savvy lactation support in the early days.

BRING HER A PUMP was all they said!

Hindsight is 20/20 right? No one ever thought to look in my babees mouth to see why he was chewing my nipples which resulted in a failed journey at two months. My second, I was able to “nurse” through an undiagnosed lip and tongue tie. Now tongue ties are tricky. Some babees can feed with oral restrictions but I promise they will show signs of compensation through tension by pulling to one side of the body, mouth breathing, snoring and more..

What exactly does a tongue tie look like?

Well you can't always see a tongue tie. In fact, an oral evaluation and functional assessment by a skilled pediatric dentist or ENT is needed to properly diagnose. Many babees I come across in my practice are told "It's a small lip tie, it shouldn't affect breastfeeding." but yet these parents are still facing symptoms with the most obvious being nipple trauma.

"You simply can't keep relatching the pain away."
- Jada Metcalf

Here are a few pics of (1) anterior and (2) posterior tongue ties which are highly misdiagnosed or unproperly released because it can be attached deep on the floor of the mouth and pretty much buried under submucosal tissue.

An oral restriction can include more than a tongue tie or it can include all of the complications listed such as low muscle and cheek tone, improper jaw development such as a recessed chin or high palates including a cleft lip palate as well.

There are classes of tongue ties that can be easily misdiagnosed by millimeters. This is why a skilled TOTs trained provider can effectively screen and assess oral function in breastfeeding babees.

What symptoms are present in infants with a tongue tie?

Symptoms in infants that warrant an assessment include:

  • Shallow latch at breast or bottle

  • Falls asleep while eating

  • Slides or pops on and off the nipple

  • Clicking sound while nursing

  • Reflux/gassiness/spitting up

  • Hiccups/Prenatal + Postpartum

  • Overly frustrated/colicky baby

  • Congestion

  • Snoring

  • Feeding feels like a full-time job (frequent feeding every 1-2hrs or more)

  • Poor weight gain

  • Milk dribbles out of the mouth while nursing/bottle feeding

  • Mouth breathing

Symptoms in Mom/Caregiver that warrant an assessment:

  • Pain during latching or nursing

  • Flattened/lipstick shaped nipples after feeding

  • Blistered/sore nipples requiring nipple shield

  • Nipple damage

  • Poor/ incomplete breast drainage

  • Blocked ducts or mastitis

  • Engorgement

  • Nipple thrush

  • Decreased milk production

Is that you and our babee, honey?

Wait, there's more..

Tongue-ties affect bottle feeding too?

Bottle feeding includes the suck, swallow and breathe pattern too and if babee cannot properly latch and create a seal to grasp the nipple of the bottle.

Many parents are told to give up their journey and just feed babee with a bottle. WTF?! This is lazy lactation and provider care.

I'll say it again....


Throwing bottles at mom is a simple fix that will not solve the issues they are struggling with from the tongue-tie. Switching to a bottle takes away the maternal aspect (pain, plugged ducts, supply issues, etc.), but it does not fix the infant issues of a poor latch, milk leaking out, reflux, excessive gas, colic, and slow feeding with possible weight gain issues.

Also, the most known complications is how tongue-ties can affect speech and language but we eventually move past the breastfeeding relationship and dive into our quality of life through eating, moving and breathing properly.

Everyday activities you do in life are profoundly affected by the tongue.…

Solids with a restricted tongue can possibly lead to sensory issues, picky eaters, gagging and choking because the tongue cannot move food around the mouth to chew and swallow. I’ve seen some toddlers 18+ completely reject food because it’s just too difficult for them to manipulate with their restr tongue. These types of cases are referred to feeding therapit’s calledan SLP.

What's the next step?

Finding a TOTs specialty trained lactation professional or IBCLC local or virtually, FIRST. There is a team

of providers to collaborate with in reprogramming the brain such at OTs, SLP, Osteopaths, Craniosacral Therapists, Chiropractors, Pelvic Floor therapists and of course the release provider. I am TOTs trained and can properly screen and execute a model of care for sustainable optimal nursing outcomes.

TOTs training and lactation support provides

"An E3 Model of Care® for TETHERED ORAL TISSUE. This includes relevant background information on how tethered oral tissues affect oral function from birth to maturity."

- Chrysalis Oromyofacial

I am trained to screen and assess your babees oral space for visual indicators of oral restrictions. I cannot nor can any other professional diagnose tongue-ties besides a pediatric dentist or ENT.

I have clinical experience at the Tongue Tie Therapy Center in Atlanta as well to assist mothers and caregivers with getting back to breast with my Untied + Latched model of care. My 8 weeks of ongoing support is a collaborative effort when it comes to releasing a tongue tie. It is not an instant nor easy fix. If there are complications that go beyond my scope of practice I have a web of specialty providers to refer to in order to keep the continuity of care moving. This model is aimed to keep the breastfeeding relationship in tact along with minor road umps of parenthood. Check out some more information on tongue ties

Everyone doesn’t choose to release the tie as they feel it will rip or stretch on its own. That’s highly likely it will rip in the toddler phase but who wants that? . Mine sure did as a small child but there is scar tissue there as well.

Again, tongue tied babees turn into tongue tied adults. There should be therapy provided which needs to happen before AND after a release to strengthen the tongue enough to sustain milk supply management on its own. We look for progression not perfection. Coupled with training and practice informed evidence my approach will continue the breastfeeding relationship without reattachment and progression for desirable outcomes.

If you are experiencing painful breastfeeding, book a home visit to address your breastfeeding and bottle feeding concerns. I am currently self pay and do not accept insurance.

***This blog does not replace the medical advice from your provider.***


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