Tongue Tie in Alexandria
All About Tongue and Lip-Ties
What is a Tongue-tie or Lip-tie?
Most of us think of being "tongue-tied" as the situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common tight restrictive piece of skin (frenum) under the tongue. This ankyloglossia limits the movement of the tongue. Lip-tie is a condition where the upper lip cannot be curled out or moved normally because of a significant frenum. Before we are born, a strong cord of tissue that guides the development of mouth structures is positioned in the center of the mouth. It is called a frenum. As we develop in the womb, this frenum is supposed to recede and thin. The lingual (tongue) or labial (lip) frenum is visible and easily felt if you look in the mirror under your tongue and lip. Everyone has a frenum, but in some people, the frenum is especially tight or fails to recede and may cause tongue/lip mobility problems.
The tongue and lips are a very complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie restriction can lead to problems with nursing, feeding, swallowing, dental, orthodontic, speech, sleep, or breathing. Problems can even persist into adulthood with sleep issues, headaches, neck pain, shoulder pain, incorrect swallowing pattern, tongue position and lisping, stuttering and other speech difficulties.
Releasing the tight frenum
In the past, the only treatment that we had to release the tight frenum under the tongue or inside the lips was to cut it with scissors and then stop the bleeding and put in a stitch or two. In babies this may mean general anesthesia. Today with LASER we can accurately release the frenum in just a few seconds with no numbing, no bleeding, no sutures, and no pain. The healing time is just a few days and the results are remarkable. Often a therapist (cranio-sacral, speech, lactation, or physical) will do some retraining of the tongue to function correctly with its new freedom.
Please review this list of signs and symptoms which are frequently related to a frenum that should be released.
Possible Infant symptoms of a tongue tie or lip tie:
- Shallow latch at breast or bottle
- Falls asleep while eating
- Slides or pops on and off the nipple
- Colic symptoms / Cries a lot
- Reflux or spitting up.
- Clicking or smacking noises when nursing
- Spits up often
- Gagging choking or coughing when eating
- Gassy (toots a lot)/ fussy
- Poor weight gain
- Hiccups often
- Upper lip curls in or under when nursing
- Pacifier falls out easily
- Doesn’t like the pacifier
- Milk dribbles out of the mouth when nursing
- Short sleeping requiring frequent feedings
- Snoring, noisy breathing
- Mouth breathing, especially when sleeping
- Feels like a full-time job just to feed baby
- Nose congestion or milk coming up through the nose
- Baby frustrated at the breast or bottle
Possible Mother symptoms of tongue or lip tie, during nursing:
- Creased, flattened or blanched nipples
- Lipstick shaped nipples
- Blistered or cut nipples
- Bleeding nipples
- Poor or incomplete breast emptying
- Painful or shallow latch
- Gumming or chewing your nipple
- Infected nipples or breasts
- Plugged ducts, engorgement, mastitis
- Nipple thrush
- Using a nipple shield
- Pain on nursing
Possible Young Child symptoms of tongue or lip tie:
- Speech issues, difficult to understand
- Difficulty with some speech sounds
- Mumbling or “baby talk”
- Mouth breathing during day or sleeping
- Sleep issues, restless sleep
- Sleeping in strange positions
- Waking easily or frequently
- Grinding teeth while sleeping
- Sleeps with mouth open
- Eating issues, frustration with eating
- Slow eater, grazing all day long
- Picky eater especially with textures
- Choking or gagging
- Spits out some foods or refuses new foods
A Guide to Straighten Your Kid’s Teeth at Home
Parents can teach their kids good oral habits to help facial growth and prevent braces
Conventional wisdom tells us that braces are just destiny. Either our child grows straight teeth or they don’t. We can help them prevent tooth decay and gum disease, but we can’t stop their teeth from growing crooked.
But we now know that’s not true.
Creating good oral habits in your child may help their jaw and teeth develop properly. We now understand that a child’s jaw and tongue function heavily influence their teeth alignment. Correcting poor oral habits could help to prevent the need for braces.
Retraining the facial muscles may take time. How long will depend on the severity of the problem and how your child responds.
Overall, myofunctional training aims to build, strength, tone, and coordination in the face. This will help guide jaw and teeth growth and improve neural balance.
The broad goals of myofunctional training are to:
- Establish nasal breathing
- Develop good tongue posture
- Train a closed lip posture
- Assist in breastfeeding, eating, and chewing
- Improve sleep, speech, and function
In this article I’m going to outline a Facial Exercise Program for Children to help you get started on correcting your child’s oral habits.
I. Establish nasal breathing
Breathing through your nose is always the best and most comfortable. This is how we were designed to breath. Early training on nose breathing can have major health benefits for all of life in addition to shaping the mouth and teeth ideally. We now know that as we force ourselves to breath through our nose, the nose passages enlarge making it easier to breath through the nose. Not breathing through your nose causes the passages to shrink. So, it may be difficult at first to breath through your nose but it will start to improve in as little as 5-10 minutes and real structural changes will happen over several years.
Steps to help move your child toward nose breathing:
- Coach your child to close their lips and breath through the nose any time you see them mouth breathing. Especially inhaling through the nose seem to be important
- If they are sleeping you may be able to just push the lips together and start them nose breathing without waking them up.
- Day time nose breathing using tape. Using a mild medical tape (3M Micropore) and taping the mouth shut with a small “X” of tape across the lips can be a good training device. Put the tape on 1 minute at a time at first, working up a little at a time while watching TV or some other reward type activity where talking is not needed. Working up to 20-30 minutes at a time will instill the nose breathing habit.
- Night time taping: As the child becomes comfortable with the tape, and the nose breathing habit becomes more natural, you can begin taping a night as well. Sometimes just gently closing the mouth while they are sleeping can adjust their breathing positively.
Nasal Congestion: Cleaning your child’s nose may be more important for their teeth than tooth brushing.
Here are three approaches to prevent and manage nasal congestion in your child:
- Always wipe the nose area with a warm moist cloth.
- Nasal irrigation: use a small amount of warm saline with a Neti pot, to remove mucus.
- Slowing breath and building CO2 tolerance. Simple breath holding exercises can help to clear congestion and slow a child’s breathing. Guide the child to pinch their nose with their fingers and hold their breath for 5 seconds. Practice this together and gradually increase this to 20-30 seconds.
If your child has a chronic blocked sinus, please check to see that they’re getting enough vitamin D and introduce them to the Dental Diet. An ENT doctor may be able to evaluate tonsils and adenoid tissue size and help create a more open airway.
Breathing exercises to slow and normalize breath:
Ask your child to lie on the floor. They should place their hand on their tummy and take deep, slow breaths that lift up their hand. Encourage them to hold their breath and then breathe out slowly. Repeat 10 times.
Blow up a balloon
Encourage them to breathe deeply through the nose then out through the mouth, strongly, to blow up the balloon.
Straw and cup of water
Place a straw into a glass of water, then ask your child to breathe in through their nose and out through their mouth, into the straw. They will probably enjoy making bubbles!
Single nostril breathing
Ask your child to try breathing in through one nostril and then out through the other, using their thumb to close the nostril they’re not using. Then ask them to start with the other nostril, alternating between the two.
II. Develop tongue posture
To encourage the tongue to sit against the roof of the mouth.
Ask your child to:
- Open their mouth wide – and try to hold it open for a time. Time them and try to make it a game as you encourage them to do it again and break their record.
- ‘Pop’ their tongue. Ask them to try pushing their tongue to the roof of the mouth and making a ‘popping sound’ by pulling it down. Repeat 20 times.
- Tracing the roof of their mouth. Ask them to push their tongue to the roof of their mouth, with the tip behind the incisors. Then ask them if they can take the tip all the way to the back of the mouth and then forward again.
- Tongue trace outside teeth – ask them to close their lips with teeth open, push the tongue out into the lips. Keeping lips closed, the tongue can trace around the vestibule between lips and teeth going clockwise 10 times and then counterclockwise.
- Windshield wiper – Ask them to put the top of their tongue against their top front teeth and lips, and wipe their tongue from side to side like windshield wipers, so it touches the edges of the mouth. Repeat 20 times.
The correct swallow means that the tongue makes a seal against the palate and pushes water back in a wave-like motion.
Here’s a test for the correct swallow pattern.
Bite and swallow – Making a big cheesy grin with lips open. Hold the teeth together and cheeks away from the teeth with fingers. Guide the child to hold a small amount of water at the front of the tongue. They then push the water from the front to the top of the mouth, and making the water move back within the seal as the mid-tongue touches the roof of the mouth and then the posterior tongue raises up to touch the back roof of the mouth continuing to push the water back.
III. Train closed lip posture
Balancing and strengthening the facial muscles can help the lips to stay in a closed position at rest.
Lip stretches help to give the lips range of motion to close comfortably at rest:
§ Pull the lips over the front teeth and in, making the “look mom-no teeth” look with both the upper and lower teeth covered as the lips pull in.
IV. Assist in breastfeeding, eating, and chewing
After 6 months of age, hard solid food should be introduced into a child’s daily diet.
Encourage them to eat some raw vegetable every day, such as a small carrot or piece of celery. Chop food into manageable and chewable sized pieces. Let a child chew!
Gum chewing (with a natural no-sugar or artificial sweetener gum) exercises, can help to grow the jaw.
V. Improve sleep, speech, and function
- Encourage your child to practice maintaining a straight back, with their head back and shoulders level.
- Remind them to sit up straight
- Remind them to speak clearly and slowly (‘so that we can hear your brilliant ideas properly.’)
- Humming – deep humming (from the diaphragm) for 2 minutes once per day can improve their control,
- Practice vowel pronunciation with them.
The vowel game – say each slowly focusing on pronunciation.
‘I’ – pointing at oneself
Eye – pointing to eyes
Oww! – rubbing arm pretending to be hurt
Yay – raising their arms as though celebrating!
Yeah – nodding head in agreement
You – Pointing at another person in the room
Whoa! – Make the palm held outwards sign for ‘stop!’
Eeee – Encourage them to squeak like a mouse.
Spot the signs to prevent braces in your child
Good facial habits sit alongside a multidisciplinary approach to childhood dental growth.
**NOTE** These exercises use the principles that a myofunctional therapist or orofacial myologist will employ to correct facial imbalances. If you suspect your child has oro-facial dysfunction, always consult a professional.
A multidisciplinary approach will often work alongside an airway or sleep focused dentist, Often, calling on an ENT, speech therapist, chiropractor cranio-sacral therapist or osteopath can also help guide your child’s dental growth.
It’s natural to push these exercises with your child – you just want to help. But wherever possible, keep these exercises light-hearted and make them into a game.
Don’t be discouraged if your child has slow or delayed progress. Some neuromuscular habits will take a lot of time to become a habit. Avoid nagging your child or constantly drawing attention to the things they need to work on, such as tongue posture or nasal breathing. This may make them feel self-conscious or uncomfortable.
It’s important to remember that some children will require professional help and monitoring to achieve the correct function. Don’t be discouraged though, what you do at home is crucial in building the right habits into their future.