When a tongue tie is identified, often parents may be eager to have a release procedure especially if nursing has been very painful or baby is having lots of symptoms.
A restricted tongue, or lingual restriction of the frenulum, can also come with other body tensions, particularly in the neck, which has important impacts for suckling function. When you have a long, complicated, or difficult delivery we often find tension in baby’s neck and tongue muscles which are connected to a small horseshoe bone (hyoid) in the neck more often.This can pull that bone out of place and impact tongue function.
“The tongue is elevated toward the palate by the combined actions of the digastric, genioglossus, geniohyoid, and mylohyoid muscles. Elevation of the tongue may be compromised if there is restriction in the mobility of the hyoid bone, in effect tethering the tongue.”
Other muscle tension, like torticollis (tension in a muscle which wraps from the back of the head around the neck and attaches at the clavicle which causes head turning preference or baby’s head to tip to one side) which is fairly common in newborns, can also impact feeding. Addressing this muscle tension prior to a tongue tie release is essential for the best outcomes. “performing any surgical release in a child with torticollis might render a poor outcome if the torticollis is not treated first to resolution or at least improved range of motion”
Deciding when to release ties is crucial for the best path toward functional feeding.
Doing a frenotomy (tongue tie release procedure) before addressing contributing factors may result in poor outcomes. Addressing tension in the neck muscles and other areas of the body results in better outcomes and faster improvement towards functional feeding.
If we do a release right away, in some cases feeding can get worse because the release offers greater range of motion of the tongue but is also disrupts the "work arounds" baby has developed to feed. Work with your Lactation Consultant, and the provider they refer you to, to decide on the best timing for a frenotomy.
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