Hearing that your baby may have oral restrictions (such as tongue, lip or buccal ties) may evoke a ton of emotions: worry, relief, disappointment, anger, etc.

It's been my experience that many new parents, especially when oral ties are suspected early on as a cause of their discomfort and their baby's slow weight gain, go through a worry-disappointment-denial cycle, which may ultimately result with the cessation of human milk feeding.

Others may feel relieved and ready to tackle the issue head-on, feeling motivated that they may be able to achieve their ideal version of their human milk feeding relationship soon after treatment.

Whatever category you fall under (or even if you're somewhere in between), it's essential that you understand the benefits and risks of treating oral restrictions, the benefits and risks of choosing not to treat them, and the impact both options may have on your human milk feeding relationship.

I've decided to break each part into a separate blog post, and for today's post, I want to focus on the benefits and risk in choosing not to treat your baby's oral ties.

Understanding tethered oral tissues.

It's often challenging to understand fully what constitutes a tongue or lip tie and how a small band of tissue can cause so many problems with oral development, speech, feeding, and breathing!!

Want to see photos of before and after a release? Check out this post, which gives you a visual of how a release can improve range of motion.

Does the concept of tongue-tie just not make sense? I’ve written a blog to provide some clarity on the topic, which is admittedly very confusing to many.

Essentially, though everyone has a band of tissue (frenulum) under their tongue between their upper and lower lips that attach to the gums, those with restricted oral tissues have frenula that are either too short or inelastic to provide the proper range of motion.

The reality of ties

It's often tempting to look at tongue/lip restrictions as a "breastfeeding" issue rather than what it actually is: an anatomical anomaly that causes a deviation from the typical biological trajectory.

In other words, regardless of what or how you're feeding your baby, a limitation of movement inhibits, prevents, or alters the optimal development of multiple body systems.

Want to assess the impact oral restriction may have on your baby’s tongue function? Download this at home Oral Assessment Sheet

The benefits of not treating oral ties

The benefits of not treating ties depend on what we define as treatment.

It's my personal and professional opinion that the management of oral restrictions needs a multidisciplinary approach: Involvement of an infant feeding expert/ Lactation professional, a well-qualified and experienced release provider, and an appropriate bodyworker.

A parent may choose not to seek care from any or all of the providers mentioned above. I often find that the release, which is a quick, surgical procedure, gives most parents pause. For those who do choose to pursue a release, many do not get the suggested pre and post releasebodywork.

So discussing the benefits of not treating in this context depends on which aspect of treatment you're considering foregoing.

Release

The main benefit of choosing not to revise is that you avoid the costs and risks associated with the revision.

Bodywork

The main benefit of choosing not to do bodywork is that you avoid the costs and risks associated with bodywork.

Lactation consultant/Infant Feeding expert

The main benefit of choosing not to seek care from a Lactation consultant is that you avoid the costs of visits.

The risks of not treating oral ties

Before I discuss the risks of choosing not to treat oral ties, it's important that I state this loud and clear: In the absence of treatment, babies will compensate (some better than others) around the limitation in function, and most will continue to grow with minimal additional intervention.

Which explains why many will not be diagnosed with tongue or lip tie until later in childhood/adulthood despite having the "signs and symptoms" of restricted oral function.

Compensation, however, does not equal optimal development and the consequences of improper oral function are necessary to understand.

I find that sharing information from providers who treat ties in adults or older children can help parents see how ties present issues throughout life.

Here's a video from the Breathe Institute, where Dr. Zaghi gives a presentation on what sparked his interest in oral restrictions as an ENT, how an understanding of tethered oral tissues changed and improved the quality of care for his patients, and his perspective on the importance of appropriate and adequate treatment.

Not getting proper treatment for oral ties may lead to any of the following:

• Improper oral development affecting the hard palate, mandible, and dentition

• Airway problems such as snoring, apnea mouth breathing, upper airway resistance syndrome (UARS), and disordered breathing

• Impact facial development

• Increased risk of cavities, need for braces, "failed" dental treatment, swollen adenoids or tonsillectomy

• Jaw tension, jaw pain, teeth clenching and grinding

• Chronic headaches/migraines

• Postural changes such as forward head posture

• Speech or feeding issues, such as gagging, choking or vomiting foods

infants, oral restrictions can lead to :

• Failure to thrive regardless of if breastfed or bottle-fed

• The inability to safely manage fluids leading to aspiration

• Reflux and gassiness due to taking in too much air (aerophagia)

• Sleep disturbances/ sleep deprivation

Final thoughts

As a professional who evaluates and supports infant feeding, it's hard to be unbiased as there is strong evidence supporting a multidisciplinary approach (of at least release and lactation support) in cases of confirmed oral ties. Unfortunately, our current understanding of oral restrictions is relatively new, and there's no perfect, one size fit all plan for every baby. Additionally, the costs of treatment can add up quickly, making it a prohibiting factor for many who do desire to get treatment but can't afford to do so.

It's true for all babies, but especially crucial for babies with oral restrictions, that they receive ample and tailored tummy time activities and get management for any feeding dysfunction. Close lactation support is essential, and guidance in selecting bottle teats (if being used) is extremely helpful in ensuring a safe and stress-free feeding experience for your baby. Lastly, avoiding devices that further impact oral development (such as pacifiers) should be a consideration when choosing to forego or postpone treatment.

If you have a baby with oral restrictions and need help in developing a plan for treatment or if you've decided to not move forward with treatment but still struggle with infant feeding, please schedule a consultation as soon as possible.