If you had a well-respected release provider diagnose your baby with a tongue tie but recommended against a tongue-tie release, you no doubt are feeling confused. 

You may even feel guilty knowing that your baby has this issue, but there's nothing you can do to fix it because the provider who can, won't. 

At this moment, you're contemplating your options & need a little bit of clarity about why they may have said NOT to release and what your next steps should be.  

I've got you covered. :)

Here are a few reasons a provider might say no to releasing your baby

• Your baby is gaining well & breastfeeding isn't painful for you.

If these two criteria are the basis of your provider's no to your baby's release, it's essential to evaluate for other, more subtle signs that feeding is impacted. You can read about a few of these subtle signs of feeding dysfunction below.

• Your baby only has a "mild" tongue-tie

There is no such thing as a mild tongue tie. I repeat, there is no such thing as a mild tongue tie. 

Tongue-tie is a functional diagnosis, meaning for a diagnosis, the provider must acknowledge that there is an impact on function. 

The evaluation process aims to clarify one of the below: 

• Yes, there is a short or tight frenulum causing impairment in oral function

• No, there is no short or tight frenulum causing impairment in oral function

Even a short or tight frenulum that only "mildly" impacts function can have significant effects on feeding comfort, safety & effectiveness. 

Sometimes oral dysfunction is not caused by tongue-tie. 

An untrained or not highly skilled provider may blame your reported signs and symptoms on tongue-tie when the cause is not a short or tight frenulum, leaving you baffled after leaving the office of the ped dentist or ENT. 

The solution in both these cases is to start with a functional exam by a highly-skilled IBCLC who can identify the cause of your baby's oral dysfunction. 

• They say your baby's tongue-tie will stretch or correct itself in the future.

This belief is rubbish and a sign the provider who diagnosed your baby's tie is NOT a skilled provider. No respectable provider who understands physiology or has read any of the published studies on tongue-tie would say this. 

• Your baby is not currently obviously symptomatic.

This situation is often most frustrating for parents because everyone acknowledges there is a tie, nobody claims it's mild or will fix itself, yet the provider still refuses to do the release. 

Many providers will NOT do a release unless there are obvious signs of feeding or breathing issues because there is no evidence to support preventive surgery. 

Nobody can predict what impact your baby's tie will have on them in the future, and while the risk for a tie's negative impact is real, the justification for releasing (from the provider's end) is lacking. 

Many argue that because a tie is a functional diagnosis and has an atypical impact on the body, the symptoms one deals with are less important than the confirmation of the tongue tie's existence. 

This perspective is valid.  From a Medical standpoint, however, preventative surgery is not standard. 

This is immensely infuriating because this highlights how the system is broken and leaves parents frustrated & confused. 

If my baby is gaining well and I'm not having any pain, should I search for a release provider?

The answer is... It depends.

As mentioned above, one should consider more factors than just lack of pain and infant weight gain. 

The quality of infant feeding is equally important. The following signs warrant further evaluation by a highly skilled provider who can assess oral function

• Long feeds lasting more than 40 minutes

• Excessively frequent feeds

• A baby that never seems satisfied after eating

• Coughing/choking, even if it's just a few times a week

• Gulping, panting, or grunting while feeding

• Constantly feeding with their eyes closed

• You have to pump after feeds to empty your breast or to give to your baby

If you have any of the above and your baby is diagnosed with a tongue-tie, the odds are high that your baby's short or tight frenulum contributes. A tongue-tie release will allow for a full range of motion. 

Sometimes the above are caused by other things than tongue-tie.

If you have any of the above symptoms and were told by a respectable provider that it's not a tie, an evaluation to find the cause is warranted. 

What should my next step be?

Meet with an oral dysfunction savvy, highly skilled IBCLC for a functional Assessment

The first step should be to meet with a highly skilled provider like myself who will thoroughly assess function and provide a comprehensive report to your provider. A release provider may often need to see the more subtle signs and symptoms laid out to feel confident a release is warranted.

Assuming that there are genuinely no current signs of a tongue tie's impact, keep an eye out for any new symptoms that arise. Regularly report these to your baby's pediatrician or the release provider. 

Focus on other ways to improve function

In some cases, a frenulum appears short & tight due to tension or asymmetries. Addressing those factors even if a tie is present will lead to best results if & when a release is indicated in the future. 

If you need an evaluation to see how asymmetries or tension is impacting your baby's feeding, or if you don't have a plan to help restore function & movement, please book an appointment. 

My motto for Mattos Lactation is The Search For Answers Stops Here. If you're ready for answers, clarity, & guidance, I can't wait to work with you.