How Can Craniosacral Therapy Help Tongue-Ties?
Parents bring their children in for craniosacral therapy (CST) sessions for a wide variety of issues; tethered oral tissues, like a tongue-tie, are a very common reason. When I first started working with babies it came up so frequently that I became a bit obsessed with the tongue: its anatomy, function, dynamics, and its crucial role in eating and breathing. I’ve taken the Breathe Baby Course at the Breathe Institute, and advanced CST workshops specifically about tongue-tie (medically referred to as ankyloglossia) in infants and children, teens and adults. I have always been a breast-milk enthusiast and my fascination with the tongue led me to pursue a certification as a breastfeeding specialist. The tongue! A mighty muscle that not only plays a role in breathing and eating but has an influence on the entire body. If there is a restriction in the tongue, it is very likely associated with tension elsewhere in the body.
How can CST sessions help? CST cannot make a tie disappear. What CST can do is help your baby (or you) feel better in their body; Less tense and more calm. CST is a whole-body approach that uses a gentle touch to release restrictions (fascial adhesions) and address bodywide compensatory tension patterns. It is quite common to find other restrictions and related asymmetry in a body challenged by tethered oral tissues, most commonly in the skull, neck, abdomen, pelvis or feet.
During our session, I use CST bodywide to find and unwind abnormal strain in the muscles and connective tissues that limit function, easing tension patterns that prevent the muscles and structures of the face and mouth from functioning effectively and efficiently. CST also helps boost the functions of our body’s most basic systems, all which relate to the tongue: eating, digestion, sleep, sensory, and neuromotor.
Typically, the earlier craniosacral therapy is introduced the more rapid the outcomes. Some improvements parents notice in their child after a CST session: less stress, increased tongue and jaw mobility, improved latch, the head or neck move more freely, improved digestion, reduction of reflux or colic symptoms, or more comfortability when breastfeeding, eating, sleeping, passing gas, or pooping.
Tongue-tie, Lip-Tie, Cheek-Ties: What’s a Tie?
Let’s dive into definitions. A “tie” is a functional restriction of motion due to tethered frenulum. A frenula (plural: frenulum) is a strand of connective tissue that anchors a semi-mobile body part (ie. the tongue), to a fixed body part (ie. the floor of the mouth). Ankyloglossia [ang″kĭ-lo-glos´e-ah], more commonly known as a tongue-tie, is an anomaly in which mobility and function of the tongue is restricted by a short or thick lingual frenulum. Lingual frenulum is a membrane connects the tongue to the floor of the mouth. Buccal frenulum connect the cheek to the gums, and a labial frenula is the soft tissue connecting the lip to the gums. Cheek-ties and lip-ties are similar in that the frenulum are thick or short and tethered to the gums tightly, restricting the proper function of the cheeks and lips. Tongue-tie, lip-ties, and cheek-ties are medically referred to as Tethered Oral Tissues (TOTS).
Signs of Tethered Oral Tissues (TOTS)
We all have frenulum. Some are born with frenulum that are shortened and thicker, others thin and soft. Some frenulums that are more visible than others. With tongue-ties, some frenulums connect closer to the tip of the tongue, others near the back. For the purposes of this post, I will be talking about ties in children, but CST is also beneficial to adults with ties. Take a moment and investigate your own frenulum. Taking a look under the tongue can be quite informative; but you can’t diagnose a tongue-tie on looks alone.
What is most important is mobility and functionality - what are the limitations and how severe?
Consider tongue-ties: does that tight piece of tissue under the tongue prohibit the tongue from elevating or moving side-to-side as it should or is it stuck to the floor of the mouth? Does it interfere with sucking, swallowing, managing food in the mouth? Licking? Speech development? Does it affect breathing habits like mouth-breathing, snoring, or apnea?
Lip-ties and cheek-ties: are the lips and cheeks able to move and properly falange? Can they properly create a seal around the breast, a bottle, or a straw? Are facial expressions limited? Is speech affected by inability to properly form the sounds of letters?
If the tie/s are too tight and mobility and functionality are restricted, ties can negatively impact breastfeeding, bottle feeding, digestion, growth and development of the airway, and the structure and shape of the mouth, face, and head. It is not unusual for babies with TOTS to have trouble breastfeeding, such as a hard time staying latched on the breast, leaking milk from sides of mouth, coughing or gagging, lip blisters, gas pain (from swallowing too much air), noisy breathing/snoring, a shallow or soft latch, milky tongue, and/or slow weight gain. Other common signs are colic and reflux. You may notice that when your baby cries, their tongue might not elevate, or you may notice that tongue does not touch the roof of their mouths as it should, or that they breathe from their mouth instead of their nose. Parents may experience pain and unusual discomfort from flattened or damaged nipples, engorgement, and mastitis. Feedings may be long or the breast not fully drained. At about 6 -8 weeks, you may notice a drop in milk production as the signals to increase supply switch from post-delivery hormones to supply/demand where the breast produces in response to how much is extracted. Some babies may become frustrated and fussy at the breast, tire quickly when feeding, or are hungry soon after the last session.
Treatment for Restrictive Ties
Many people have ties and either are functionally fine or manage by physical compensations and adaptations, such as squeezing the nipple between the gums instead of sucking, or needing to be in a special position to eat or digest. When ties are more severely restrictive, it sometimes takes a multi-faceted approach and multi-membered team.
To get a tie accurately assessed, seek out a dentist or ENT that specializes in oral motor function. They can properly diagnose tethered oral tissues and rule out a false tie, which is when all the symptoms of a tie are present but the restriction is actually due to tight and tense muscles, not tethered tissue. The doctor will evaluate function and give their diagnosis and recommendation for treatment. Treatments vary. Minor ties can be addressed with bodywork (ie. CST, stretches, and mouth/tongue exercises). Ties that are more severe and limiting may require a procedure called a frenotomy that releases tethered frenulum. The procedure is often referred to as a release or a revision.
Should you choose to revise? That is entirely your choice. The doctor will advise you of the risks and benefits of a release. Release procedures are usually quick, resulting in a small wound that typically bleeds very little and heals quickly. Many parents report an improvement with breastfeeding immediately afterwards, if not a day or two later. CST is recommended before and after the procedure, to facilitate the release of tension and improve sensory and proprioceptive awareness to the mouth and body.
Regardless of your decision to revise or not, in addition to bodywork, I highly recommend also consulting with an International Board-Certified Lactation Consultant (IBCLC) to assist you and your baby in finding the best way to manage and maintain a successful breastfeeding relationship. As I mentioned, restrictive ties rarely exist without breastfeeding challenges. An IBCLC can help you maintain ample milk supply to keep your baby well-fed and satisfied, instruct you in how to boost your milk production if supply has diminished, manage nipple discomfort, keep tabs on baby’s weight, and teach both of you oral sucking exercises and stretches. If your baby is bottle-fed, an IBCLC can help you find the best bottles/nipples size and shapes to support optimal oral function, and with timing, pacing, and technique to help your baby manage the intake of milk, encouraging proper latch, sucking, and swallowing instead of biting and gulping.
At home, a great activity to engage your baby with often is tummy time! Tummy time helps stretch and strengthen the muscles of the entire body, and in the case of a tie, it is instrumental in stretching the base of the tongue and the neck. Find a link in the resources at the end of this post to learn more about the benefits of the Tummy Time Method.
Other practitioners that are beneficial to have on your team are a chiropractor, occupational therapist, physical therapist, or a Speech Language Pathologist experienced with TOTS.
Controversies
Aren’t tongue-ties a fad? Actually, tongue-ties are nothing new. Historical records dating back to 1473 suggest that midwives cut frenula with a fingernail kept especially long and sharp. There are also depictions of physicians performing frenotomy on infants as far back as 1620. More recently, in the decades prior to ours, many parents were misled to believe that formula feeding was more convenient and better for babies than breastmilk. As exclusive breastfeeding increased in popularity there’s corresponding revival in awareness of TOTS as women committed to breastfeeding seek help with latch and pain.
Won’t my baby just grow out of it? Nope. As Dr. Maura says, “they will grow into it.” Severe restrictions will require compensation, accommodation, and upkeep at each stage of development if revision is indicated but not chosen. As our bodies grow into adulthood, issues with breast or bottle feeding could evolve into challenges with properly chewing solid foods, managing soft foods in the mouth, and other eating issues such as pickiness or gagging. There may be issues with excessive drool, trouble talking, poor body posture, asymmetrical development of the mouth, jaw, face, or head. Other issues that may be related are headaches, visual disorders, bedwetting, and TMJ disorder.
Why didn’t my pediatrician notice a tongue-tie? Ties can be missed. And on the contrary they can also be misdiagnosed. There is a variability of the location, structure, or size of a tie and differing opinions on what is normal or abnormal. Pediatricians are trained many hours in many areas, but not much time is spent in the realm of TOTS and optimal oral function. It’s important to get a tethered oral restriction evaluated by a pediatric dentist, ENT, or IBCLC that specifically specializes in pediatric tongue and general oral function and understands the essential function of the tongue in the dynamic of breastfeeding.
Resources
Tummy Time Method
Dr. Bobbi Ghaheri - renowned specialist on ties
La Leche League - breastfeeding and lactation resource
Kellymom - breastfeeding and lactation resource
Luna Lactation - breastfeeding and lactation resource