One of the most common questions parents ask about tongue ties is "Who can diagnose this, who can fix it, and how soon can we get this tongue tie fixed?" When breastfeeding is hard because of a suspected tongue tie or lip tie, parents tend to be in a rush for support, understandably so. Sometimes, however, this leads them in the wrong direction for tongue and lip tie support. In this article we will discuss how to get a tongue tie diagnosed and the best option for tongue tie release.
Who can diagnose a tongue tie?
I frequently have parents tell me they believe their baby has a tongue tie because they check many of the boxes on common symptoms of tongue or lip tie, but their doctor told them one of two things: "Yes there's a slight tongue tie, but it's not serious enough to cause breastfeeding issues," or, "No your baby does not have a tongue tie because they can stick their tongue out."
These two common statements from pediatricians and ENTs, some dentists, and sadly, even lactation consultants are extremely pervasive amongst my client base. Many of these mothers find themselves seeking an answer to their breastfeeding issues, being told by providers they trust that there is no identifiable issue and they might just need to give up on breastfeeding... For new moms struggling to breastfeed, this kind of response can lead to an intense feeling of helplessness and hopelessness. But all hope is not lost if your doctor said something like this. If you believe your baby has a tongue tie but your provider said one of these two statements, I recommend a seeking a second opinion. While IBCLCs can not formally diagnose conditions because they are not doctors, some IBCLCs are trained in identifying oral restrictions that impact functional breastfeeding. Your IBCLC can communicate and collaborate with your healthcare provider to explain whether or not oral structure is impacting feeding. Your IBCLC may also be able to recommend a provider experienced in identifying and treating tongue and lip ties for a seasoned second opinion.
How to identify a tongue or lip tie
Identifying a tongue or lip tie requires a comprehensive visual and functional examination. As a lactation consultant, when I assess a baby suspected of having a tongue tie, I visually examine the frenulum (tissue connecting the tongue to the floor of the mouth), the shape of the tongue, and the tongue's range of motion. I also assess the baby's ability to breastfeed, how they respond to certain stimuli, and of course, how they manage breast and/or bottle feeding. This assessment can be done in person or virtually (believe it or not!!! Moms are great at facilitating these exams virtually!). Depending on certain factors I observe visually and functionally, I can determine whether or not tethered oral tissues could be negatively impacting breastfeeding. But I don't stop there! I make sure there aren't any other factors contributing to breastfeeding challenges such as feeding routine, mismanaged expectations, hormonal conditions in mom, other conditions in baby, etc.d
Treating Tongue and Lip Tie
Many people will say, "Why bother seeing a lactation consultant first. Shouldn't I just go straight to a tongue tie release provider?" To that I say **NO** you shouldn't. Going directly to the release provider risks a "cut and go" style release, which increases the likelihood of complications, and decreases the likelihood of fixing breastfeeding issues. The fact of the matter is tongue tie release is a procedure, but fixing breastfeeding issues related to tongue tie is a process. That process requires properly preparing your baby's mouth for release, knowing what to expect after the release, proper wound management, and continuing to teach the baby how to properly use the tongue. Your IBCLC will be able to help you start teaching your baby how to breastfeed better by adjusting positions, implementing certain supportive measures and devices based off your needs, and teaching you exercises to do with your baby inside and outside of the mouth to improve their range of motion. Beginning this process before the release sets a foundation for your baby to more easily learn (and tolerate) post-operative exercises. Your lactation consultant can also assist you in implementing measures that help reduce oral defensiveness/oral aversion after the surgery.
What to do next to advocate for your tongue tied baby
If your baby is showing signs of being tongue tied and you're wondering what the next step is, first I recommend meeting with an International Board Certified Lactation Consultant experienced in tongue tie and oral habilitation to identify the root cause of your breastfeeding issues. If tongue and lip tie are a contributing factor, your lactation consultant will develop an appropriate customized breastfeeding care plan that includes feeding adaptations, oral exercises, physical exercises, referral to appropriate providers, and follow up directions. You'll start implementing the care plan as described by your tongue tie savvy lactation consultant, then see the recommended skilled tongue tie release providers to determine if release is the next step. It is important to let your lactation consultant know that you are scheduling this appointment with the release provider so she can send over her assessment and notes to the provider. This allows the provider to understand the full impact of the tethered oral tissues on your feeding experience.
Why wouldn't I just see the release provider first? Can't they teach me the same stuff?
While it can feel logical to get released ASAP, most release providers do not have the skills to assess the overall breastfeeding picture and understand other contributing factors to feeding. For example, sometimes tongue tie can cause low milk supply. But sometimes low milk supply is caused by a hormonal issue, and a non-tongue tied baby could show symptoms similar to those of a tongue tied baby, without actually being physically restricted inside the mouth. Another common scenario is that BOTH of these conditions exist together. The baby is tied and the mother has a hormonal issue and the combination of the two is making breastfeeding nearly impossible. Only a lactation consultant is qualified to sift through this kind of scenario and develop an appropriate care plan to address all aspects of the complex feeding situation.
In conclusion, if you are struggling to breastfeed your baby in any manner, I strongly recommend working with a tongue tie savvy lactation consultant as the first step toward achieving your breastfeeding goals.
Jaimie Zaki is a mother of 5, published author, birth doula, Licensed Practical Nurse, and International Board Certified Lactation Consultant (IBCLC). Jaimie has completed multiple tongue-tie trainings including the IBCLC Masterclass. Additionally Jaimie has personal experience with tongue tie release with herself and each of her 5 children. Jaimie supports breastfeeding families in Wichita Falls, Texas and across the United States via Telehealth Lactation Consultations. Jaimie accepts TRICARE, Aetna, and is a partner with The Lactation Network to expand insurance coverage for lactation support.