Looking Beyond the Tie

Updated: Apr 8

You may have read about a story like this in a Facebook group, or heard it from a friend. Their baby had a tongue tie, got it clipped, and their feeding challenges disappeared like a miracle, a rainbow appeared, all their problems were solved, and the family lived happily ever after.

I had two babies with oral restrictions, and on top of that, one of them had a motor processing disorder and one had a birth injury that caused issues with feeding and function. I know the struggle all too well. If a parent tells me they feel something is wrong, I listen. They’re almost always right. At the beginning of an assessment, I go over what the body is supposed to do and how the tongue is supposed to look and function, then start assessing a baby. After that conversation, many times it’s the parent who spots what’s “off” during the assessment. And I want to be very clear.


There is no such thing as a mild/slight/insignificant tie.


There is function and dysfunction. There are tongues that look textbook perfect but have terrible dysfunction, and tongues that may look restricted that aren’t and they function well. If anyone uses those words (mild, slight, insignificant tie) to describe oral restrictions, they’re telling you they don’t have the experience to assess oral restrictions and oral motor dysfunction. Seek out an experienced provider’s opinion.


I want to go over some very common reasons that your rainbow might not have appeared yet.


1. Before your sweet little baby even entered the world, they were growing body parts and tissues while they were still inside you. It’s so important that everything in the body fits together like the pieces in a mechanical watch. If one thing is out of place, the function of the rest of the parts is changed. One of the providers we know and trust to evaluate for oral restrictions will also look for other things that could be contributing to your baby’s symptoms - inflammation in the throat from excessive acid, issues with the voice box or palate. He looks at the whole picture of your baby, he doesn’t just clip away at some extra tissue and send you on your way saying “Best of luck!”. Looking at the whole baby is essential for improving function.


2. Your baby develops the suck reflex in the third trimester. When something touches the roof of their mouth, they suck! If there is dysfunction, they’ve had lots of time to learn to suck and respond to stimuli in a way that isn’t functional for them. Even babies without tethered oral tissues can have oral restriction and oral dysfunction. Those reflexes might not be working the way they should. The baby might have an overactive gag reflex, or not know how to manage their saliva in their mouths. Your baby shouldn’t need to clamp with their jaws in order to maintain strong suction, and they shouldn’t dribble or leak milk out the sides of their mouths. If their tongue isn’t functioning well, the rest of their bodies will jump in to try to help. This is called compensation. Babies compensate with their cheeks, their mouth muscles, their jaws, and their throat, neck, and shoulder muscles. These babies usually have squishable chubby cheeks and tense bodies. They don’t look relaxed. Their hands stay in tight fists. Their shoulders are up by their ears. They may prefer looking (or feeding!) to one side and hate the other side, or the lactating parent may feel pain and pinching of the nipple on only one side. They may scream during tummy time. They might have flat or uneven spots on their heads. Their whole body changes to make up for the fact their mouth isn’t working the way it should. Simply going in there and snipping away at some extra tissue doesn’t unwind all of this tension their little bodies have acquired to compensate, and it also doesn’t teach them how to function properly.



When I do an oral assessment, I often start at the hips. I definitely get funny looks from parents for this! I want to look to see if any parts of their bodies are compensating for dysfunction somewhere else. Then I work my way up. There are plenty of times I see tension and dysfunction without oral restrictions. No two babies are alike, and no two care plans are identical. We work closely with bodyworkers - specialists who help with structures and function in the body. Myofascial release is a type of physical therapy that releases any connective tissue restriction. Occupational therapy helps retrain the muscles to work together the way they should, and calm down any reflexes that are overactive while strengthening the reflexes that should be doing the work. Experienced, certified and pediatrics-specialized chiropractic care and craniosacral therapy help with anything that has pulled out of place or is misaligned. We’ve already talked about how essential it is that everything in the body works together the way it should. These specialists are trained to gently adjust things back into place. A non-tied baby can be struggling with feeding and growth because of unaddressed tension and impaired function. We work with an amazing team of professionals we refer to depending on each unique situation.


Sometimes a simple handout of things parents can work on at home is enough to turn things around. Other times, a visit or two with one of our experienced and brilliant preferred providers we refer to can get a baby back on the right track and heading back up their growth curve after experiencing a dip, or feeding functionally without their parent experiencing pain. Sometimes we see GERD symptoms dramatically improve, or bottle aversions turn around. Sometimes the baby who hates tummy time is now a Tummy Time Champion. I’ve spent years studying and going through additional training as a nurse and an IBCLC, learning from national experts and collaborating with some of the best minds around. As I tell my clients and patients during consults - “Oral motor function is my jam.” It’s my area of expertise, my love, and my passion. If your gut tells you something is off with your baby’s tongue, mouth, body, or function, please reach out so we can get to the bottom of it together. There are also wonderful providers all over the world, so if you don’t live in Metro Detroit and need hands on assistance, we can still help point you in the right direction with referrals in your area. It’s never too late (or too early) to improve things so you can experience the sun coming out from behind the clouds and that rainbow appearing.


*If you want to reach out, you can contact me at allison@skilledlactationsolutions.com or request a consult here.


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