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Pediatricians and Tongue Ties

Why didn't our pediatrician tell us about our baby’s tongue and lip ties?

Our pediatrician says he doesn't have a tongue tie.

Our pediatrician says his ties are "minor", "small", or "won't affect feeding", and does not need to be treated.

My pediatrician says there's no such thing as a tongue tie.

Our pediatrician says it's a fad.

My pediatrician says tongue tie providers prey on babies to make money.

I am not going to try to speak for any one pediatrician as to why they might say any of the above to families looking for answers, but I may be able to shed some light on why many pediatricians give confusing, and often incorrect, answers to parents…

A Pediatrician’s influence on Breastfeeding success

I will never forget my first client who decided to listen to her pediatrician about her baby's ties. I consulted with this family and discovered that their baby had a pretty obvious tongue tie. It was the kind that you actually do find pictured in pediatrician textbooks as being a feeding concern. Her nipples were shredded. She was in a lot of pain. Her baby was not gaining weight nursing, but the mother could pump plenty of milk. The baby just couldn't get the milk from her breasts even with optimal positioning and latch.

It was evident that this baby's feeding was impaired by the tongue tie. At least it was evident to me. I made my recommendations to the family to visit with a tongue tie release provider that I work closely with. The family saw their pediatrician shortly after I saw them. The mother told me that their pediatrician felt that the tongue tie diagnosis was a fad and that the baby's tongue tie should not affect feeding. I asked the mother if the doctor gave an alternative explanation for why the baby could not get milk while breastfeeding. He clearly had not. She elected not to follow up with me and I assume her breastfeeding journey ended.

Why didn’t the Pediatrician know?

A pediatrician is a medical doctor who has specialized in the disease states of children and monitors the development of children. You might think that since they diagnose other congenital anomalies in children, that diagnosing a tongue tie would fall into their "wheelhouse". It's a logical assumption. There are pictures of tongue ties in medical textbooks. The textbook may describe some symptoms associated with these ties but, in general, this is an anatomical finding, and not a physiological one for the pediatrician.

Most treat it like a variation of normal, similar to finding a birthmark or other benign anomaly. They may not even think it worthy of mentioning to parents if they see one. And if a parent asks about it, they may tell the parents it's nothing of concern.

Identifying anatomy is not the same as assessing the function of that anatomy. And since the vast majority of pediatricians are not also feeding/breastfeeding specialists, that same majority is unlikely to be able to accurately assess the function of a baby's tongue in the context of feeding. Or, further, to assess the effect on palate structure, swallowing, aerophagia, weight gain, milk supply, breast health, airway, breathing and sleep patterns, and future developmental impact.

Providers who know: Raising Awareness

Any practitioner that does know about Tongue Ties and Lip Ties, no matter their credentials, is someone who sought this information on their own. Usually, this is because a baby with oral ties has come into their lives and led them down the path of learning about them. These practitioners become wonderful allies with families looking for answers.

A pediatrician in my area knows quite a bit about ties because years ago, a patient demanded that he release her baby's ties. Prior to this he had not identified or treated any tongue ties in his practice --- much like other pediatricians. Now, years later, not only does he release ties in children, but he is trying to raise awareness in the pediatric community about ties.

An ENT in Washington didn't know a lot about ties until his own babies were found to have tongue ties and his wife struggled to breastfeed them. He now releases hundreds of babies each year and works to educate providers and families about the impact of ties on feeding, breathing, and development. He also conducts research that helps to pave the way for more providers to receive this education earlier in their career.

My favorite provider was a math teacher until her first baby was born. Her early mothering experience with breastfeeding and tongue tie caused her to leave teaching and enroll in nursing school. She now holds her doctorate as a Family Nurse Practitioner, and her IBCLC, and has built a practice around helping families with early infant feeding. She performs tongue and lip tie releases on babies, children, and adults. Her breastfeeding medicine practice fills a major gap in women’s health care. She also works on research and education for other providers.

From professionals like these, there are now organizations that have formed with the purpose of educating providers on these topics such as the International Consortium of Ankyloglossia Practitioners (ICAP), International Association of Tongue-Tie Professionals (IATP), American Laser Study Club (ALSC), and others.

A Success Story

I recently met with a sweet family whose baby was not able to transfer milk from breast. The mother was able to pump lots of milk, and her baby would latch and nurse. She looked like she was doing great! My scale disagreed, though. She had not transferred (drank) any appreciable milk.

Upon assessing her suckle, it was clear why she could not transfer milk. Her suckle was weak and her tongue did not cup, lift, and hold the way it should. Her middle tongue did not lift to her palate for a proper swallow. A look under her tongue and lip just confirmed what I already suspected. She had a tongue tie and a lip tie.

I referred the family to my favorite provider where the baby’s ties were released and she transferred 3 ounces of milk from breast immediately following the release! This dyad is still enjoying a successful breastfeeding journey.

Find the Help You Need

Finding the right health care professional to assist you in a tongue tie evaluation and/or release can be tricky. For example: despite mentioning an ENT above, I would never refer a family to any of the ENTs in my area. The credentials aren't as important as the individually sought education and dedication specific to treating oral ties.

There are Dentists, Nurse Practitioners, ENTs, and others who might be the expert on tongue and lip ties in your area. To find a good provider in your area, ask a local *IBCLC, a La Leche League volunteer, or an *SLP.

Tongue Ties Are Real

Tongue ties are not new or imaginary. There's a growing body of research on oral restriction supporting the diagnosis and treatment of these restrictions, or ties. They are not over-diagnosed. In fact, I would argue they are still largely underdiagnosed, but that is for another post...

I think there will come a day when diagnosing ties will be more common in the pediatrician's office, or even at birth places like hospitals and birth centers. But that day may still be many years off. Until then, the person most qualified to assess the function of your baby's mouth for feeding is probably not your pediatrician. It will more likely be an *IBCLC, or SLP, who will then refer you to an excellent practitioner for formal diagnosis and treatment —- also probably not your pediatrician.

*IBCLC - International Board Certified Lactation Consultant

*SLP - Speech and Language Pathologist

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