Tongue Tie: Why I Can’t Wait for the Research

By Melanie Potock, MA, CCC-SLP

I’m in the trenches. I’m the one holding a mom’s hands while she tears up and asks me why her baby can’t eat solid foods after the GI test results can’t pinpoint a problem. I’m having delicate, respectful discussions with physicians, but who insist that “If the baby can bottle feed with that tongue, then they can learn to eat solids with that tongue” or worse, “Don’t worry if he can’t breast feed, he’ll be eating solids soon and won’t need the breast.”  I’ve had preschoolers finally end up on my caseload after seeing several different medical professionals (including geneticists), but never a feeding professional. It’s what spurred me on to write three articles for the American Speech Language Hearing Association – Just Flip the Lip and Tip Back the Tongue. Later, I shared my clinical observations in the article Three Structures in A Child’s Mouth that Can Cause Picky Eating.

From my perspective, I can’t wait for the research on ankyloglossia (tongue-tie) in order to further determine how tethered oral tissues might be impacting an individual child’s functional skills for feeding. As a professional, I have the utmost respect for evidence based practice.  If I child can’t move his tongue adequately for safe chewing and swallowing, it’s my job to determine why, with or without a study. Problem is, that child can’t wait for multiple studies to support what I see in plain sight as an experienced clinician. I’m going to consider all the possibilities impacting a child’s ability to eat in an age-appropriate manner using my differential diagnosis skills. I don’t see tethered oral tissues in all my clients, but the ones that are clearly tied can’t manipulate food safely.  It may not be the only culprit, but I’m not going to ignore what’s right in front of me.

Would we question an occupational therapist’s clinical observations if they reported that a child’s fine motor skills were delayed due to syndactyly (webbing of the fingers)?  Would we expect that OT to provide months of therapy to rule out other causes for the child’s motor challenges before discussing their clinical observations with the pediatrician, hand surgeon or other members of that child’s team? Would we question a physical therapist’s clinical observations if they reported that a child’s gross motor delay was related to progressive heel-cord contractures?  At some point, it comes down to clinical experience and knowledgeable assessment skills, an understanding of typical development, a respect for the family’s concerns and frankly, decent eyesight.

On one hand, I can’t wait for the research!  I want to learn more! We need it, but for now, I’m in the trenches.

In short, I can’t wait for the research because it’s not fair to these families.  My job is to assess function for feeding.  It’s pretty clear to me when I’m evaluating a child’s oral motor skills and her tongue has limited range of movement because of a tie.  As a feeding specialist, I know the range of movement necessary for safe and comfortable eating.  I can’t wait for the research and I think that’s enough of a reason to speak up and help these kids.


To learn what research we do have, and what we know so far, check out this post on the Talk Tools website, as well as their new book being released soon!

Functional Assessment of Feeding Challenges in Children with Ankyloglossia by Robyn Merkel-Walsh, MA, CCC-SLP & Lori Overland, MS, CCC-SLP, C/NDT, CLC.  In this excellent article highlighting Walsh and Overland’s presentation at the 2017 American Speech Language Hearing Association, the following references were provided:

References:

American Academy of Breastfeeding Medicine (AABM). (2016). Protocol # 11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. Retrieved from: http://www.bfmed.org/Media/Files/Protocols/ankyloglossia.pdf

Amir, L.H., James, J.P. & Donath, S.M. (2006). Reliability of the Hazelbaker assessment tool for lingual frenulum function. International Breastfeeding Journal, 1(3).

American Speech-Language-Hearing Association (2015). ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology Preparing for Implementation. Retrieved from: http://www.asha.org/Practice/reimbursement/coding/ICD-10/

Boyd, K. (2014). Impact of tongue-tie over a lifetime: an anthropological perspective. Presentation at the IATP 2nd World Summit. Montreal, Quebec.

de Castro Martinelli, R.L., Marchesan, I.Q., Gusmao, R.J., de Castro Rodrigues, A. & Berretin-Felix, G. (2014). Histological characteristics of altered human lingual frenulum. International Journal of Pediatrics and Child Health, 2, 5-9.

Ferres-Amat, E., Pastor-Vera, T., Ferres-Amat, E., Mareque-Bueno, J., Prats-Armengol, J. & Ferres-Padro, E. (2016). Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Journal of Oral Medicine and Pathology, 1:21 (1):39-47

Francis, D.O., Chinnadurai, S., Morad, A., Epstein, R.A., Kohanim, S., Krishnaswami, S., Sathe, N.A. & McPheeters, M.L. (2015). Treatments for ankyloglossia and ankyloglossia with concomitant lip-tie. Comparative Effectiveness Reviews, No. 149. Agency for Healthcare Research and Quality. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK299120/.

International Affiliation of Tongue-Tie Professionals (2016). Classification. Retrieved from: http://tonguetieprofessionals.org/about/assessment/classification/

Kummer, A. (2016). To clip or not to clip? That’s the question. Presented at the annual convention of The American Speech-Language-Hearing Association. Philadelphia, PA.

Martinelli, R.L., Marchesan, I.Q., & Berretin-Felix, G. (2012). Lingual Frenulum Protocol with Scores for Infants. International Journal of Orofacial Myology, 38, 104-113.

Merdad, H. & Mascarenhas, A.K. (2010). Ankyloglossia may cause breastfeeding, tongue mobility, and speech difficulties, with inconclusive results on treatment choices. Journal of Evidence-Based Dental Practice, 10(3):152-3.

Messner, A.H. & Lalakea, M.L. (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology, 54(2):123-31.

Overland, L. & Merkel-Walsh, R. (2013). A sensory-motor approach to feeding. Charleston, SC: TalkTools.

Sethi N., Smith D., Kortequee S., Ward V.M. & Clarke S. (2013). Benefits of frenulotomy in infants with ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 77(5): 762-5.

Head’s UP! I just pre-ordered the new book by Walsh and Overland: Functional Assessment and Remediation of TOTs.  You can order it here for the pre-sale price, as of today, for 50% off, on the Talk Tools website.

 

 

 

How to Stop a Kid From Chewing on the Crib

Babies have always chomped; it’s just that gums don’t leave marks. Parents can help by giving kids an appropriate way to relieve their discomfort.

By Matthew Utley

Waking up in the morning to find the crib railing peppered with tiny tooth marks can be disconcerting, but it’s not necessarily cause for concern. Babies’ mouths are like deep space probes, analyzing everything they come across. It’s called the rooting reflex; anything that brushes against their cheek or lower lip gets a gum job. It’s a natural instinct that doesn’t really cause harm – in fact, it’s quite soothing – although popping everything in their mouth certainly poses risks for the baby.

Read more on Fatherly >>

How To Pick A Lovey For Your Kid & Give Them Perfect, Easy-To-Hold Comfort

By Caroline Shannon-Karasik

My husband and I have what we call Brave Little Toaster syndrome. It’s our theory that the ’80s Disney movie that assigned feelings and personalities to inanimate objects officially scarred us for life. To this day, our 33-year-old selves will see a stuffed animal on the side of the highway and not only mourn the fact that it lost its human, but that we can’t cross four lanes of moving traffic to rescue it. When we had our daughter Claire, we had no idea how to choose a lovey that was a safe and comfortable choice for her, but we knew it was inevitable she would cling to something given her lineage. Still, we weren’t sure: What was the best choice for her?

Read more on ROMPER >>

13 Tips to Help Prevent Kids From Choking

Choke-proof their world: Follow our guidelines to confidently keep teeny toys and “too-big” bites of food from being posing a choking danger to your kids.

By Stephanie Booth from 

On a bright morning last March, Tara Chazen’s 2-year-old son was toddling around his neighborhood park and munching on a graham cracker when a piece of it suddenly got stuck in his throat. Chazen was at work, and by the time his babysitter noticed that something was amiss less than a minute later, the cracker shard had moved from his trachea into his lung. The boy’s face turned purple and he fell to the ground, unconscious.

Read more on Parents.com >>

Why New Eaters Bite Themselves And How to Help

By Patrick A. Coleman

Kids new to finger foods are fighting reflexes, but parents can help them get a handle on their tongues

Experienced eaters don’t generally bite their tongues and fingers—though, when it happens, it’s a terrible reminder of the ever-present potential for excruciating pain in even the most pleasurable moments. Adults don’t have to think about not biting their own hands or the insides of their mouths when they eat, because chewing and chomping safely is reflexive. Not so for babies. And as toddlers transition from breastfeeding to finger foods, the victims can often be their actual fingers.

Read more on Fatherly >>

Why You May Want to Skip the Sippy Cup for Your Baby

By Melanie Potock, MA, CCC-SLP

Syda Productions/Shutterstock

Are sippy cups really the best cup to introduce after (or alongside) breast or bottle? Experts suggest a straw or open cup instead, and here’s why.

First comes breast or bottle, then sippy cup, right? Not so fast. Experts report you may want to just skip the sippy cup for your baby. Surprisingly, sippies weren’t designed as a tool for feeding development, but were invented years ago by a dad who just wanted to keep his carpets clean! (Ha ha, we can relate.) Today, parents often think that a sippy cup is what they are supposed to offer to help kids eventually learn to drink from an open cup.

Read more on Parents.com >>

7 Success Strategies for Safe Baby-Led Weaning

By Jenna Helwig

To raise an adventurous eater, many moms swear by letting a baby feed himself. Whether you want to try this method, called baby-led weaning, a little or a lot, here’s what to keep in mind.

The formula vs. breast-milk debate was so your life six months ago. As your infant approaches his half birthday, the pressing question now is: Will you give him pureed food or bite-size chunks to pick up and eat? In a nutshell, that’s the “baby food” versus “baby-led weaning” debate.

Read more on >> FitPREGNANCY

When Do Babies Hold Their Own Bottle?

By Lambeth Hochwald

Feeding baby her bottle is a wonderful bonding experience. But let’s be honest, it would be nice to have your hands free at some point. While it’s ultimately up to baby to decide when she’s ready to serve herself, there are a few things you can do to help her get ready. After all, baby holding a bottle is an important milestone. It’s a sign her brain and muscle development is right on track—and a tiny reminder for mom that taking care of baby does get easier. So when do babies hold their own bottles, and how can you help them along? Read on for answers.

Read more on The BUMP >>