As a new parent, you are constantly faced with questions like how are feedings going? Is there pain in breastfeeding? Is the baby sleeping through the night? Does your baby seem comfortable? While these questions can become daunting with their repetition, there is much to uncover by investigating your answers. 

At Mercy Grace, we strive to help parents achieve a healthy feeding relationship with their child. Whether breast or bottle-fed, the presence of tongue ties or lip ties can become a major obstacle in the feeding relationship with your newborn — and beyond. 

What Are Tongue or Lip Ties?

Tethered oral tissues (TOTs), or more commonly referred to as ‘tongue ties, or ‘lip ties’’ are connective tissues present that are too thick, tight, or short and restrict proper oral movement in your child. There are three different kinds of ties: lip, tongue, and buccal (cheek). 

Symptoms

Breastfeeding

For the infant, symptoms can not only cause discomfort, but serious consequences impacting the growth and development of your baby. 

The infant will:

• Have difficulty latching or maintaining a deep latch 
• Allow milk to spill from the sides of their mouth
• Consistent suck blisters on lips 
• Frequent spitting up
• Clicking or smacking sounds while nursing
• Prolonged and/or frequent nursing due to poor milk removal 
• Gassy or fussy often
• Frustration at the breast or even refusal of breast
• Poor weight gain

Unfortunately, the mother will also experience significant signs that your baby is having a hard time latching effectively. 

These include:

• Bleeding, cracked, scabbed, or blanched nipples
• “Flattened” nipples or a “lipstick” shape after feedings
• Severe pain while breastfeeding
• Plugged milk ducts or mastitis
• Low milk supply
• Thrush
• Anxiety and frustration/difficulty bonding with the infant
• Nipple shield required for nursing

Bottle Feeding

With bottle-feeding, it is necessary to keep in mind that presenting symptoms may be related to oral ties, or, perhaps other factors such as swallowing problems, bottle flow rate, reflux, etc. Always consult with our pediatric staff to navigate this. 

Symptoms include:

• Difficulty latching
• Gagging 
• Chewing/gumming the bottle nipple
• Clicking sounds while drinking
• Frequent pulling away from the bottle
• Prolonged feeding times
• Upper lip curling inward
• Gassy or fussy often
• Frequent spitting up
• Dribbling while feeding

Solids

Introducing solid foods to your baby is always an exciting but perhaps overwhelming time. There are many choices available. However, regardless of the method you choose, it is critical to keep an eye out for red flags that can indicate your baby is having a problem. 

Some signs may include:

• Choking or gagging on liquids or foods 
• Prolonged tongue thrusting 
• Avoidance of certain foods
• Difficulty with thicker textures
• Difficulty with foods that require more skilled chewing patterns
• Excessive spilling of food 
• Putting the food in the cheeks or roof of the mouth

Lesser-known factors that can be impacting your baby’s ability to start solids are sensory processing difficulties, reflux, and low muscle tone, to name a few. The staff at Mercy Grace is equipped to help you identify these. 

Sleep/Breathing

Sleep is a physiological process that involves the use of the head, neck, mouth, and sinus cavities. If the normal development of these structures is imparied by TOTs, this can result in poor sleep and obstructed breathing patterns. For your baby to grow and develop well, you want to ensure your baby is free from the following symptoms:

• Sleeps with mouth open
• Excessive drooling while sleeping
• Gagging, coughing, or choking during feeding/sleeping/swallowing
• Snoring (quiet or loud)
• Restless sleep (kicking or moving while asleep)
• Frequent headaches or neck pain
• Low-energy during the daytime
• Changes in behavior 

Speech

If your child seems to be struggling with words and/or sounds, we recommend you bring your child in for an oral tie assessment. Leaving a tongue tie untreated has the power to negatively impact your child’s speech development. There are a number of reasons a speech problem can develop, other than tongue function, it can be related to hearing difficulties or developmental delays. It is important to remain consistent with your regular check-ups. 

Signs to look for:

• Unclear speech with more complex sentences
• Lisps
• Mumbling/difficult to understand
• Issues with B, P, M, and W sounds 

Dental 

This may come as a surprise, but dental issues can arise if a tongue or lip tie goes undiagnosed and untreated. Many of the problems are due to the child’s inability to swallow food properly, but other times it is due to physical restrictions in the mouth from tongue ties or lip ties.  

Symptoms may include: 

• Overbite
• Open bite
• Gum disease/recession
• High palate
• Tongue getting stuck between front teeth
• Gap between the two front teeth

 

What Should You Do About It?

Even if you have made it beyond the initial feeding stages with your infant, that does not mean the symptoms just go away. As your baby grows up, more problems that we have described above can begin to present. 

We understand that this can all feel overwhelming. Mercy Grace’s pediatric team is here to help you and your child through this process of identifying and correcting oral ties.