Manual Osteopathy for Babies
A couple of months ago, Dr. Ash forwarded me an email from the College of Family Physicians of Canada titled “Trying Tongue-Tie Treatment – Does Frenotomy Fix Feeding Frustrations?”
The conclusion was… maybe, sometimes, but often, not really. In the study they referenced, maternal nipple pain was reduced by about 2 points on a 10-point pain scale (uhh, ouch) and effects on baby’s weight gain and continued breastfeed were unclear because of the large amount of crossover in the control groups.
What is a tongue tie, you may be asking.
Well, let’s dive in: an ankyloglossia, or a “tongue tie” occurs when the lingual frenulum (that piece of skin that attaches the bottom of your tongue to the bottom of your mouth) is shorter and thicker than it needs to be. This prevents the tongue from moving freely (a freely moving tongue is essential for baby to feed easily).
But wait! There’s more! Because there are actually seven frenula in the mouth, there is more than one place for an oral tie. The less commonly recognized oral ties are lip and cheek (or buccal) ties. A maxillary lip tie occurs when the skin of the upper lip is attached to the lower part of the gums, between the two front teeth (or where your baby’s front teeth will one day be). A cheek tie occurs when the frenulum (piece of skin) inside the upper cheek is too tight and/or short.
“Well, why does any of this even matter?” You may be wondering.
Oral ties affect the ability of a baby to latch onto a nipple (whether that nipple is silicone or their mother’s nipple is irrelevant). For a baby to have a good latch, there needs to be an airtight seal around the nipple. Oral ties increase the amount of tension in a baby’s mouth, and one of the first signs of a tie is difficulty latching. This is can show up as a shallow latch, an inability to stay latched, getting tired before they are full, frustration when the nipple is close to their mouth, a clicking or smacking noise while they eat, or milk running out of the corners of their mouth while eating (this last one is usually seen more in bottle-fed babies).
Oral ties are usually diagnosed by a health care professional or by a lactation consultant. Some recommend surgical correction of the tie, some recommend against surgical correction of the tie. If you dive into the rabbit hole, you will find equal amounts of conflicting evidence both for and against a surgical release or oral ties. So, what’s a parent to do?
In my clinical experience, oral ties do not exist in isolation. They are the end of a chain of tension that usually resides in the diaphragm, thoraco-lumbar junction (TLJ), shoulders, neck, throat, the base of the cranium and of course, the mouth. Releasing the oral tie does loosen the end of that chain, but it does not address the tensional pattern. Tensional patterns in babies can show up as, a head-rotational preference, moving one arm a lot more than the other, a newborn curling onto their side when sleeping or a baby whose neck is often in extension (looking up).
In addition to affecting feeding, oral ties often disrupt a baby’s digestive system and their ability to regulate. For an infant, “being regulated” shows up as predictable sleep-wake cycles, appropriate muscle tone (not too stiff, not too floppy), calm breathing and heart rate. Manual osteopathy can help to reduce to discomfort in the baby’s digestive system, it can help balance the baby’s nervous system and it can balance the baby’s movement patterns.
In my opinion, this is what the research on oral ties is missing – the addition of osteopathy to your baby’s care. As the tensional patterns are released, a surgical correction has the potential to be more efficient, providing relief for both baby and parents.
Combining care from your primary care provider, osteopath and lactation consultant is the best way to arm yourself with the tools to navigate your baby’s care.
