A Lactation Consultant’s Perspective on Oral Ties and Feeding
Continuing our series, It Takes a Village, we are honored to highlight the value of lactation support. We asked Abby McLaughlin, owner of Mal’s Milky Way, to offer her insight on oral ties and how they could impact a parent’s feeding journey. Here at Baby Bear, we see a high amount of patients who have both torticollis and oral ties, so we appreciate her approach to this sometimes-confusing topic!
Oral ties… what a HOT TOPIC in the breastfeeding world! While I am not an expert at oral ties and am unable to diagnose them, I wanted to share my personal perspective on them as a private practice International Board Certified Lactation Consultant.
What are signs and symptoms of oral ties?
Oral ties can cause a shallow latch while nursing, leading to things like slow weight gain/weight loss, fussiness during feedings, decreased diaper output, decreased milk supply and nipple pain and damage. Other signs include a strong gag reflex/easily gags on bottles/fingers/pacifiers, colic, frequent feedings without satisfaction, consistently long feedings (like regularly over 30 minutes), poor stamina with feedings, and a sleepy baby, just to name a few!
In my practice, I never do an oral exam on an infant unless symptoms from mom or baby tell me to. I am pretty hands off during my consults to not only avoid invasiveness, but to boost confidence in mom and baby to be independent and successful when I am not there.
Many mothers come to me with latch concerns and/or nipple pain and damage. While nipple pain and damage can be a sign of an oral tie, it’s not what I immediately jump to. I always begin with the BASICS! Let’s look at positioning and technique in the current breastfeeding relationship. Are there any tweaks or adjustments we can make to improve symptoms or issues? If yes - WONDERFUL! I love a simple fix to a big problem! If no - my next step is to put on my detective hat and investigate why the latch is causing damage. While a whole slew of issues could be responsible for these symptoms, I only do an oral exam if i can rule out more simple explanations! While I cannot diagnose, I can use signs, symptoms, and the oral assessment as evidence towards a sinking suspicion of an oral tie.
What is an oral tie exactly?
EVERYONE has tissue that connects our lips, cheeks, and tongue to our mouths. What makes it an oral tie is when this tissue is tight and restricts FUNCTION. So part of the oral exam is not only visually assessing these pieces of tissue, but also assessing the function of the infant’s mouth. If the tissue appears tight along with decreased oral function on exam, along with all of the signs and symptoms that brought them in, I would then suspect an oral tie to be the culprit of the damage!
What are the next steps if an oral tie is suspected?
If I suspect a tie after putting together all the evidence, I start my referrals! I take a multiprofessional team approach to manage oral ties, because it takes many different techniques and knowledge sets to truly make a difference for them. If you prefer a conservative approach, which I recommend the majority of the time to avoid invasive procedures and traumatic stretches in the healing process, I start with these professionals: speech therapy, chiropractic therapy, craniosacral therapy, myofunctional therapy, and massage therapy. A lot of time, parents can not only see improvement in their kiddo but FEEL improvements with nursing with these therapies. If all of these have resources still haven’t completely solved the issue, the next step is a frenectomy or oral tie release.
The gold standard for this procedure today is finding a conservative provider that does a mix of laser and scissor release techniques. Using a laser decreases scar tissue and healing time, while scissors allow for more precise tissue release. After the procedure, I HIGHLY recommend continuing to use all the therapies previously listed as the release doesn’t allow babies to just know how to use their new, looser mouth and it surely doesn’t remove the tension elsewhere in the body. It is very typical for babies to be disorganized while eating after releases and they are not used to the freedom of oral movement. This is where speech therapy will come into play; helping your infant learn to properly use their new and improved mouth! It is also very common for babies with oral ties to have tightness all over their bodies that can be seen as things like torticollis and colic. This is where the bodywork is vital to help release the tension all over the body.
It Takes a Village to Be Informed
While I am not the expert on all the effects oral ties have on things like speech, eating solids, mouth breathing, etc, I focus on how the ties affect the breastfeeding relationship. If ties are suspected and can be improved without the release with above therapies, great! If you want to investigate the potential risks of not performing the release, please do! I think when making any decisions as a parent (and for ourselves too!), reaching out to multiple professionals for different opinions, various expert knowledge, and obtaining a list of benefits, risks, and alternatives to ALL of your options is so empowering. Feel confident in following your intuition, shopping around for a provider that’s a perfect fit for your family, and making an INFORMED decision.
While navigating through feeding difficulties can be challenging, reaching out to support before it becomes an emergency is vital for both physical and mental health! Lean into supports and fight for peace and ease for your journey… you and your baby deserve it!
Meet Abby McLaughlin
I am the founder and owner of Mal’s Milky Way LLC. MMW is a private lactation counseling practice where we provide personal lactation support along with prenatal education classes. I have a passion for helping others, giving parents and their children the education and tools to meet their goals as a family, while setting them up for health and success. I am an International Board Certified Lactation Consultant (IBCLC) with a Bachelor’s Degree in Nursing, and I am a Registered Nurse with neonatal intensive care unit experience.
I had a traumatic pregnancy, labor and delivery, which ultimately led to a traumatic start to our lactation journey. I struggled with overwhelming pressure from myself and my care team to provide breastmilk for my daughter, however was not provided anywhere near the support I needed to continue. I grew to resent feeding my daughter and could not get her to gain weight. I received mixed advice from the hospital lactation team, her pediatrician, and my obstetrician. I did not know what to do or who to listen to. I finally started listening to my body and my daughter, and it was only then that we both THRIVED.
I’m proud and so thankful to be able to say I successfully wrote a new story for myself and my second daughter! With Margaret, of course, there were pieces of our journey that were out of our control, but we were able to create such a peaceful and beautiful breastfeeding experience together. I share this to say it is possible to change your story too, and I’d be honored to help.