Does your baby have a tongue tie? Maybe you’ve had it diagnosed by a specialist, or maybe you just suspect it might be the case based on your circumstances - poor weight gain, sore or cracked nipples, a fussy, colicky baby or the clicking sound they make while breastfeeding.
The term “tongue tie” suggests that the main thing you need to fix is the tongue, and while that’s most often the start of how to treat tongue tie, it’s not the whole picture. In fact, many families who get the tongue tie “revised” - clipped by a medical professional - don’t experience relief from the symptoms if they don’t seek further help. That’s because a tongue tied baby has more going on than just an overly restricted tongue.
Your baby’s tongue tie is just the tip of the iceberg - a sign that there is tension and restrictions throughout the body, from the tip of the tongue into the neck and shoulders and all the way through to the tailbone. Craniosacral therapy can help address the underlying tension that is keeping your baby from breastfeeding well and causing pain and discomfort.
What is a tongue tie?
A tongue tie, also referred to as ankyloglossia, is when the frenulum (the small piece of connective tissue under your tongue) is tight or short, restricting the tongue’s movements. In order to breastfeed, a baby’s tongue needs both lift and extension. Extension - meaning they can stick their tongue out far enough and open their mouth wide enough to create a seal around the breast. Lift refers to the tongue moving up and down in a wave-like movement, which creates a vacuum inside the mouth that draws out the milk. If lift and extension aren’t happening, or if they aren’t happening well enough, it’s difficult for a baby to adequately drain the breast, leading to low weight gain and/or painful nursing for the mom.
What are some signs and symptoms of a possible tongue tie?
Slow weight gain
Poor or shallow latch
Clicking sound while nursing
Gassiness
Grunting
Reflux, Colic or general fussiness
Pops of breast frequently or seems to gag
Cracked, sore nipples for mom or painful nursing
Creased, flat or blanched nipples after nursing
Low milk supply, or alternatively, engorgement
Plugged ducts or mastitis
Waking frequently to eat
It’s important to note that not every mom and baby will experience all of these symptoms. But a tongue tie won’t get better on its own, so if you suspect one, seek help from trained professionals.
How is a tongue tie connected to muscle tension in a baby? Why isn’t clipping their tongue tie enough to resolve the issue?
Muscular tension can both be part of the root cause of a tongue tie and a symptom of it, contributing to a fussier baby who just can’t relax (and is often quite hungry - a double whammy!).
Although we don’t know exactly what causes tongue tie, researchers think it has both genetic and epigenetic causes (meaning our DNA and how our DNA is affected by our environment). A tongue tie is considered a midline defect, similar to a cleft palate or deviated septum.
This midline restriction can run the length of the body, not just in the tongue, creating an overly tight midline from head to toe. You’ll often see tongue tie babies curled up in a c-shape with their head, arms and legs reaching over to one side. Others will have their arms above their head and their backs constantly arched. Some have shoulders pulled back together. Torticollis, a consistent head tilt that can lead to a flat spot on the baby’s developing skull, is also common in tongue tie babies. All of these twist and turns are just baby’s attempt to get comfortable, eat and digest their food.
Some tongue tied babies may already have some midline tension from how they were laying in utero or from birth. Add to that trying to breastfeed with a tight tongue and neck, and you get even more tension. Tongue tie babies are also missing out on a key part of breastfeeding - the relaxation that’s triggered when their tongue touches their hard palate. Nerves in the hard palate trigger a calming response for babies, part of why breastfed babies can get “milk drunk” after feeding. Babies who can’t get that kind of lift with their tongue have a hard time finding that milk bliss.
So while clipping the frenulum allows the tongue to move more freely, it doesn’t address the bigger picture. A tongue tie is like a snag in a piece of silk - although it may only be one small thread, it creates ripples of tightness through the whole garment. If we want to help a tongue tie baby breastfeed well, we need to address the underlying tension. That’s where Craniosacral therapy comes in.
What is Craniosacral therapy? What does a craniosacral therapy session with a baby look like?
Craniosacral therapy, or CST, is a light-touch therapy that helps release restrictions in the pelvis, spine, neck, and skull, which improves the function of the central nervous system. CST is an extremely gentle way to release tension in the midline, allowing improved motion for the tongue and the entire body.
Unlike getting your baby’s tongue tie revised, which usually involves a laser or sharp tool in their mouth, a CST session is actually relaxing for babies. Many babies fall asleep or “bliss out” - just smiling and relaxing during their session. Although sometimes we lie baby back on a table, I often hold a baby or work on the baby while a parent holds them. Babies can even breastfeed while getting CST! For older babies, we have toys available, and I’m happy to move around the room as needed to treat them. No need to lie still, and we stay responsive to baby’s needs - pausing if they are stressed or uncomfortable and letting them show the way.
With a tongue tie, I like to start releasing tension at the sacrum and work up, allowing tension to release and to create room for movement further up. This way when we get to the cranium the releases are more effective, more comfortable and less painful. If I skip these releases throughout the body, baby will often protest and let us know they are uncomfortable - so we start low and keep working our way up to create sustainable releases.
As a mom myself, I want each baby and parent to be comfortable, relaxed and happy during their session. Because many tongue tie babies are fussy and colicky, I’ve had many a mom come in and say, “I’m the only one who can hold my baby without them screaming.” First, it’s totally possible to have mom hold baby the entire time, but many parents are pleasantly surprised at how relaxed their babies are with CST and how that relaxation increases as their bodies release tension.
What kind of results can I expect from craniosacral therapy for tongue tie?
Although each mother and baby are different, some common results from even just one session of craniosacral therapy for tongue tie are:
Baby is able to stay latched on longer
More comfortable latch
More effective nursing - getting more milk
Better sleep - longer naps or stretches of sleep
Baby grunts less
More balanced nursing on both sides
Less tension in baby’s body
More smiles, coos and pleasant moods
How many sessions should you do? It varies. While many families see some results after just one session, it’s best to do at least 2-10 sessions to make sure the underlying muscular tension is fully addressed, so it’s less likely to recur. As far as how often to schedule treatment, it can depend on the situation. If you’re experiencing really extreme symptoms such as very low weight gain or failure to thrive, we can start with twice a week and space out sessions as symptoms improve. Other families may find that once a week or once every two weeks works well to start and appointments can be spaced out from there.
If you suspect a tongue tie but haven’t had it revised, it’s a good idea to come in before you have your baby’s revision done. Doing so can help begin the process of unraveling your baby’s tension, making the revision more successful, and continuing to address that tension after the revision with a few more appointments.
It Takes a Village to Address a Tongue Tie
For moms who are struggling with a tongue tie baby, I wish it was as simple as just getting the frenulum revised and having the issue resolved. But I’ve spoken to many moms who have little to no relief from having their baby’s frenulum clipped, a truly terrible situation when they’re already struggling!
In my experience, it takes at least a trio of providers to address a tongue tied baby. A trained medical professional can help you identify a tongue tie, such as pediatric dentist Brett Kingma or Grady Randall at Mitten Kids Dentistry. Although many pediatricians, doctors and midwives might look in your baby’s mouth and give a diagnosis one way or the other, if you suspect a tongue tie, it’s best to have someone who specializes take a look. It’s easy to miss a tongue tie if you aren’t trained to know what to look for. If your doctor didn’t put two gloved fingers in your baby’s mouth and lift the tongue, they’re probably not well-trained enough in this area to identify a tongue tie.
Although many parents choose to get their baby’s tongue tie revised through a short laser procedure, it can be possible in some cases to address a tongue tie without surgery, through a combination of craniosacral therapy and help from a lactation consultant.
A good lactation consultant, particularly an IBCLC, is essential, both for dealing directly with the tongue tie and the additional breastfeeding issues that often accompany tongue tie, like problems with milk supply or pain. We’re lucky to have two wonderful IBCLC’s in our area who are well-versed with tongue ties. Someone I love working with in West Michigan is Shira Johnson, an IBCLC who trained with many experts on the West Coast, including shadowing Dr. Bobek Ghaheri, one of the foremost experts in the US on tongue tie. Shira can provide additional exercises, tips, positioning and support for moms and babies with a tongue tie. Her experience and encouragement is invaluable! Reagan Gielincki is another IBCLC, as well as an occupational therapist, who is brilliant at recognizing on how integral the body is in a successful nursing relationship. Both are skilled providers who can help you meet your breastfeeding goals with knowledge and empathy.
This trio of practitioners - a trained professional like a pediatric dentist, a good lactation consultant and a craniosacral therapist - can give you the support you need to correctly identify a tongue tie, decide how to address it, as well as taking care of underlying issues that may affect to you and your baby’s wellness. I know, it seems like a lot, doesn’t it? But for parents experiencing the pain, frustration and stress of a tongue tie, these providers together can help you overcome the issue and meet your breastfeeding goals.
We know that moms with tongue tied babies are less likely to reach their breastfeeding goals. Maybe you’ve even been told by a well-meaning pediatrician, “Maybe you should just bottle feed. Don’t make yourself crazy over it. Breastfeeding just doesn’t work for everyone.” Of course, you should feel empowered to make the choices that are right for your family. But we know that breastfeeding has long term health and emotional benefits for mom and baby, and it is possible to reach your goals with the right support. Everyone deserves a team that will help them find the solution they need.
Got questions about tongue tie, or wonder if CST can help your baby? Check out our online course, The Tongue Tie Tool-Kit, with expert interviews, exclusive content and more.