Tongue-tie and Lip-tie Treatment in New York City

A tongue tie and or lip tie can be frustrating for both mom and baby, and possible lactation issues and baby’s lack of weight gain. Tongue-tie is a condition in which the baby is born with either a shorter, thicker, or tighter band of tissue connecting the bottom of the tongue to the floor of their mouth.

A lip-tie is a condition in which the piece of tissue in the front of, above and in the middle of your two top teeth, behind and above the upper lip (frenulum) is too short, too thick or is attached in a movement restrictive way.

Both Tongue tie and lip tie is generally seen in only 5% of the newborn baby population.

Tongue Tie and Breastfeeding

Tongue and lip ties can generate tissue tension and interfere with breastfeeding causing the mom to experience nipple pain, soreness, cracks, slow weight gain for baby, and lots of feeding frustration. Ties can also affect swallowing, and potentially contribute to reflux, colic, speech, and dental health.

Babies don’t just “grow out” of tissue tension.  If it is not dealt with properly a Posterior Tongue Tie (PTT) can manifest into many different health issues as the child grows – TMJ pain, headaches, scoliosis, torticollis, developmental delays, speech impairment, lack of proper weight gain, spinal subluxations, etc., are all very common.

Some signs of Tongue Tie or Lip Tie in infants:

  • History of poor suck
  • Shallow latch
  • Clicking sounds
  • Ineffective milk transfer
  • Poor weight gain or weight loss
  • Gas or reflux
  • Fussiness at the breast or arching away
  • Frequent sliding off the breast
  • Flattening of the nipple
  • Coughing or choking while feeding
  • Spilling milk from sides of mouth
  • Poor tongue movement

Tongue Tie and Lip Tie in Older Children

When TT’s and LT’s are not diagnosed early enough many issues can arise. In older children it could be the lack of maximum expression of health. Such as:

  • speech delays
  • developmental delays
  • postural asymmetries
  • facial incongruence
  • labored swallowing
  • breathing difficulties
  • snoring
  • TMJ
  • Many other Challenges

Misunderstanding of Posterior Tongue Tie and Lip Tie

There is much misunderstanding and controversy when it comes to Tongue and Lip ties. The reason for that is due to the medical professions lack of knowledge about breastfeeding and the relationship with tongue and or lip tie.

There is from the medical community a blatant ignorance of the anatomy and physiology of the oral-facial suckling mechanism. A lack of knowledge about the normal function of the infant tongue during breastfeeding is the first issue. The second problem new mothers are facing, is not knowing that most Pediatricians, Pediatric Dentists, lactation consultants and many ENT’s don’t understand the proper examination techniques which prevent them from correlating common baby symptoms with abnormal tongue or lip anatomy and physiology.

What is not properly examined are the tissues around the tongue and on the exterior, the neck (cervical spine) is not properly assessed for tissue and muscle tightness which can be a contributing factor and limitation of the suckling mechanism. A thorough evaluation of all soft tissue structures in and around the neck, throat and tongue must be evaluated as the true origin of bottom and posterior tongue tie.

This Doctor explains it perfectly, Dr. Bob Ghaheri:

Research, Posterior Tongue Tie

A study from 2015 by Pransky and colleagues retrospectively evaluated 618 babies presenting with breastfeeding symptoms. In this study, only 20% had Posterior Tongue Tie (PTT) alone and a further 5% had both PTT and Lip Tie.

A posterior tongue tie is the presence of abnormal collagen fibers in a submucosal location surrounded by abnormally tight mucous membranes under the front of the tongue. A classic anterior tongue tie is referred to as the posterior tongue tie (in front of the mouth and under the tongue). Therefore, any tongue tie causing breastfeeding problems is truly a posterior tongue tie.

In older children, undiagnosed or newly developed ties can cause various health issues as well. Such as, speech impairment, developmental delays, lisp, stuttering, anxiety and more.

Tongue Tie Revisions are over diagnosed and as a result create a failure rate in correcting the among other issues, the suckle / latch reflex.

Pediatricians, Dentists and ENT’s

The other major misunderstanding that medical professionals have about Tongue Tie is the idea that the tie is somehow “deep” and that it intertwines with the muscles of the tongue. This is not the case. The abnormal collagen fibers of the PTT are intertwined within the mucous membrane covering the tongue muscles. The muscle of the tongue beneath this mucous membrane is in a completely different tissue layer and is therefore not involved in tongue tie anatomy.

A common misconception is that a tongue cannot be tied if it can extend out of the mouth beyond the gum-line or lips. This is completely false. First, the tongue is capable of numerous different movements, and normal mobility in one direction does not guarantee normal mobility in all directions. Furthermore, the motion of the tongue during breastfeeding is very specific, the primary movement that is important for the tongue to perform during breastfeeding is up, not out.

Upward Tongue Movement During Breast-feeding is key

Another piece of published research by Donna Geddes’ in 2008 (and later corroborated by David Elad’s paper in 2014) demonstrated the importance of the upward motion of the tongue. The lack of strong upward movement, inhibited by a tongue tie’s abnormal collagen fibers restricting the tongue to the floor of mouth and jaw, is shown in common symptoms: poor suction/seal on the breast, frequent breaking of the seal with resultant clicking, air intake (aerophagia), slipping off the breast and having to bite down to hold on to the nipple and so forth. These symptoms can occur with bottle feeding as well.

Definitive and Correct Examination

Examining thoroughly the underbelly of the tongue and understanding of the normal movement of the mouth during breastfeeding, including the tissues involved is crucial in determining the right course of treatment. Many Tongue Ties can be significantly improved with Craniosacral Therapy by simply facilitating the softening of the tissues under the tongue.

A comprehensive examination of the Craniosacral Mechanism and the potential presentation of cranial misalignment is as important as the examination of the tongue and all of the surrounding tissues and bony structures. Without challenging the upward movement of the tongue, we will never understand if a limiting and palpable restriction exists. Many issues arise from the uneven alignment of the jaw and possibly some of the bones that make up the head and face.

Cranial misalignment is very real and 9 out of 10 times goes undiagnosed, effecting the soft tissue structures of the tongue, lip and overall mouth with tightness and spasm of these tissues, giving the presentation of tongue and lip ties. Dr. Kaminsky is trained to evaluate and treat your child for cranial misalignment.

To Revise or Not to Revise Surgically

Along with the misconceptions about PTT anatomy come misconceptions about PTT revision. Many able and skilled providers combine a poor examination technique with apprehension about PTT release. Why is there apprehension about the procedure? The most common reason is the misunderstanding of how deep one must cut to fully release the tethered fibers. The posterior tongue fibers intertwine with the mucous membrane and do not involve the muscle.

Surgery Risks

Proper surgical revision technique involves a central release of the fibrous band and then a release of the mucous membrane on either side of the central band. A release of the mucous membrane lateral to the band (resulting in a diamond-shaped wound) must be done with precision because the mucous membrane around the tie has shrink wrapped around the muscle to only allow the movements that were present prior to the tie release.

Once the central band is released, you must also revise the mucous membrane on both sides of the tongue to allow the tongue to actually move up. The actual depth of the initial incision is surprisingly shallow (approximately 1mm). Neither the central release nor the lateral mucosal releases should involve the muscle belly of the tongue. A PTT can be released with scissors or laser, the release technique is far more important than the tool used.

Why the Tissue Reattaches

Unfortunately, many surgical revisions of PTT result in reattachment and a further impairment of the tongue. The reason for this is simple, when a wound is created, it will undergo specific, predictable changes in an attempt to close that wound. The cutting or lasering of the tissues is an unnatural process and so the body heals by reattaching these very same tissues.

It is always better to release the tissues non-invasively, with craniosacral therapy, by allowing them to soften and lengthen with conservative intervention from a skilled and experienced Craniosacral Therapy practitioner.

If the revision has already been done, it is still very beneficial to have craniosacral therapy done immediately after and with consecutive sessions to help further relax and sustain the tissue and muscles of the tongue / lip and surrounding softening of the mouth.

How Can Craniosacral Therapy Help

Craniosacral therapy is a crucial non-invasive, hands-on gentle care that can relax the tension patterns that surround the tongue, mouth and lips; thereby, improving mobility, and function of the entire mouth.

The important thing to understand is that the baby can have primary issues that are causing the tissues in the mouth to become bound, those potential issues can be as follows: the baby may be restricted at the occipital cranial base (where the head meets the neck), may have tight muscles throughout the neck, may have a recessed chin, may be stiff and tense throughout the body, may have torticollis (tightness greater on one side of the neck muscles), cranial bone jamming at the sutures, or other (allopathically undetected) issues; all which negatively influence the tissues of the tongue / lip and surrounding tissues of the mouth.

Craniosacral Therapy can facilitate improvement and mobility in the tissues of the tongue by also decreasing the restriction and tension patterns throughout the body that have contributory affects from the neck, head, chin, jaw and mouth, thereby alleviating further breastfeeding and other issues.

Improved understanding of PTT, combined with taking the right approach will improve your long term breastfeeding success.

Have your child evaluated and treated by alternative, non-invasive ways. Through CranioSacral Therapy fascial tongue and lip tie restrictions are naturally repositioned, muscles are relaxed, realignment occurs, the baby becomes calmer, less tense, has improved jaw and tongue mobility, and latch and milk transference improves drastically.

Make an appointment to visit Dr. Alex Kaminsky, there is good potential for great results.

About Dr. Kaminsky & Craniosacral Therapy

Dr. Kaminsky is a 1999 graduate of the University of Bridgeport College of Chiropractic. He is licensed to practice in NY and has completed close to three thousand hours of professional continuing education since becoming licensed in March of 2000.

The primary approach used in his office is Craniosacral Therapy (CST) which is a method focusing on the cranium (head) and sacrum (a large bone at the base of the spine) scientifically proven to control life sustaining fluid flow throughout the body.

Craniosacral Therapy is a gentle, non-invasive, hands-on manual therapy approach that brings about healing via the fluidity of the body. The existence of the Craniosacral System was first discovered by Osteopath Dr. William Sutherland in the early 1900’s, calling it Cranial Osteopathy.  And later rediscovered, validated, and developed by Dr. John Upledger in the late 70’s early 80’s, who renamed it Craniosacral Therapy after doing five years of research at the Michigan State University, School of Medicine. In 1983 Dr. John, as he was fondly called, established a teaching institute in Palm Beach, Florida, to teach this cranial sacral method to all healthcare providers. The Upledger Institute is still very active today.

The craniosacral mechanism pumps fluid which is produced in the brain, called cerebro-spinal fluid (CSF), through the fascial network of the body, the purpose of which is to lubricate joints, muscles, organs, all cells and all tissues. It is the driving life force for your body’s systems to function properly, CSF also carries healing properties to bodily traumas, injuries and past surgeries.

The proper function of your cranial sacral mechanism, via CSF flow, maintains the normal tone of your muscles, provide nutrients to your organs, and keeps you out of pain. It sustains human life and allows your nervous system to stay responsive to challenges of daily living and your mind-body life experiences. The better your craniosacral mechanism functions, the better the flow of this life sustaining fluid, the better your body can handle physical and emotional stress. The uninhibited flow of this fluid throughout your body allows you to thrive, opposite of survival mode.

CSF is part of the Autonomic Nervous System (ANS) brain and spinal cord), which is physically encapsulated within the dural membranes of the spine and head.

One of the functions inside of your brain is to automatically generate energetic rhythmic impulses that function to pump CSF throughout your body, regulating your peripheral nerves, nervous system and organ systems, which in turn, sustain your function (physiology) and life. It is an important force that maintains everything functioning in your body. This is what we call the Craniosacral System, or Craniosacral Mechanism. It is the hydraulic, energetic and rejuvenating system of your body.

This measurable life force of moving fluid is palpable to a trained craniosacral therapist, like the heart rhythm, pulse rhythm, breathing rate, that can all be felt, so too can the Cranial Sacral Rhythm (CSR) be palpated and measured. It is the foundational diagnostic tool in real-time used to evaluate your current state of well-being (or lack thereof), and potential for health improvement and healing.

Compromises of your rhythmic impulse, correlates to CSF flow restrictions in the system which the body is unable to self-correct or overcome on its own. This is the reason why over time we develop pain, dis-ease, symptoms, conditions, mind-body disconnect and basically all human physical and psychological ailments.

When the fluid isn’t flowing optimally, your bodily rejuvenation is affected, and this is where the skill of an experienced craniosacral therapist becomes valuable. By placing his or her hands on your body, most commonly on your head and sacrum, for diagnostic purposes, the practitioner can detect, feel, evaluate, and rate the SSQAR (strength, symmetry, quality, amplitude, rate) of the rhythm; then bring forth correction of any limitations with subsequent experienced hand placements on different parts the body during a session.

A craniosacral therapist helps your rhythm reset, restore and renew allowing for healing to take place of the mind-body connection, musculoskeletal tightness and spasms, neurological deficits, autoimmune issues, organ function, many common conditions, and of course pain. Through a practitioners properly focused and attuned touch, your body is facilitated to release channels of fluid stagnation and flow restriction, which ultimately breakthrough, overcome and improve CSR and the function of vital fluid flow.

Dr. Alex Kaminsky is an advanced practitioner of Craniosacral therapy, having studied up to advanced levels including SER and pediatric courses. He has built a solid foundation with many years of experience, treating babies, children and adults.

To learn more, visit the other pages on this website. Call to schedule your appointment with Dr. Kaminsky.