Pediatric Care for Tongue-Tied Diagnosis
Posted on 5/26/2017 by Aileen Lysaught, M.S., CCC-SLP
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Being a first time mother, you don’t really know what to expect after your child is born. My son Rowan was born unexpectedly at 35 weeks. While I was in labor, the nurses warned me of all the complications that may occur with a premature baby. The neonatologist was present for the delivery, and my son was quickly whisked away before I could hold him. While he was being examined by the doctors, I couldn’t wait to hold him for the first time. I could hear him crying as well as the nurse saying, “It looks like he has a tongue tie; my grandson had one, too.”
It seemed slightly ironic, being a Speech-Language Pathologist (SLP), that my son would have a tongue tie; however, I was too overjoyed with his birth to worry about the consequences of this during our first moments together.
When I looked in Rowan’s mouth, I could see he had what’s called a Class 1 tongue tie (the small fold of membrane that normally extends from the floor of the mouth to the midline of the bottom of the tongue attaches all the way at the tip of the tongue). This would significantly impact his ability to move his tongue for feeding.
Our first attempt at breastfeeding was when things became difficult. Being a preemie, he had some difficulty feeding as the sucking pads are not developed in babies born prior to 37 weeks. The tongue tie also made it difficult for him to coordinate the movements necessary for breast or bottle feeding. So, being an experienced SLP, I knew to ask, “When can we have the ear, nose and throat (ENT) doctor come do the frenectomy?”
A frenectomy is a procedure for children struggling with speech or feeding difficulties related to tongue tie. This procedure would help my son improve his feeding skills and get the adequate nutrition needed. The next day, the ENT arrived and quickly performed the procedure. By our first pediatrician appointment the following week, he was back up to his birth weight and then some.
As time went on, I noticed some symptoms in my son that led me to believe he still had tongue restriction and a potential lip tie. He suffered from reflux, which caused him to arch his back and become fussy after feedings. He was gassy and didn’t sleep very well.
Aileen and RowanI began to research as much as I could about tongue tie in babies and children. I took courses and joined support groups for other parents with tongue tie babies and groups in which SLPs would discuss their experiences with tongue ties. I found that some of the other symptoms my son was experiencing could be related to his tongue tie. I also found that many physicians or dentists who are not specially trained in tongue tie may not perform complete revisions, which may result in the need for a second procedure. By this time my son was six months old.
After a lot of research and careful consideration, I went to see a pediatric dentist who was highly recommended and performed successful frenectomy procedures on many of my patients with great outcomes. I was worried, but I couldn’t help but think about how many times I have recommended a family to have the procedure done. The pediatric dentist we saw was extremely knowledgeable.
After he examined my son, the dentist said Rowan’s initial frenectomy was likely incomplete and he would have to use a laser to perform another revision on Rowan’s tongue as well as revise his lip tie. I trusted his recommendation and the procedure took less than five minutes.
I knew the importance of aftercare procedures, including stretching 10 times per day for 10 days and oral motor exercises to improve Rowan’s tongue’s strength and range of motion. I noticed significant improvements in his feeding abilities, ability to babble and gross motor development. Now that Rowan is a little over a year old, has well over 20 words in his vocabulary and is beginning to eat a variety of foods, I couldn’t be happier that he is able to move his tongue freely.
My situation was quite unique being a practicing pediatric SLP with experience in this area. Many mothers struggle and have to give up their attempts at breastfeeding before they discover what may be impacting their child. Many babies have difficulty with weight gain, suffer from reflux or are diagnosed as colicky when the issue lies in their tongue’s ability to function correctly. Parents may not realize their child has a tongue restriction until they have been diagnosed with a speech delay or struggle with a toddler who refuses to eat.
Tongue ties impact many areas of speech and feeding development, and it is important to find knowledgeable professionals to help with the process. It is essential to work with a SLP who can evaluate and identify if a tongue restriction exists and treat the symptoms (speech and feeding difficulties). It is also important to get referrals to an ENT or pediatric dentist to determine if a frenectomy is advised.
Having experienced these issues first hand, I feel that it not only makes me a better mother, but a better SLP. I am dedicated to helping other families overcome these difficulties so their child’s quality of daily life can improve.
Aileen LysaughtBy: Aileen Lysaught, M.S., CCC-SLP. Aileen is a pediatric SLP and the assistant center manager at NovaCare Kids Pediatric Therapy in LaGrange, IL. She has been a practicing SLP since 2010.