Physical Therapy, An Important Piece in the Tongue Tie Puzzle

A true tongue tie, or ankyloglossia, is a condition where two things must be true. First an infant’s lingual frenulum, the tissue connecting the underside of the tongue to the floor of the mouth, is too short or tight. All babies have a lingual frenulum, but not ALL frena (plural of frenulum) are tight enough to restrict tongue movement. The second important piece to a tongue tie diagnosis is that the tight frenulum needs to affect an infant’s function. In infants, this usually presents as feeding and/or sleep challenges such as:

• Poor milk transfer at breast or bottle

• Poor weight gain

• Shallow latch

• Painful latch

• Coming on/off breast or bottle

• Low milk supply

• Falling asleep during feeds

• Snoring

• Mouth breathing

Each of these symptoms in isolation doesn’t immediately point to a tongue tie, but if you are crossing a few of these off the list, it would be smart to get your baby evaluated by a provider trained in functional oral assessment.

If your baby has already been diagnosed with a tongue tie, you are likely already feeling overwhelmed by weeks of challenging feeding and lack of sleep. The idea of your baby needing a surgical procedure such as a frenectomy (surgery to release tongue tie) can bring up even more emotions. Finding the right professionals to support your baby and your family at this time is essential!

Make it stand out

Here is an image that I made to explain the important members of your baby’s Tongue Tie Team.  Often, one professional can play a few of these roles. Infant Physical Therapists with feeding specializations such as my Certified Breastfeeding Specialist certification can provide feeding support, bodywork, functional therapy, and family support.

The Role of Physical Therapy Before Surgery

A lactation-informed infant physical therapist who has additional professional training around the treatment of tongue ties plays a crucial role in preparing babies and their parents for the procedure and optimizing the baby’s recovery. Here are five ways how:

• Improving Feeding Skills: Prior to surgery, it’s important that you have ruled out other issues that could be affecting your infant’s feeding. Therapists can provide guidance on different feeding positions and techniques to help infants with tongue ties maximize their intake.

• Reducing Body Tension: When you are working hard to eat, you start using everything you’ve got to help. Babies with tongue ties very often have a lot of body tension. Working with a therapist to reduce this tension prior to a frenectomy is an important step to being “ready” for a release.

• Strengthening Oral Motor Muscles: Physical therapists perform gentle exercises (and teach you to do them, too!) to strengthen the muscles around the mouth, jaw, and tongue. These exercises help improve and maximize the infant's feeding function (latching, sucking, and coordinating their oral movements) prior to surgery.

• Addressing Compensatory Patterns: Often babies with tongue ties develop compensatory movement patterns, such as tongue thrusting, chomping (ouch!), or mouth breathing, to compensate for their limited tongue movement. Babies will work with whatever they’ve got to complete their most important jobs, breathing and feeding. A few visits with physical therapy can be so helpful to begin to correct these habits prior to moving forward with a frenectomy.

• Reducing Parental Anxiety: One of the most important signs of an infant’s readiness for a frenectomy is that their parents are ready too! It is so important that both parents are in agreement with having the procedure, that they fully understand the details of the procedure, and that they are aware of the details of post-operative care. Knowing what to expect is a very important piece to achieving a successful outcome. I find it particularly important to “walk” parents through exactly what will happen on surgery day to give them some peace of mind at a stressful time.

The Importance of Physical Therapy After Surgery

After a frenectomy, physical therapy continues to play an essential role in achieving the best outcomes. Here is why post-operative physical therapy is so important:

• Promoting Healing: In addition to the exercises prescribed by the release provider, physical therapy provides gentle soft-tissue mobilization that promotes the desired healing at the surgical site.

• Enhancing Tongue Mobility: Infant Physical Therapists perform targeted exercises to increase your baby’s ability to lift, cup, stick out, and move their tongue side-to-side. Now that your baby’s tongue has more mobility, they need to learn how to use that new movement in the best possible way.

• Improving Feeding: Physical therapy can help infants improve their feeding skills by achievement of a deep latch, strong suction, and coordinated tongue movements.

• Monitoring Development: Babies with tongue ties often have gross motor delays. Tension in their mouths and bodies make it very difficult to be successful with tummy time. Also, working hard to feed every few hours doesn’t leave much energy for achieving the next motor milestone. Physical therapy sessions after your baby’s tongue tie release will also focus on getting your baby back on track developmentally.

Per the American Academy of Physical Therapy (APTA)’s definition:

“Physical Therapists are licensed doctors who work with multiple patient populations impacted by disease, injury, and movement dysfunction. They optimize quality of life by maintaining, restoring, and improving patient's ability to move, function, and live more active lifestyles.” 

When we apply this definition to babies with tongue ties, this is what I see:

“Infant Physical Therapists with additional tongue tie training are licensed doctors who work with infants impacted by tongue ties and oral movement dysfunction. They optimize quality of life by maintaining, restoring, and improving an infant’s ability to move their whole body (including their tongue), function (eat, sleep, and play) and live a more active lifestyle (achieve motor milestones).”

How to Find a Qualified Infant Physical Therapist

If you suspect your infant may have a tongue tie or if they have been diagnosed with one, it's important to consult with a qualified infant physical therapist. Some great resources for finding an infant physical therapist near you include the International Consortium of oral Ankylofrenula Professionals (ICAP) directory and Milk MattersPT Tongue Tie Scholars Mentorship Program directory. It might also be helpful to seek out a therapist that has either CBS (certified breastfeeding specialist) or CLC (certified lactation counselor) after their name, signifying that they have achieved additional credentials in regards to supporting breastfeeding infants.

If you live in southern New Hampshire, you’re in luck! Playful Progress Pediatric PT provides in-home, pre- and post-frenectomy therapy for babies with tongue ties. You can learn more about me and my practice here, and if you are considering working together, you can schedule a free consultation using the button below.