Every time I hear of “minor,” “mild” or “small” tongue ties alarm bells ring. This often means the provider is not well educated when it comes to posterior ties.
When a provider examines for tongue and lip ties they should not only look and feel in the mouth, but, should take a full history to include current and past symptoms (depending on age). It is all about function.
If it is an infant or breastfeeding child and IBCLC who is familiar with posterior tongue and lip ties is often the best resource. Sometimes it is not possible to work with an IBCLC, or it may be an older child or bottle fed infant. Some providers will offer an assessment via email. Another resource is the Tongue Tie Babies Support Group on Facebook – they will not diagnosis, but, there are many knowledgeable parents and providers that will offer insight, as well as an international list of frenectomy providers.
The photos below are a sample from my own children – there are many more presentations than the ones pictured here. Just remember, it is all about function!
This is the “minor” tongue tie. In actuality it was severe. Notice how only the very tip and sides elevate – this is during a full cry, the very highest she could lift her tongue. Her symptoms included: Thrush (see white in edge of mouth), weight loss/poor gain, clicking and slipping off the breast while feeding, little to no milk transfer and falling asleep while feeding, choking on the bottle, reflux. My symptoms were damaged nipples, engorgement and oversupply followed by low supply.
This photo also shows a posterior tongue tie that revised incompletely (choose your provider carefully and if you have doubts get a second opinion from someone more experienced!) Here the tongue lifts a little more, but, still not enough to properly milk the breast.
This was taken the same day as the previous photo, often when the tongue is lifted enough, a posterior frenum will “pop” into visibility. When these photos were taken her symptoms were slow weight gain/failure to thrive, clicking and slipping of the breast reflux, and poor milk transfer, and poor coordination while feeding.
This is her lip tie, notice how little the lip lifts, she often rolled it inward while nursing and it prevented her from latching deeply.
Here is a high and narrow palate, when the tongue is restricted, babies cannot properly “spread” their palate. When the palate is high it causes additional sucking difficulty, dental problems, and is just one more sign that a tongue tie is likely present.
This is a poor latch caused by tongue and lip tie. Notice that not much of the breast tissue is being drawn into the mouth, and the upper lip is rolled in. After nursing the breast would be flattened (think lipstick), whitened, and have teeth marks due to her restrictions.
This is also a posterior tongue tie, my 5 year old. Notice how far the tongue can stick out, but, also take note how it turns down, and has a heart shape at the tip. He reports pain when lifting his tongue, choked and spit up (projectile) often while breastfeeding as an infant, fed constantly, and I had severe pain for more than 6 months. His tie was not found until recently…not one doctor or IBCLC we saw every looked or mentioned it. We treated ourselves for thrush for months only to have a culture done which concluded we did not have thrush at all. Thrush and tongue tie symptoms feel very similar!
Notice here that he has to close his mouth to lift his tongue this high, you can also see the triangle shape at the base of the tongue where the floor of his mouth is being lifted as well. He complained that it hurt to do this.
Here he is “clicking” his tongue and the posterior frenum has “popped” into visibility – very short and thick!
Links for more information:
Consquences of Untreated Ties (TongueTie.Net)
Articles Specific to Infants and Children (Dr. Lawrence Kotlow, DDS)
Case Studies about Tongue Ties, and Related Physical Issues (Dr. Brian Palmer, DDS)
Resources and other Parents Dealing with Ties (Tongue Tie Babies Support Group)