Alternatives to Surgical Intervention for Tongue-Ties

Tongue-tie is a condition present from birth where the frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth, is shorter or tighter than normal. This restriction limits a baby’s tongue movement and hinders their ability to breastfeed successfully. 

While the traditional treatment for tongue-tie often involves a frenectomy or frenuloplasty—a minor surgical procedure to cut or laser the frenulum—there are several non-surgical alternatives that can effectively manage the condition. 

1. Lactation Consultant Support

Typical first steps for managing tongue-tie, especially if breastfeeding challenges are present, include consulting with a lactation consultant. These specialists can: 

• Assess Latch and Feeding: They evaluate how the baby latches onto the breast and make recommendations for improving the latch to make feeding easier despite the tongue-tie.

• Suggest Feeding Positions: Different positions, like the football hold or side-lying position, can help the baby feed more comfortably and effectively.

• Provide Breastfeeding Aids: Nipple shields or specialized breast pumps can be used to alleviate some of the challenges with breastfeeding. However, these may not be ideal long-term solutions.

2. Oral Motor Exercises

Oral motor exercises are techniques that improve the mobility and strength of the tongue and other oral muscles. These exercises, often guided by a speech-language pathologist or occupational therapist, include:

• Tongue Stretches: Gently encouraging the baby to move their tongue in various directions can help increase flexibility. This can be done by gently stroking the sides of your child’s tongue from back to front, alternating sides.

• Sucking Exercise: Using a breast-like nipple shield or finger can help the baby practice sucking, and promotes better tongue control. 

• Mouth Stimulation: Soft brushes and the tapping of the gums can help stimulate oral muscle development. 

3. Myofascial Release Therapy

Myofascial release therapy is a form of gentle tissue manipulation (akin to massage) that can help release areas of muscle or tissue restriction throughout the jaw, neck, and even shoulders and spine that can contribute to tongue tie. Babies are often quite compressed in the womb for a few months prior to delivery, and this unique compression – plus the trauma of delivery – can lead to restrictions throughout the body, including the head and neck. Some myofascial techniques that may be used include:

• Gentle spinal traction

• Range of motion techniques for the neck and shoulders

• Cranial releases (through gentle compression of the cranial bones)

• Soft tissue releases of the lateral neck muscles (through gentle but sustained pressure applied with a few fingers to those areas)

4. Feeding Support and Adaptations

Incorporating adaptations can make feeding easier for a baby with tongue-tie. The following are a few helpful recommendations for babies that are bottle fed:

• Paced Bottle Feeding: This technique involves holding the bottle horizontally and allowing the baby to suck at their own pace, mimicking the breastfeeding experience. 

• Selection Adjustments: In some cases, adjusting the nipple flow rate or shape may allow the baby to latch and feed more easily and effectively. Dr. Brown bottles have mechanisms that can limit the amount of air swallowed and the flow rate. Many brands like Comotomo have different nipple sizes that can also help control the flow rate to accommodate your baby’s needs.

• Frequent, Smaller Feedings: Offering smaller amounts of milk more frequently can reduce the effort required for feeding and may be easier for a baby with limited tongue movement. 

Conclusion

While a frenotomy remains a common treatment for tongue-tie, several non-surgical alternatives can offer relief and support. These approaches involve professional consultations, oral exercises, myofascial release therapies, and practical feeding strategies. If you suspect your baby has a tongue-tie or is experiencing feeding difficulties, consulting with a pediatrician can help provide you with valuable guidance and support.