Thanks for tuning in this episode of MomTalks with Christa, this is our special Q&A segment that we have with Kristen Sorondo who is a lactation consultant and nurse from Florida and this is actually our third segment we are doing with her now. In this episode, we're going to focus all about tongue and lip ties. There's so many questions that people have about this and so we're just so excited to dive right in so, welcome Kristen. 

Kristen: Thank you, hi everybody, super excited to be here and to be able to talk about this topic that seems to be on everyone's brain when it comes to breastfeeding. Does my baby have it? Do they not have it? Is it causing issues that I’m having? So, I think this will be a great talk to help at least give you guys some resources and some basic information to help guide you through some of the decision-making process and when to reach out to somebody if you feel like you need to. 

Christa: Perfect, and I know I also see a lot of questions out in the group and I always just tell everyone, I’m like, talk to a medical professional have someone that's in the field that knows about instead of sharing a picture and just getting an idea online. It's always best to, that was another reason why I was telling everyone in the group I was like we have an interview coming up but always check with the medical professional first. So for anyone that hasn't tuned in to these episodes yet can you just do a brief introduction to who you are and what you do? 

Kristen: Actually absolutely, so my name is Kristen and I am a lactation consultant out of Orlando, my company is Orlando lactation and I’ve been a nurse for 16 years a lactation consultant for 11. This has always been my passion women's health in general, providing support and just overall comfort to moms, giving them kind of a resource that they can go to. So have really made it my passion, I struggle with breastfeeding my kids, so really have a personal side when it comes to breastfeeding. Which if you talk to most lactation consultants usually that's probably why they got into the field. There was some issue or some type of family thing that just kind of migrated them to that and kind of took over, so here I am, 11 years later. 

Christa: Awesome, well thanks for coming back I’m really excited to dive in this topic of term and lip ties. So for anyone listening, first things first, what is a tongue or lip tie? 

Kristen: Okay so, and that's great let's start right from the beginning. So, a long time ago and people say, well why is it all of a sudden now, one of the things that people are talking a lot about, has it never been there before? Has it always been there? So it's something naturally that grows in the mouth but I personally, I don't really feel like we ever knew that there was a purpose for it. So a lip tie which is also called a labial frenulum is the piece of skin that attaches the lip to the gum tissue. It helps give its purpose when sucking babies are getting seals it helps provide that ability there on that upper lip to be able to do some of the functional aspects that it needs to. So if you guys stick your tongue up on your lip and you rub it back and forth you're going to feel a little piece of skin there. As well as the lingual frenulum. So the lingual frenulum is the one that's under the tongue, it's supposed to be there, you guys have them but when it starts to come into an issue is when the baby developed in utero. How the tongue and how the lip developed, how those frenulums kind of developed where they are, if it went too far down, if it didn't go far enough, if the tissue is too thick. So it's not kind of like you have two lungs and you have two kidneys and they grow this perfect organ, it can have some variances on how it's attached, where it's attached. So what has happened is over the years, they finally, dentists, speech therapists, lactation consultants, and ENTs well this does provide a purpose and it helps the mouth be able to function in many different ways. So when we look at it as a lactation consultant, yes, the baby could have one which you guys share pictures all the time, well do they have one? Well, you're supposed to have it but how is it functioning? You could have one and it could be attached too close to the tip of the tongue or too far back or it could be thick, but is it functioning the way that it's supposed to? So when we look at it, when it comes to feeding, that's the big aspect that we want to look at. Yes, they probably are visible we see it, but that doesn't necessarily mean is it hindering anything because technically it's supposed to be there. For the lip, what the lip portion does is it provides that upper lip to the gum line. If it goes down too far to where the gum is where your teeth would be, sometimes the babies have a hard time flanging the lip out because you have something kind of pulling it back down. You might see when they drink from a bottle or they're at the breast, this upper lip consistently kind of pulls down and it's not able to flange out the way that it's supposed to. These also maybe when you were grown up these might have been the kids that had a gap between their two front teeth, if that frenulum went down too far it pulled up on the gum ridge and it actually had a space there and so when the teeth came in it made that gap there between their two front teeth. A lot of times I’ll ask parents typically they are hereditary so I’ll ask the parents, did you have a gap between your two front teeth, growing up did you have to have braces that had anything to do with spacing there on that upper gum line. But is it doing what it's supposed to? So some of the things that we look at as lactation consultants, can I move the lip up towards the nose? Is it nice and stretchy? When the baby's feeding does that upper lip flange out? Okay, so that's one thing the lingual frenulum is the one that is under the tongue. So this one here definitely a little bit more of a priority because the tongue does a lot of things other than just being in the mouth. We use the tongue to be able to feed, to swallow, it actually helps in breathing and sleeping, so it does provide a lot of other things than just feeding wise. So typically, if I have a baby that's got a tongue tie, these babies might be the ones who aren't sleeping well, they're constantly up, they don't take naps, they spit up a lot, they have a lot of gas, and it's because when the tongue is resting in the mouth, the mouth doesn't close properly, it's not moving the food through properly so the babies get have a lot of gas or a lot of air so when we talk about, is it an issue? Those are some of the things that we look for, can I might be able to see it, but can the baby stick their tongue out? Can they move their tongue side to side? If you guys put a pacifier in their mouth, are they able to cup their tongue around the pacifier when you're feeding them the bottle? Do you see that their tongue curls up like a little taco around the bottle around the breast tissue? Do they spit up a lot does milk come out the sides of their mouth? So there's a lot of things that we look for, so overall when we're looking at the big picture they'll go, moms go to their pediatricians and say well it looks okay, well it might look okay but is it functioning the way that it's supposed to? As long as it is functioning the way that it is supposed to then we don't do really anything about it. It's something that we watch, but it's not, it has to have the babies tongue clipped or lasered or anything like that so we have to look at all of the different aspects. One, assessment of it. Two, how are they doing feeding, what are some other things, are they spinning up a lot? How do they sleep? Do they cry a lot? Are they gassy? So it’s contributing to any other factors, there's when babies are having issues as far as colic, gas. Sometimes, pediatricians might tell moms to stay away from diet or diet food items because babies having a lot of gas or spitting up. Well it might not necessarily even be related to that but maybe related to some oral weakness or tongue tie that's actually causing it. So when mom before moms do drastic things like completely change their diet or start baby on medications, I always recommend when I see in these Facebook groups and social media, see a lactation consultant first because it could be an easy fix. Maybe mom just has an over milk supply that's causing some of your issues or maybe there is oral issues that are going on that's causing it. You'll see that if you take all that stuff out of your diet you do the medications that for reflux, nothing gets better because it wasn't really those things to begin with. You guys kind of know what they are, they're meant to be there everybody has them it's just how they're attached like I said usually it's hereditary, so if you had one child that has it definitely get on top of it with another child if you had feeding issues and then we have to look at the functionality are they able to function and do what they have to do in order to feed and sleep and all the things that are fundamental things of life that they have to be able to do. If all of those are the case, then it's not something that we typically refer you to see somebody. If the baby does have a lingual labral from him usually they have both just how it developed during utero. What you guys are going to want to do is have a team of people, you're not just going to be seeing a lactation consultant so this is one of the other areas that a lot of moms have questions about well who do I see? What do I do? This person told me that it's not causing an issue but this person said. I don't ever go against what the pediatrician say, but I do find that they're not the ones that they're feeding. So, yes assessment wise they're looking at it they feel like it's okay but we have to look again at the big picture. Are they feeding and doing what they need to be doing as far as feeding goes and what are some of those other habits that the baby is doing? If you're having a lot of issues, first, definitely see a lactation consultant, feeding specialist to kind of assess whether it be with bottle feeding or with breastfeeding so we can see what the baby's physically doing at the breast. Again, they will have a lot of symptoms that we actually just by feeding can see that they're having issues just by how they how they feed. Usually, you're going to see a lactation consultant for the feeding aspect, the breastfeeding aspect. Then you're usually, we call it a team approach so you're going to have a speech and language pathologist or oral motor therapist depending upon how they're trained to do an oral assessment. Lactation consultants usually can do some type of oral assessment but it's really out of their full scope of practice to be able to do a full oral assessment, that's really when we kind of go to the therapist for that portion of the exam, they'll give you their advice as far as orally is it causing any issues or maybe the baby just has some muscle weakness maybe in the cheeks or the lips that are causing very similar issues. So you see the lactation consultant for feeding then we see send you over to the therapist let them look at you. Usually they're going to be the ones that will give you the recommendation. I feel like it's hindering your feeding, maybe sleep patterns, other issues, then we send you usually to a dentist for a consultation for a release. When you're seeing a dentist most of the time they will do a consultation and they will do an assessment on the baby and usually tell you do they feel like it is causing issues to where that release needs to get done. Sometimes they will give you their opinion sometimes they'll be like yes absolutely this is something that is significant that we need to do or they'll say this is something let's just watch, or they might take into consideration the opinion of the lactation consultant and the speech language pathologist to, based upon what we're seeing we feel like it is definitely hindering feeding. Which the baby could be having weight issues, not thriving the way that they're supposed to, so yes let's go ahead and get this done to see if it'll help improve that aspect. Another part of the team is somebody that does bodywork, so when we talk about bodywork it could be a multiple different disciplines either a physical therapist who's trained in babies or children we are connected from head to toe, so if a baby is having feeding issues a lot of times again like I said they're going to have usually spinning up, gas things like that. Well the physical therapist what they do is they also will help with body type things. Positioning, posture, tummy time, things like that will help kind of facilitate that so we're usually looking at a physical therapist, maybe a craniosacral therapist, a chiropractor, somebody to kind of help do some of that bodywork because if all of this is tight or the lip or the tongue have been attached to the gum line or the floor of the mouth for so long, when it's released it doesn't necessarily know what it's supposed to do or when it's attached tightly it also causes tightness in other areas of the baby. Again like I said, usually these babies will also have tummy issues constipation a lot of different things that'll kind of go along with it so you're looking for a team approach so your lactation consultant, your speech and language pathologist, or your occupational therapist, your physical therapist, somebody to do some body work as far as physical therapy or cranial sacral therapy, chiropractor and then your dentist usually comes in if that release is needed. Definitely after the release usually we want you to see the speech and language pathologist prior to release as well as after because what they're going to do is they're going to give you exercises to go ahead and start strengthening up some of those muscles so when the release is done it's not so overwhelming to the baby. We've kind of already practiced putting our hands in our mouth doing some exercises so then now that the revision is done, I don't want anybody's hand in my mouth because now I’ve had the revision done but I’m a little bit more willing so we want to kind of see those babies first to get that assessment in get some therapy going then have the release if needed and then ultimately you're going to be seeing the therapist after as well. But again that's if the release is needed. 

Christa: Awesome, wow, that was a lot of information. No that's perfect because I think I was saying before is we get a lot of people that will just post a picture in the group and say this is a tongue tie and then they hear their friend or whatever had a baby with a tongue tie that needed to be removed so they have this negative connotation with tongue ties, so that was awesome what you said about it needs to actually be seen by a specialist see how they feed on the breast or a bottle, the other mouth is moved. So that was amazing information to hear it for in that case and so when we did get this question off of Instagram about needing a release so if they go through a release is there a chance that the tongue tie could be regrown or I know you can you talk also about physical therapists where they would help move the mouth. Can it reform ever is that possible?

Kristen: It is so once you have the release done I actually just had my eight-year-olds done. Pediatrician as well as my pediatric dentist blew me off for years. Horrible sleeper, horrible feeder had low milk supply, had lots of breastfeeding issues with her just had hers done at the age of eight. When you have a release done you have to do exercises because think about when you have a wound on say your arm or your any type of tissue on the skin, it wants to grow back together. It wants to heal and go through that healing process. So the same thing with the mouth, if we are not doing exercises a couple of times a day to that area of that wound and parents are like, well it's so horrible because I’m actually sticking my finger on the wound where the baby just had the laser treatment done. Well we want to get in there and just make sure that we're moving that area around, we want it to heal properly to where it doesn't reconnect all of those tissues back together so it is definitely important to make sure that you're doing the exercises and that's probably one of the things that is the hardest for the parents. For me I didn't have it done with my daughter as a baby I had it older but literally by that night she didn't really have any discomfort and she just used her tongue and moved it back and forth on her lip, didn't have any issues with reattachment. With her, our biggest thing remember I mean she's eight now so her smile was actually crooked, she doesn't close her mouth fully, she sleeps with her mouth open, poor sleeper so she had a lot and like I said I struggled with milk production with her, she had a poor suck reflux and it was all related to her lip and her tongue tie as a baby that I was trying to be proactive about but kept being put aside by medical professionals that weren't trained in it. So again we'll talk about that in just a second but you have to kind of go with your gut feeling if you don't feel like things are going well definitely reach out to somebody. You're going to find that you're going to have some hesitancy from different providers, whether it be your pediatrician or your dentist saying, no everything's fine but also, I kind of go with mom's intuition I knew that there was something that was wrong, she wasn't feeding like my other three kids were feeding, I didn't feel like the breast was empty when she finished feeding, she wasn't transferring the milk so definitely go with your gut feeling because a lot of times it's just you don't know what you don't know and I find that my older doctors typically not as gung-ho about it, just because it's something like I said, there's something more newer that's being talked about that people are learning about. I find my younger doctors are now learning about it in school, they're more aware of it, they have a little bit more knowledge about it, not to not say that the older doctors don't, but they're the ones that well, it's been there forever it's not really causing any issues. So make sure that if you don't feel comfortable with the answer that you got, reach out to somebody else for a second opinion because your body, your child. Did that answer your question? I think that was it, I was like, did I go off topic? Or did it answer your question? No, that was definitely. I want to go over a list of signs, maybe your baby has some type of oral issues lip or tongue tie that maybe they have but hasn't been diagnosed but you're seeing some things that you're not really sure what they are. So for a mom if you're breastfeeding a lot of times it will be a painful latch, your nipples might be all tore up and cracked because the baby's actually not latching properly and what I mean latching properly maybe they're not able to get their tongue under the breast tissue the way that they're supposed to actually get the milk out of the breast so they're not getting their tongue underneath of there so they kind of be, they're more nipple feeding than necessarily breastfeeding. The nipple when the baby comes off could be flattened or a funky shape, so those are some things physically with breastfeeding. Sometimes you could have a low milk supply. Okay, maybe my milk never came in its day six and the baby's eating all the time but still don't really feel like I have any changes in milk production, well remember if a baby is not feeding well, then they're not actually taking the milk out of the breast the way that they're supposed to so then in return your milk starts to slow down or it doesn't come in and ultimately hinders milk production. So how breast milk works is whatever is taken out gets replenished in the beginning as long as I’m having stimulation is sending signals to my pituitary gland to make milk, so as long as that process is going then things will happen but if the baby's not feeding properly your body's not getting those signals so it can delay milk from coming in or ultimately decrease milk supply. You could have some of those soreness or funky shape when the baby comes off maybe the baby nurses for 10, 15, 20 minutes on each side and comes off and they're still hungry. They eat very frequently about every hour and they don't seem content maybe they are not peeing and pooping. Babies being content between feedings, mom's not having any pain with breastfeeding, and the baby's having wet and dirty diapers lets me know that the baby is getting plenty of milk from the breast tissue. So if the baby's not having those wet in those dirty diapers, they're constantly crying, they're eating frequently, though that's letting that there is something not going right. Whether it be could the baby have a lip or tongue tie could it have some oral issues we have to kind of it's like a little puzzle we have to kind of put all the little pieces to the puzzle together. So those are some things that mom could see with her with baby like I said, decreased output not content. With their mouth this little divot here in your lip sometimes they'll have a little blister right there so it'll be I’ll have a little bubble there or maybe on their lips in general a bunch of little ridges kind of we call it like cobblestone lips. So if you think of what a bunch of bricks lay in and how all the little grooves are their lips would look like that. What happens why the babies typically have that is either say that labial frenulum is pulling down to where the lip is rubbing against mom's breast tissue it could cause those blisters or if they are not strong enough to actually hold on to the breast themselves or to be able to get the milk out, what tends to happen is the lips compensate for that so the lips kind of grip down on the breast tissue to hold it and maintain it. So by doing that it's constantly being rubbed and causes all those little blisters and chapping of their lips. So that's definitely if your baby, if you see that on your babies definitely make sure that you reach out to somebody, just for an opinion on how they're doing feeding. Again, are they content? How often are they feeding? Are they having those what in those dirty diapers? Then we get into are they just really gassy and fussy all the time? Do they constantly spit up? When they sleep, do they sleep with their mouth open? Babies aren't meant to be mouth breathers, they're nose breathers so the reason for that is because the tongue doesn't lay properly in their mouth so it's actually a defense mechanism for them to keep their mouth open so that way they can breathe. So there's a lot of different things that you can see when they drink from a bottle, does it take them a long time to drink from a bottle? I would say a baby could drink a bottle within 10 or 15 minutes if you have a baby that's taken 30 minutes to drink a bottle and we're talking like two ounces, that would be an indication that there's something going on. When you feed them a bottle or they're breastfeeding, does milk consistently just drip out the sides of their mouth or down here at the bottom part of their lip? That would be a good indication so there's a lot of things that you moms can just be looking for and that doesn't mean a baby is going to have all of those things. But, if there's any of those things that they're doing, there could be an issue that you're not even aware of because you don't necessarily know that that is indicative of anything. 

Christa: So as we were kind of talking about that and how you mentioned your daughter at eight years old had it fixed too. So, let me think about like timing and stuff as well so it's kind of a two-part question but, is there circumstances where a baby might have an issue but they can kind of grow out of it? And the other question would be if they do need the surgery or doing the treatment, is there a best age or time or is it ever too late to kind of get it done as well? 

Kristen: I have colleagues that just had it done in their 30s and 40s believe it or not. So it was something that they never really knew that they had and then they kind of got into the field and oh, well I constantly have backache, I constantly have migraines, I have like TMJ and here it's all correlated to just having a tongue tie. So it's amazing research how I could go on gamuts of different things of research that once a release was done, different things that went away with people and just it's kind of interesting how just something as simple as that could make so many other things so much better. So if I knew of a baby going from my personal experience and from what my knowledge is in my field, the earlier, the better. It's going to save you a lot of headache. I’ve had years of not sleeping because of my eight-year-old and here probably all was just due to apnea and not being able to sleep properly because the tongue wasn't laying properly in her mouth. So I definitely, personally, I would say the earlier the intervention the better. It’s going to save you a lot of headache and long-term issues medical interventions that you would have to do. Is it something that just resolves itself? No, okay if they have it, they have it. It's not like okay babies has a really tight lingual frenulum and it's just one day going to go away, no. When I talk to you about some of my colleagues that have had it done later in life, they've learned to deal with it and they've compensated for it. So again, these were the kids in school that probably had some speech issues, had issues saying particular sounds you can't stick your tongue out when you lick on a lollipop or a popsicle, you're not able to extend your tongue out to get it underneath of those things. Those of you guys who are older possibly would be something that you would want to have look at as adults, one of the things that people always say, well when they French kiss can you move your tongue around that's usually one of the big ones. No, my tongue doesn't move and I always have a hard time with that. Well, you probably have one and like I said it's usually hereditary one way or another that if mom or dad have it usually one of the children if not all the children would have it. So definitely if you are an adult and you've had issues sleeping for years, you had issues growing up with speech therapy, feeding, you have issues with texture and swallowing and different things like that you're a mouth breather and like I said it's funny how we're all connected from our head to our toe. As an adult if you have a lingual frenulum again sometimes it can be correlated to headaches, neck ache, backing, some GI stuff because if there's tension and tightness up in here, it does affect a lot of different other organs throughout the body. Remember, the tongue plays a huge part not only in just feeding but swelling and sleeping and if we're not sleeping then our body's not healing and kind of going through some of that healing process. Will it naturally fix itself? No. Could the body naturally people learn to compensate with it? Yes, but you technically probably would find that as time goes on you'll have other issues. These children usually are like I said, poor eaters, difficulty taking a sippy cup, maybe on bottles for longer periods of time because won't take a sippy cup or it takes them a long time. Speaking of my eight-year-old, she didn't take solids until she was a year old and I constantly was concerned and reaching out to the pediatrician and he said it's fine as long as she's getting her main source of nutrition through breast smoker formula it's okay, because they're really not using feeding at that particular time as the main source of nutrition is just them learning to have things in their mouth and textures and how to move their tongue but she couldn't do that, she always pushed everything out because she wasn't able to move her tongue the way that it was supposed to. Even if you just see a provider for a consultation just to get an opinion what they think and again, if you guys even just do some research long term tongue ties, lip ties how it can affect us as adults and those of you guys who are adults, your parents that are watching, ask yourself, oh my gosh I do have a lot of those. Maybe I have it with, maybe my child has it, so it never hurts to see somebody just for an evaluation and how much it could change your life just by having something so simple like that taken care of. I personally I find that I have a better response, my babies seeing dentists that use lasers there are some ENTs that will cut it. A long time ago they used to surgically cut it and then suture it. More today if it's pretty thin a lot of times pediatricians or ENTs will snip it. But usually the best way to kind of take care of it and for it to know that long term that it will completely heal and not reattach, laser would be my first choice and that's what we ended up having done with our daughter so and completely healed. I mean within a week the tissue is completely healed, no issues so much better so, definitely just even reach out to somebody for a consultation, it doesn't mean you have to have any type of procedure done but just to kind of for your sake know that you have some type of information to kind of go off of. 

Christa: Who knew a tongue or lip tie could be tied to so many other things. You just mentioned migraines, and TMI, backaches so that's super super interesting and I mean I think we're always learning more especially in the medical field. It's cool to see that the different changes in research that they're finding out about it., awesome well this was very informative there's so much here that I think our moms will take away from it. Because like I said, we get these questions all the times in the group and so I think this would be really helpful to share so I can't wait to share it with them for anyone that again it hasn't followed you before on these show, on these episodes, can you tell them where they can follow you? 

Kristen: Absolutely, if you guys have any questions definitely even as a lactation consultant, constantly learning I just came back from a conference. Constantly learning, this is an ongoing process so you definitely can reach out to me if you have any questions which I’m Orlando lactation so www.orlandolactation.com also one of the things Christa that we didn't talk about is how do you find a provider? So when you guys are looking for a lactation consultant or a speech and language pathologist or a dentist or anything like that to have a consultation done or for somebody to look at it make sure that you're looking for somebody who is TOTS trained T-O-T-S which is Tethered Oral Tissues. We are trained and specialized in lip and tongue ties. So you want to make sure that you're seeing somebody that has some type of knowledge on it. Also, when you guys are searching for a pediatric dentist, pediatric dentist that does lingual label of frenulums, sphenotomies, sprenectomies they're called a lot of different things. You can always, our dentist here locally, I always tell my moms, they're going to tell you if it needs to be done or not so always schedule a consultation. Have them see you, give them, let them give you their opinion that doesn't necessarily mean you have to have anything done, but at least it'll give you a resource that you guys go to, we'll do an assessment, they'll be able to tell you, yes we feel like this is hindering things. It's something that you guys need to take care of. So make sure that you're looking for somebody who's TOTS trained and again it's T-O-T-S. There's a lot of social media groups that you guys can look into just search just locally touch trained provider where I live. And then also when you're looking for dentists, when you go to their websites and you see what services they offer, you'll see that they'll offer phenotomys or anecdomies that will talk about lingual label for any lungs laser any of that type of stuff. So make sure that you're doing your research and looking out for people in your area that are knowledgeable about the tongue and lip ties. 

Christa: I actually just made a post in our group about making sure when you are getting a medical question to go to the right person, right in in the medical field, don't go to a Facebook group and just ask a random person you really want to make sure this is something that's very serious and need to go to the right person. 

Kristen: Well in most insurances pay for lactation services. So anybody that always reaches out to me, I always have them go through my insurance first, let's see if we can get it covered through insurance. Most insurances will pay for lactation services. If not, fairly reasonable, so reach out to somebody because the earlier the interventions, the better the outcomes. And when I talk about that I mean like as far as milk production. If we have a baby who's not feeding well it's going to hinder production so make sure that you see somebody earlier versus later or if you just don't get a good feeling like things are going right or they're having some of the symptoms or characteristics of some of the things that we talked about definitely reach out to somebody just to get some answers for you and make sure that you're kind of in the right direction. 

Christa: Perfect, awesome, and guys as you're watching if you have any other questions that come up that you want to ask Kristen. Remember we are doing these once a month so we're kind of covering different topics each month so, we do always look at the comments too, so if you guys have questions maybe we can answer them on a future episode. So thanks everyone for tuning in and thanks Kristen for coming on. 

Kristen: Thank you guys, thanks guys, bye-bye.

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