By Jennifer Tow, BFA, MA, IBCLC, LMT, CSOM
Intuitive Parenting Network, LLC
Holistic Lactation Consultant, Holistic Health Coach (focus in nutrition), founder Holistic Lactation Institute™
A tongue-tie release is a process, not a procedure.
There may be nothing more confusing for parents today than the mythology and misdirection that swirls around the topic of oral restrictions, often referred to as “oral ties.” Yet, within that opening sentence, there is already confusion, because oral restrictions are not always ties and all oral restrictions, whether ties or not, have their impact on the entire body. Nothing happens only in the mouth of an infant.
When it comes to the specific question of oral ties, parents may find themselves in one of two unenviable positions.
Frequently, after searching high and low for the cause of their baby’s feeding challenges, often for weeks or months, they are exhausted and financially drained by nurses, peds, lactation professionals (IBCLCs or not), SLPs, OTs, bodyworkers and ENTs telling them there are no ties, yet offering no solution for their pain, low milk supply, or conversely, oversupply and passive feeding, as well as reflux, “colic”, slow weight gain, inability to take a bottle, poor digestion, food intolerances and so on.
Often, parents are misdirected or misled into thinking it must be their own fault, too often leading to anxiety or depression. Eventually, discovering there were ties all along is little comfort to anyone drowning in the consequences of so much poor advice.
At the other end of the spectrum, they may immediately have someone, possibly in hospital or an IBCLC, point out oral restrictions but feel uncertain as to whether a potentially painful and possibly ineffective procedure is necessary “just for breastfeeding.” Often, even though ties have been identified, they are left to fend for themselves in finding resources and resolving their feeding issues.
Naturally, parents turn to the Internet for solutions, where the field becomes even murkier.
Breastfeeding has long been an area where everyone fashions themselves an “expert,” whether because they breastfed a child, they took a weekend course or are a health-care professional in another field. Adding to the burden, for the past decade, tongue-tie has become its own Wild West of bad advice and pseudo-experts.
TikTok and Instagram have become flooded with influencers who are paid to promote products by marketing themselves as having expertise they do not, often simply pirating their “information” from other sites. Yet, after so much bad advice, a kernel of truth from anyone can sometimes feel like a revelation. It can be maddening for parents to know where to turn, especially when the “experts” have already failed them.
No matter the misdirection all over social media, infant feeding is the wheelhouse of the IBCLC. While many others will claim to have expertise in infant feeding, it is important to understand this is a consequence of social media and not actual training and skill. While parents need a team to resolve oral dysfunction, they don’t need a kitchen full of cooks either. No other professional is trained to meet the needs of the breastfeeding dyad—two individuals who function very much as one.
Just as with any profession, there will be those who are highly skilled and those who do the minimum to maintain their credentials, so just as you would in seeking out a pediatrician or a release provider or a bodyworker, you need to review a practitioner’s qualifications before contracting with them. Look for someone who is not simply acting as a referral vector, sending you off to solve your own problems, but rather someone who has advanced training in working with complex feeding issues—especially as they relate to oral function—who has the ability to identify compensations and the skills and resources to work with you to gain competency, who understands the role of bodywork, collaborating effectively with them, guiding you every step of the way through the process of gaining competent rather than compensatory feeding. Learn more.
Sometimes parents land on the idea that bodywork can be the solution to their challenges. And sometimes it can! Whether or not it’s the entire solution, it most assuredly is going to be a part of it. But, bodywork alone cannot release oral ties, so seeking out a bodyworker before an IBCLC is going to be an ineffective use of resources. A bodyworker should not imply they can resolve feeding issues without an IBCLC involved because they cannot guide the parents in eliminating compensations while feeding, resolving supply issues, appropriate use of supplements and the multitude of other factors that influence feeding success. Collaboration is key in resolving infant feeding issues, and the team you need in place are the IBCLC and the bodyworker, with the IBCLC ultimately determining when a referral is made for a release.
If ties need to be released, then the release provider will be the third team member needed. The release provider should never be the first step, as a functional assessment is required for diagnosis, and function means feeding. The release provider should rely on the IBCLC for that assessment before doing their own assessment. A release provider who does not require an IBCLC is doing a disservice, as their approach will reduce the chance of a good outcome.
The bottom line is that while social media has created a crowded field with everyone from complete novices to unqualified professionals jockeying for the moniker of “expert,” parents deserve the best possible care from the most qualified and collaborative team available. Start with an IBCLC, but do your due diligence to ensure the IBCLC has the skills and experience needed to recognize compensatory feeding with all of its consequences, the ability to educate you so that you feel confident in your decisions and the ability to guide you through the process of releasing restrictions in a way that results in competent and functional feeding.
Heal the mother, Heal the baby™