Navigating Challenges in the Care of Tongue-Tied Babies Lecture Pack

In the NICU, oral feeding is a milestone which infants must achieve before discharging home. For many, the inability to complete full oral feeds can lead to prolonged NICU stays, G-tube placement, cessation of breastfeeding, or use of maladaptive feeding practices in an effort to get infants home. Although there are many different components that one must consider when working with medically fragile infants in the NICU, tethered oral tissues may not always be identified, treated, or surgically released via frenotomy due to limited knowledge, training, or hospital policy. Currently there is limited research for assessing and treating tethered oral tissues specific to the NICU population. This presentation will provide participants with a more thorough understanding of how to approach tethered oral tissues in the NICU, barriers to consider, and how to work collaboratively with NICU medical staff to assess, treat, adapt feeding, and prepare for a potential frenotomy.

When working with families on the journey of an infant tongue tie diagnosis, we frequently find ourselves in complex scenarios with desperate parents: mothers who have experienced painful breastfeeding, sleep deprivation, frustration and uncertainty due to few results, expressed in the baby's slow weight gain, gastrointestinal symptoms, fussy/sleepy babies and confusing or little guidance from their health providers. Depending on the time these families arrive at our specialized Tongue Tie Protocol, they might present with high and unrealistic expectations regarding a “quick release” of the restrictive lingual frenulum and without a proper understanding of the pre- and post-release requirements that can facilitate optimal results. Our protocol has evolved over the years, refining the elements that have demonstrated better adherence to the recommendations and greater commitment to the pre- and post- release strategy designed by a multidisciplinary team of pediatrician IBCLC, pediatric surgeon and bodywork group integrated by occupational therapist and fonoaudiologist/ speech therapist, who is in charge of guiding orofacial muscle competence. This holistic and integrative vision has allowed us to support families to achieve their breastfeeding goals with greater ease and enjoyment, develop the baby's myofascial competence so that they are not simply compensating, facilitate more fluid transitions to starting solid foods, promote predominantly nasal breathing patterns, and build the potential for more harmonious and functional facial development.

Despite a growing amount of research and interest on neonatal ankyloglossia or ‘tongue tie’ in breastfeeding infant for the last decades, evidence regarding indications of diagnosis, and effectiveness of treatment or management remain unclear and controversial. The purpose of this presentation is to report the results of an integrative review on available evidence on tongue-tie issues and whether specific tongue-tie interventions improve breastfeeding outcomes. Database searches including PubMed, Cochrane, and CINAH will be conducted using keywords such as ‘ankyloglossia’, ‘tongue-tie’, ‘lingual frenum’, diagnosis and treatment/management of tongue-tie to locate evidence from 2014 to 2024. The presentation will summarize the current consensus and controversial on ‘tongue-tie’ among healthcare professionals. The overall effectiveness of frenotomy on improved breastfeeding outcomes will be discussed. The quality of collective evidence including strengths and weaknesses of research will be presented. The goal of this presentation is to provide the most up-to-date evidence to lactation professionals who assist breastfeeding mothers and infants regarding tongue tie management to apply the current information to everyday clinical practice. The implications of this evidence review will help improve lactation professionals’ understanding of the controversies surrounding ankyloglossia in breastfeeding infants that lead to a more collaborative and family-centered care.

Ankyloglossia or tongue-tie, brings with it many challenges. Along with the many consequences of tongue-tie for both mom and baby and the family as a whole, there are broader challenges related to a lack of consensus among professionals. Learn more about the difficulties related to establishing a definition of tongue-tie, where the research stands on the question of incidence and the various tools that exist to aid in assessment and their differences and similarities. This presentation also presents clinical cases studies and details about how our ankyloglossia intervention unit integrates all of these unique challenges.

When we think of assessing for tongue tie, we usually think of an exam that includes touch. Palpating the tissue quickly gives us valuable information. Do we feel tension? What is the tongue doing during the exam? But what if we are not able to be in the same room as the dyad? Or what if our role or training does not support inserting our finger into a baby’s mouth? OR what if the parents do not give permission for that type of exam? Even in these situations it is still possible to gather information needed to make recommendations regarding tongue tie. This presentation will teach you how to how to use the skills you already have to do an evaluation–even if you cannot touch the baby.

Feeding and swallowing are the most complex functions an infant must do to maintain hydration and nutrition. As infants grow and develop, complementary foods are introduced to support skill development and to maintain adequate nutrition. The World Health Organization (WHO) recommends the introduction of complementary foods at 6 months of age in addition to human milk (WHO, n.d.). Cultural knowledge and research influence how families approach introduction of complementary foods. Meanwhile, evidence and developmental milestones for progression of mastication have not been established. Arvedson, Brodsky, et. al. (2019) provides a framework but this is not well supported by the research. Therefore, feeding therapists and healthcare providers are making diagnosis of delayed or disordered feeding of complementary foods without a solid foundation of normal development. Dysphagia, or difficulty swallowing, also has limited evidence and understanding of normal swallowing and frequency of normal aspiration without complications in the infant population. This is given restrictions in research on studying normal healthy individuals. Layer in the limited but growing body of research on ankyloglossia, one can develop theories on how it may impact mastication, complementary feeding and/or dysphagia. This presentation will explore evidence available, theories, and case studies to elicit critical thinking, guide clinical practice and education, and spark interest in further research.