Tongue tie

What is a “restrictive” tongue tie?

The lingual frenulum is the small fold of tissue linking the underside of the tongue to the floor of the mouth. Every baby has one. It is called “restrictive” when it limits tongue movement to the point of getting in the way of sucking.

What the frenulum looks like is not enough for a diagnosis. A frenulum can look short without bothering the baby, and the other way round. Function is what counts: how the baby opens their mouth, positions their tongue and feeds.

How can osteopathy help?

A tie that limits the tongue never acts alone. To compensate, the baby tightens their jaw, purses their lips, stiffens their neck or feeds on one side only. These compensations can remain even once the tie is released, and keep getting in the way of feeding.

What I look at

• tongue mobility: does it lift, move forward, cup around the breast;
• the jaw, lips, palate and neck;
• the baby’s symmetry: do they turn their head both ways, feed as well on both breasts;
• their overall posture and how well they relax at the breast.

What I work on

With gentle techniques suited to infants, I work on tension in the mouth, jaw, floor of the mouth and neck, to give the tongue as much freedom as possible.

I work in liaison with the team following your baby and refer you to the doctor whenever anything calls for it.

Frenotomy: should I see the osteopath before or after?

A frenotomy means cutting the tongue tie. It is a medical procedure, decided on and carried out by a doctor. The French National Academy of Medicine recommends that it remain exceptional, after sucking has been assessed and the usual measures have failed. Osteopathy can have a role at both stages:

• Before, the session helps clarify what comes from the tie and what comes from the tension around it, which is useful to the doctor deciding on a frenotomy. Releasing the compensations also shows whether sucking improves before any decision to operate.
• After, it helps the baby use their newly freed tongue and regain more effective sucking, alongside exercises and breastfeeding support.

The timing is agreed with the professionals following your baby.

Which signs may point to a problem tie?

Some signs come up often, but none is specific:

• the baby struggles to latch or comes off the breast often;
• they make clicking noises during feeds;
• feeds are very long, and weight gain is slow;
• feeding hurts, with damaged nipples.

These signs often have another cause, most often position and latch. That is why the assessment starts by watching a feed.

Who should I see?

The assessment involves several professionals:

• the midwife or lactation consultant, who watches the feed and adjusts position;
• the doctor or paediatrician, who examines the mouth and decides on any frenotomy;
• in addition, the osteopath, who looks at the baby’s mobility as a whole.

The French National Academy of Medicine recommends that frenotomy remain exceptional and be decided with the family doctor or paediatrician, once non-surgical measures have failed.