10/08/2020
Fact: Unfortunately, there is little to no training provided to most providers in how to identify or treat anything other than the most obvious tongue tie -- this includes the basic training and education that dentists, pediatricians, ENTs, lactation consultants and speech language pathologists receive. Providers who are interested in working in this area must seek out additional training (continuing education) to learn how to accurately assess whether a tongue is in fact “tied,” and understand the therapy and treatment needed to address the problems that come with a tie.
There are some “red flags” that can indicate that the specific medical provider does not have the skills to assess or treat a tie.
🚩 The assessment is done just using a tongue-depressor to lift the front of the tongue.
🚩 You are told any of the following:
1️⃣ “Your child can stick out their tongue, so there is no tongue-tie”
2️⃣ “Breastfeeding always hurts at the beginning, you just need to wait for your ni***es to ‘toughen up’.”
3️⃣ “The surgery is not necessary because your baby is doing great gaining weight.”
4️⃣ “Tongue tie is an Internet fad,”
5️⃣ “Lactation consultants think every baby is tongue tied.”
6️⃣ “Your baby just has a little bit of a tie, it will stretch out over time.”
7️⃣ “Let’s wait and see if it causes speech problems later.”
8️⃣ “Breastfeeding is not a good reason to have a tongue tie surgery.”
9️⃣ “You need to wait until your child is older to have this procedure.”
🔟 “X-type of providers are only doing this procedure to make money.”
🚩 The assessment/exam is completed by only looking in the baby’s mouth and is very quick — usually less than a couple of minutes. (This may not be true for very obvious ties.)
So how is a parent to know if their provider is skilled in assessment and treatment of a tie?
❓ Ask what specific training they have had in this field, or what organizations they are members of.
Here are some (not all) examples of the training and organizations that are available to professionals working in this field. Many of these have searchable directories.
🔹 IBCLC Masterclass: Oral rehabilitation of the breastfeeeding dyad (Open only to IBCLCs) (https://www.ibclcmasterclass.com/attendees)
🔹 Talk Tools - not all classes are about ties ( https://talktools.com/)
🔹 Chrysalis Oralfacial training by Autumn Read Henning (https://www.chrysalisorofacial.com/resources)
🔹 TummyTime™️ Method and other classes by Michelle Price Emanuel
(https://www.tummytimemethod.com/professional-directory.html)
🔹 Myowild Training (Michale Chatham) (https://www.myowild.com/store/c1/HealthandWellness)
🔹 The Breathe Institute (https://www.thebreatheinstitute.com/)
🔹 International Association of Oral Myofacial Therapists (https://www.iaom.com/certification/)
🔹 International Association of Tongue Tie Professionals (https://tonguetieprofessionals.org/)
🔹 International Consortium of Ankyloglossia Professionals (https://www.icapprofessionals.com/)
🔹 Anklyoglossia Body Workers website
http://www.ankyloglossiabodyworkers.com/
‼️ Know what a full assessment looks like and entails.
https://www.drghaheri.com/blog/2014/2/15/how-to-examine-a-baby-for-tongue-tie-or-lip-tie
▶️ The exam should include history and both a functional and an anatomical assessment.
▶️ The provider should collect a full history that covers all possible symptomatic areas (feeding, digestive, sleep, airway, speech, etc.).
▶️ It should include a full oral exam (usually performed with the child’s head towards the provider and feet pointing away from the provider), where the frenulum(s) are visually assessed.
▶️ The functional assessment requires the practitioner to observe the patient performing normal activities, such as feeding, eating, talking, playing and/or sleeping.
▶️ The provider should be checking the child’s oral functions (suck, lift, extension, lateralization, peristalsis, etc.).
▶️ Ideally, the provider should be using one of the standardized and validated tools for assessment and documentation. Examples of these tools include the Hazelbaker Oral Assessment, Bristol Tongue Assessment Tool, and Martinelli Tongue Tie Assessment tool, etc.
▶️ The provider should also be examining the infant for other issues that can mimic or be related to a tie, such as torticollis, plagiocephaly or muscle tightness
▶️ Ideally the provider should provide documentation via photos and written documentation indicating what functional deficits (if any) were noted. This is especially important to be able to document improvement with any therapy or surgery.
▶️ Full assessments usually take a significant amount of time and cannot be adequately performed in a 10-15 minute appointment..
❓ Ask about their experience.
How long have they been working with oral restrictions and how many patients they see weekly or monthly for this issue? If they perform this procedure, ask how many procedures they do each month.
❓ Ask what resources do they refer to?
If there is a functional deficit or related issues identified in the exam, the provider should have recommendations for referrals for the appropriate team to address these issues. This is usually more than just referring to the frenotomy provider to have the tie “clipped.”
