Everyone’s been talking about tongue ties and oral restrictions but what is it really? A tongue tie known as ankyloglossia is “an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement” (1). When you look under the tongue, most people have a frenum or this connective tissue you see connecting the tongue to the bottom of the mouth. It’s the severity of tongue restriction that we are really paying attention to and what functions are being affected. In obvious cases where you can clearly see a restriction, you may hear the term anterior tongue tie. But in some cases where a diagnosis comes from symptoms of what seems like a tongue tie, it could be due to a posterior tongue tie. You can have other oral restrictions like a lip tie (labial frenum) or buccal ties (buccal frena).
These oral restrictions are unfortunately not usually discovered until there’s an issue. Oral restrictions like a tongue tie can cause nursing/latching issues with mom and baby. It can cause feeding issues even if baby is bottle fed. You may notice that baby is really gassy, fussy, not gaining weight, reflux and constipation just to name a few. If it stays unaddressed as the baby gets older you may notice difficulty chewing foods, issues with textures, using a straw, speech delays, snoring, teeth grinding and possible developmental delays. If you feel like your child may be exhibiting any of these signs you can get them checked by a IBCLC (lactation consultant), pediatric dentist or pediatric ENT. We can check them in office as well but will always refer you to one of our preferred providers for an official diagnosis.
So where does craniosacral therapy (CST) and adjustments fit in once a child has been diagnosed with an oral restriction? Immediately! If a child has been diagnosed with a tie the best treatment is to get a revision (laser preferred) because that restriction will always be there no matter what you do. BUT getting CST and adjustments pre-revision and post-revision will help so much in their recovery and healing. Adjustments help the body stay well aligned so we don’t form and adapt to comfortable positions and postures as baby/child gets older. For example, favoring a side due to torticollis or misalignments in the cervical spine (neck) will cause baby to adapt all habits to that side. When there’s a misalignment in the body, it causes an interference to the nervous system. The very system we live and breathe by so we always want to make sure that we are functionally optimally. When there’s a tongue tie involved it’s a lot harder to break habits and hold adjustments because it’s a midline defect. So it affects all body systems. The better we can keep the body aligned, the less work we have to do to break those habits or keep bad patterns from forming. Adjustments for babies and children are safe, effective and gentle. It requires no more pressure than what you would use to check a ripe tomato or avocado.
Craniosacral therapy uses light touch to work on the cranial bones, more specifically addressing the cranial sutures and structures inside the cranium. We have this fluid called cerebrospinal fluid (CSF) that courses up and down the dural tube from cranium to sacrum 11-16 times a minute. Every time that fluid moves and courses through the cranium the cranial bones move very subtly into flexion and extension. Our head is moving all the time. Obviously as a baby so we can be born, so that we can grow and so we can sustain injury. CST helps to address any tension or misalignment that can be caused from birth or oral restrictions. A baby’s cranium is very pliable so the sooner the baby can receive care, the better outcome baby can have.
When there’s an oral restriction, a tongue tie specifically, the tongue cannot properly touch the palate to help it to expand and grow. When the tongue is able to touch the palate it helps to open up the bones and the sinuses in there for the cranium to grow and mold properly. If the tongue cannot touch the palate, it stays high and narrow. When babies have a high palate and tongue tie, latching to mom’s breast is difficult because they cannot lift their tongue high enough to fill the gap and get a good latch. Some babies can have a gag reflex that is on the palate (or even cheeks) instead of the back of the throat where it should be. This is when you see babies gagging or choking easily when being fed as well. They’re not getting proper stimulation to de-sensitize that area. CST/adjustments before a revision addresses all these issues and makes sure all the tissues and fascia in the body are nice and loose so that nothing would be tight for the revision. That way, children take to the revision better and it would be more complete because you're not lasering through tight tissue.
Now we need to continue care for at least 6 weeks post revision because as the child learns how to use their new tongue, new things will be happening in the body. They need to relearn how to properly use their tongue because it’s never been able to do certain movements before. The tongue may also be weak so we need to make sure it stays strong through adjustments and intraoral suck re-training. As the tongue is getting more range of motion, the child is going to be able to get their tongue to touch the palate. This is where cranial work is important because as the tongue touches the palate it's going to change and mold the cranium. We need to make sure it continues to mold the cranium correctly. If you have an older child with speech issues, you may see big changes there because the tongue and palate function are so important in forming consonant sounds. We also want to make sure babies are able to coordinate this new latch, suck and swallow while feeding as well. Before we had to stimulate their palate with intraoral work, now we need to ensure the tongue is strong and supporting muscles and tissues stay loose enough so they can do it on their own. CST and adjustments will also make sure that there's no dural tension from cranium to sacrum that would hinder their healing. The first 6 weeks after a revision will be the biggest changes you'll see and we just want to make sure they’re healing as best they can. This is on top of making sure you're doing all of the recommended exercises, stretches and tummy time at home.
A tiny caveat into tummy time. Babies with oral restrictions may not like tummy time because there’s so much tension in their system. They’re in this extended position all the time and when you put them on their bellies, they’re not a fan. This causes babies to be on their back more and you may notice some flattening of their cranium. Again, their cranium is so pliable that if they stay in a position or in things like swings on their back all the time, the cranium will mold that way. Then if there’s a misalignment somewhere in their neck and they prefer a side, that’s the side you may notice some flattening first. If baby doesn’t like tummy time flat on the floor you can do it across your lap or on a yoga ball to start. Babies need at least 30 minutes- 1 hour of tummy time a day. If anything, 4-5 times a day as long as they’ll tolerate it.
We talked a lot about babies and kids cause this is the best time to address it before deeper patterns are ingrained in the body. Also, it’s usually when oral restrictions are found. But the same goes for adults as well. CST and adjustments will still benefit if you find out as an adult that you have an oral restriction. Some symptoms adults can have are difficulty chewing, TMJ issues, snoring, sleep apnea, speech delays as a child turning into improper dictation of words and sounds. Some adults also complain about chronic headaches, digestion issues or chronic congestion which all can be related to oral restrictions.
As always, thank you for reading and we hope it was helpful and educational. If you have any questions please feel free to email us at email@example.com.
(1) Marasco L. Letter to thr editor regarding N, Sethi, et al., benefits of frenulotomy in infants with ankyloglossia, IJPO (2013), https://doi.org/10.1016/j.ijporl.2013.02.005. Int J Pediatr Otorhinolaryngol 2014; 78 (3):572.