Tongue-tie or reflux? Treatment helps babies' appetites

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It's a nightmare for any new parents: their newborn doesn't eat or sleep, and doctors aren’t sure why. Reflux is a common diagnosis.

When the correct diagnosis is finally made, it’s not their stomach at all.

There’s never been anything wrong with baby Holden’s appetite, but satisfying it was a frightening struggle.

“He needed to eat," said Jray Lieberman, Holden's mother. "He wanted to eat, and it was a struggle for me to keep him on me because he would just go, ‘Pwapwapwa.’”

That’s because extra tissue tied to the bottom of his tongue was pulling his mouth off his mother. It’s called tongue-tie.

“I was a nervous wreck, honestly,” Jray said.

BayCare Dr. Monica Kharbanda says problems breastfeeding are one of the best early warning signs of tongue-tie.

“Studies have shown that if you don’t fix it in some kids, when they get older, they could have issues with taking food,” Kharbanda said.

And there can also be problems with oral hygiene and speech. Ignoring it can be a real problem later.

“We’ll end up having to get the tissue because we’re trying to move the teeth orthodontically or we’re trying to restore teeth and there’s that big hunk of tissue in between the teeth," dentist Dr. Larry Lieberman said. "It really is a big issue that most parents have no idea about.”

To fix it, a surgery called a frenectomy can cut and remove the tissue.

Ironically, Larry Lieberman is Holden's grandfather. And a laser the dentist uses in his practice removed his grandson’s extra tissue.

“I would not clip every tongue-tie that I see," Kharbanda said. "It depends on the positioning of it, how symptomatic the child is.”

But it worked for Holden.

“Having this addressed correctly from the beginning is just really important," Jray said. "It will save a lot of heartache.”

No one is sure why, but tongue-tie is more common in boys than girls.

REPORT #2610

BACKGROUND: Tongue tie can be defined as a structural abnormality of the lingual frenum. When the frenum is normal, it is elastic and does not interfere with the movements of the tongue in sucking, eating, clearing food off the teeth in preparation for swallowing and, of course, in speech. When it is short, thick, tight or broad it has an adverse effect on oromuscular function, feeding and speech. It can also cause problems when it extends from the margin of the tongue and across the floor of the mouth to finish at the base of the teeth. No recent epidemiological studies have been done to estimate the number of people who have tongue tie. A study in 1941 quoted the incidence of tongue tie to be 4 per 1000 of the population. Research at the University of Cincinnati, published in 2002, found that around 16 percent of babies experiencing difficulty with breastfeeding had a tongue tie. Another study at Southampton General Hospital, UK, found that 10 percent of babies born in the area had a tongue tie.

INTERVENTION FOR TONGUE TIE: Up to the year 1940, tongue ties were routinely cut to help feeding. When this changed, because of a fear of excessive/unnecessary surgery and a reduction in the practice of breastfeeding, the belief that tongue tie was not a “real” medical problem but an idea held by over-zealous parents became widespread. Early intervention is ideal since it avoids habit formation and the negative effects of failure: whether it is due to messy or slow eating, funny looking teeth or speech problems. When there are no strong habits to eradicate there is a better chance of success in correcting the difficulties that poor tongue mobility has caused. Once a tongue tie has been diagnosed, the primary need is to correct the structural anomaly causing the problem. After the structural problem has been successfully corrected, it is reasonable to expect to improve function, and to treat secondary problems successfully. The type of treatment that is most appropriate depends on the problems that have been experienced. A lactation consultant can help with correcting poor sucking which will improve breastfeeding. A speech-language pathologist will help with speech and language problems. A dentist or orthodontist can help with problems of crooked or decayed teeth and infected gums.

NEW LASER DENTAL TREATMENT: A soft tissue laser does NOT cut, it is more a “vaporization” of tissue that occurs with light energy. There is very little discomfort with the laser. Some babies and children sleep through the procedure. There is almost no bleeding from the laser procedure. Lasers sterilize at touch therefore have less risk of infection. The healing is very quick. A laser stimulates bio-regeneration and healing. The result is beautiful tissue, less chance of relapse. Cold laser therapy, or low-level laser therapy phototherapy, utilizes specific wavelengths of light to interact with tissue and can help accelerate the healing process. It is an effective, non-invasive, drug-free healing aid that has no known side effects. Cold laser therapy has been used in clinical practice all around the world as a means for reducing pain and speeding the healing process for over 40 years. Professional clinicians use phototherapy to stimulate the body’s natural repair processes at the cellular level.