BS”D
[ last updated Sep. 1, 2008 ]

Subfunctional Tongue and Upper lip release in nursing babies
And the repercussions of neglect in children and adults

Death and life are in the power of the tongue” King Solomon"

A mother’s milk supplies a baby with most of what he needs for his development, as well as with natural and immunological protection, the building of his body’s systems and the security, intimacy and warmth that will sustain him throughout life. Breastfeeding is the most natural, simple, healthy, easy and inexpensive method of feeding a baby and maintaining his health. Keep in mind, as well, that that is how we were created…

For more than half a century, and due to understandable economic considerations, great efforts have been made by the wealthy manufacturers of infant formula (in the Western world) and cow’s milk (in weak countries) to do away with breastfeeding – by taking advantage of the inherent difficulty of the natural process versus the easy compromise (baby mortality in the world, a direct outcome, reaches 1,600,000 a year!) and sweeping the medical establishment to their way of thinking.

Evidence is mounting of infant formula being a major cause of juvenile diabetes, obesity in children and adults (clearly life-threatening conditions), life-long allergic sensitivity, chronic ulcerative colitis of varying degrees (usually subclinical, and which can actually be diagnosed and treated by alternative medicine), asthma etc, as well as being connected to an increase in baby mortality(!).

According to Dr. Bueno De Mesquita (a noted family physician and homeopath) – giving formula to babies constitutes the largest uncontrolled experiment ever conducted on human beings!
It is worth noting that expressed breast milk is not on par with genuine nutrition and protection, despite it being many times better than any formula! (the proofs of the importance of breastfeeding are many and unquestionable – see links).

Consequently, breastfeeding was relegated to the sidelines until, absurdly, organizations and information had to be established in order to reinstate knowledge and understanding that are thousands of years old. Recently, breastfeeding has recaptured center stage, and more mothers understand the importance of, and insist on providing their babies with, that which is natural, suitable and healthy. Today, these mothers and lactation consultants the world over are at the forefront of this maternal revolution.

A major obstacle in the path of a great many babies (about 20%!) to proper nursing is the subfunctional tongue ,most known as tongue-tie (ankyloglossia, 6%) or a short tongue. It has recently become apparent that a tight upper-lip frenulum is also a common phenomenon, combined with the first. In light of the abundant experience accumulated in the combined procedure, and the consequent dramatic improvement in breastfeeding, our clinic recommends performing a clipping of both simultaneously.
Treating nursing babies and getting to know their families has opened the way to the crucial discovery, so far unknown – the effects on a person’s entire life!

The tongue is a powerful tool – it drains the ears, nose and sinuses, it scrubs the palate and the tonsils in its movement, it shapes the skull-bones the palate the nostrils and the respiratory tract, and it is the main factor responsible for the activity of the digestive system and the quality of the digestive process.

A tied tongue is a tongue that is connected to the floor of the mouth by a thin membrane which restricts its movement. In distinct cases – known to some of the doctors, the membrane fuses the entire tongue up to the tip, or less, and in the case of a short tongue the floor of the mouth is too forward and it binds the tongue downward. Both cases limiting the tongues movement and abilities .



The babie's subfunctional tongue is incapable of sucking – it has a rolling, instead of a longitudinal, motion and it causes the nipple to chafe, bruise and crack. When the lip is tight – it does not extend forward to latch on to the nipple deeply enough, and the baby squashes it to the point of pain and spasm.
A baby’s recurring loss of latch on the nipple causes `clicking’, a chafing of the baby’s lips, leading to nursing blisters, anger and frequently giving up the effort to nurse, tiredness and falling asleep while nursing. Keep in mind that nursing is the baby’s aerobic exercise (heart lung endurance) and if it goes unrewarded, then the exertion is in vain! Nursing sessions may last an hour and more (instead of 10-20 effective minutes). Letting go of the breast often lets a lot of air to enter the baby’s stomach (“bubble nursing”), resulting in powerful and frequent spit-ups, gas, pain, frequent waking-up from hunger (!) and other reactions, up to malnutrition – either because the baby hasn’t sucked enough, or hasn’t accessed the hindmilk needed for her growth. Some babies have lost up to 1/3 of their weight and even rushed to the hospital in a state of malnutrition ,extreme dehydration,and kidney insufficiency - all life-threatening conditions.
Additional phenomena: Following a decrease in secretions – there is an increase of newborn jaundice to the extent of being exposed to ultra-violet light in the hospital for many days, and postponing circumcision – to those concerned ; frequent spit-up of milk through corners of the mouth or nostrils (reflux) due to limited, interrupted and backward swallowing motions; thrush on tongue and cheeks due to insufficient tongue activity (there is no mechanical removal by sucking); congestion in respiratory tract, nasal discharge and phlegm due to weak swallowing and insufficient draining.
A mother may experience pain in the nipples and breast, to the point of bruising, cracked nipples and breast spasms (whitening and sharp pain); low milk production, or alternately, extreme engorgement up to mastitis, thrush and even clogged milk ducts, lack of sleep for both parents (it is proven that the parents of a nursing baby enjoy an average addition of one-hour of sleep per night!), as well as: tension, frustration and disappointment in addition to the difficulties of recovering from childbirth – conditions which, in many cases, lead to a partial or full early weaning, and loss of the quality bonding between mother and baby, which may be manifested in the child’s physical and emotional health throughout his life! As an example, an up-to-date study shows a connection between non-nursing and hypertension at an older age! In other words, more breastfeeding - less disease and medication.
In an extensive study being carried out in our clinic over the past several years – testimonies are added with regard to the many phenomena experienced by adults - caused by the subfunctional tongue. These problems now necessitate greater awareness::

1. The tongue’s absence from the palate-- also the floor of the nose, causes insufficient development of the upper respiratory passages – for usually, the strong tongue muscle shapes and expands the thin bone while the baby is still a fetus (muscles building bone!), thus opening up the nostrils and determining for life the volume of the nasal breathing. The s.f.tongue is detached from the palate, and has very poor, or non-existent, contact with it- leaving the palate narrow and high –blocking respiratory passages! The constricted nostrils bring about breathing problems ,eating and sleep disorders in all ages. These cases will eventually referred to adenoid (polyp) removal, in order to open the airways as much as possible.
In most cases, from the day a young baby’s tongue is clipped, the process of palatal expansion will have occurred within a few weeks on its own. Until the age of approximately 13, it is possible to perform an expansion for a child using an orthodontic device (retainer) for six months to a year. There is yet no such option for adults.
2. A breastfeeding baby with respiratory difficulty risks inhaling milk into the lungs (aspiration), a condition which might cause choking or a congestion of liquid in the lung. In any case, such a condition creates great tension surrounding the nursing.
In addition, inadequate closure of the windpipe due to weak swallowing may cause the penetration of liquid and chronic bronchitis throughout childhood, as well as a dangerous disposition to pneumonia,allergies, and, again, the use of antibiotics and steroids.
3. Weak and limited swallowing does not drain liquid from the ears (the Eustachian tube is located above the back part of the tongue), causing frequent ear infections,'flooding' of the ears,loss of hearing to various extents - to the point of inserting “tubes” (which has recently been claimed to be an unnecessary surgery),and administration of lots of antibiotics
In severe cases, complications escalated to the point of ruined eardrums and mastoidectomy (removal of infected bone behind the ear) as a result of repeated infections. Research we did in our clinic clearly showed that such a baby’s siblings, uncles, aunts and cousins also suffered from repeated ear infections.
4. The limited tongue does not perform efficient scraping of the tonsils and very often these babies will contract chronic throat infections; they will be carriers of streptococci, which endangers the heart valves, and are the distinct clients of tonsillectomy.
5. Non-drainage of the sinuses (due to narrow respiratory passages and poor swallowing) can cause recurrent or chronic congestion of the nose and sinuses, copious and even inflamed nasal discharge, breathing difficulties, interrupted sleep, and even an atrophy of facial bone development due to the high viscosity of the sinus contents. Obviously, it might also necessitate risking needless antibiotic treatments (there are no medications that are free of short- or long-term effects.)
6. Blocked upper respiratory airways – whether due to structure or to a congestion of mucous and phlegm – result in open-mouth breathing, a drying up of saliva, a major decrease in the mouth’s ability to clean itself, fast-advancing carries and expensive and redundant life-long treatment (research available regarding the connection between poor oral hygiene and tongue-tie).
7. Wanting to pronounce words properly (though lisping may occur anyway ) forces people with tongue-tie to jut out their lower jaw in order to properly articulate labial and dental letters (d tl'n, z s'sh)- thereby making irreversible changes in this jaw, which is stabilized in the early stages of adolescence. A tight upper labial frenulum may cause gapping in the front upper teeth. The steady pressure of the tongue causes the lower teeth to fan outward .A constriction of the palate leads to crowded front teeth. Various combinations of these problems may appear– and require an extensive orthodontics.
8. A tied tongue may be highly sensitive to touch, with a strong gag-reflex in reaction to nursing (!), to the touch of a hand or a foreign body (such as a toothbrush…) and might lead to eating difficulties (sometimes very extreme)- mainly refusal of grainy foods and preferation of soft or fluid.
9. Partial chewing of food causes it to be swallowed too early – when it is not yet sufficiently processed and then it rots instead of being digested – causing toxicity instead of nutrition, and consequently, pain and disturbances in the digestive tract, constipation, diarrhea and gas, up to hormonal and metabolic disorders in extreme cases and emotional problems based on these conditions, as well as sleep problems and problems with skin, blood vessels ,varicose-veins, hemorrhoids, etc. etc. (This is greatly elaborated on in conventional medicine, alternative medicine and psychology. Note an interesting fact: the Chinese diagnose digestive and full-body problems by studying the tongue !)
More and more cases in the clinic prove the efficiency of clipping, for eating and digestion problems in infancy, childhood and for adults: A 3-year-old boy with chronic constipation and accompanying pain – The problem was solved four days after the tongue was clipped. A two-month-old baby with one bowel movement a week (“that’s normal,” they were told at the baby care clinic, “the milk is absorbed in the organs”) – had gone to two bowel movements a day two days after clipping. A baby who weighed less than his birth weight (“liver problems” said the doctors…), children who don’t eat `hard’ foods ,grownups that go only once every two days or more, etc
10. Speech disorders- trouble articulating the letters z, sh, r, ts, d, t, l, n, delay in the beginning of speech, stuttering , and also tongue-tied parents reported emotional difficulty in speech during their childhood, and trouble talking before people at present too;
At one case we performed clipping on the father of a baby that claimed that as a professional singer, he was limited by th his tongue-tie .
11. Severe sleep disturbances – at an older age, also partially due to the changes blocking the respiratory system, may advance from heavy snoring to apnea (loss of breath during sleep). It is also becoming apparent that a lack of contact between tongue and palate is cause for light and nervous sleep, and from there to chronic fatigue. After a tongue release of another father, for reasons of digestion disorder –he reported a deepening of his sleep and great improvement in the his awaking and daily alertness patterns. Similar success was since then achieved in many cases.
Top lactation consultant, Katherine Watson-Jenna (U.S.A.), reports that a senior teacher, about 40 years old, who heard about a clipping performed on her friend’s baby, and intuitively associated her great tiredness at the end of her work day (ongoing talking) to her tied tongue, had her tongue clipped. She solved her fatigue problem forever.

Dr. Brian Palmer, of the U.S., has been dealing with the issue for many years and he may be the first and most thorough in understanding the repercussions for adults. He has even raised the question of a possible connection between this condition and SIDS in babies – one of the many questions examined in our clinic at present ( a visit at his net site is more than recommended ). We are also checking the possible connection to back-aches ,varicose-veins, and thyroid among many other phenomena (mostly led by Chinese medicine ) .
Dr. Ruth A. Lawrence, in her book 'Breastfeeding: A Guide for the Medical Profession', offers indications: a tongue that is fused close to the alveolar ridge and is sticking out; when the baby cries – the tongue tip stays anchored behind; a tongue that is heart-shaped or is indented; a tongue that is difficult to stretch; and a short (less than one centimeter long) and inflexible frenulum. A Canadian article had collected more than eight different essesment tools and did not manage to find any that will serve.
According to Alison Kay Hazelbaker (MA, IBCLC, CST) in her book 'The Assessment Tool for the Lingual Frenulum Function', the diagnosis of tongue-tie must be made: "primarily on function and secondly on appearance".
This is certainly the indication we now embrace. But as we see it, both above-mentioned approaches are lacking in perspective. They focus on the short-term!
We perform regular questioning of the baby’s parents in order to deepen our understanding of the range of phenomena described. According to the database – we find a distinct familial and genetic connection. In the baby’s family there will, almost always, be a first- or second-degree relative who has more than two of the accompanying problems. We are convinced that without observing the shape of the palate, teeth, tongue and skull of the parents and siblings, without studying their medical history, and without understanding what is in store for the baby in the future, given the family profile, and providing the complete treatment it needs – until the full release of the tongue and upper lip, an orthodontic palatal expansion during childhood, repairing and practicing speech, breathing and eating, and maintaining coordination with the practicing doctors (to the degree that we will indeed be fortunate to have physicians interested in learning the issue) – the existing approaches are superficial and yield bitter results. Thus, we recommend – distributing this article among the families who come to us, in order to inform them of the possibility of repair and of the possible repercussions if the matter is neglected.

The generation-long battle against breastfeeding resulted in a situation, in which a nursing mother seeking relief from her pain at a pediatrician’s will often be advised to stop nursing even if tongue-tie is diagnosed. A pediatric surgeon will recommend waiting a year (and who will wait then to nurse?…) and then operating under full anesthesia (!!!!); a baby care clinic nurse will offer similar advice if she wasn’t trained. Only in few cases, so far, will the mother be referred to a lactation consultant and from there to a frenotomy. All that, despite the change in medicine in the United States, Britain and Canada. Every few days, mothers with older babies (3-9 months, and older) arrive at our clinic and complain that the medical system had led them away them from solution.
It is important to perform the clipping at the early breastfeeding stage: at two days to two weeks, so as not to miss the time at which the milk-production is being regulated, and also because the speed and ease of recovery are at their peak the younger the baby is, although the procedure can easily be performed without anesthesia or any other preparation – in less than 30 seconds – up to the age of a year .The procedure is simple, almost risk-free. When required, it is performed at all ages – using mild sedation for children, and merely local anesthesia for adults, without any stitches or pain. The thin membrane or underlying skin is carefully snipped, usually with hardly any bleeding.
Tongue-tie is usually accompanied by a parallel condition of a tied-upper-lip, characterized by 'nursing-blister's on the it; so in most cases -a double clipping is performed, top and bottom (there is no need to repeat a top lip clipping).


The baby experiences pain for a very short time and immediately forgets (the problem is more with the parents’ pain…). After a short inspection of the bleeding, he is immediately given over to the mother to nurse, since the mother’s milk is the best medicine and comfort. Usually, there is no need for continued treatment or an additional examination. In rare cases of restlessness, usually in babies over a month old, one can calm the baby using light painkillers .
Lesions in the oral cavity appear whitish-yellowish in the course of healing – so there is no concern of the site being infected. These sores should not be touched, cleaned or removed in any way; if the baby’s temperature is normal and steady – there is no infectious process taking place, and none is expected. Only in the rare case of a rise in temperature the infant must be taken immediately to the nearest hospital. Joyfully – this warning has so far been useless.
In the vast majority of cases, the mother immediately reports an improvement or a change in the latching and nursing. Usually within three nursing episodes to one week, the full improvement has been reached. The younger the baby is, the sooner the incorrect nursing pattern can be corrected. In cases in which the breast was wounded or in pain – the healing will be gradual, and the time needed by the mother for recovery, should be accepted with understanding.

When there is insufficient improvement or change, or when there is an improvement and then a regression, and even in the case of a change for the worse – these are encouraging signs (!) that prove the possibility of adjustment between mother and baby. In these cases, a repeat procedure is performed on the tongue, approximately two weeks after the first one. For a while after the clipping and until new nursing patterns are established, there is a possibility of increased milk spit-up, as well as a slow change in the rate of the milk production. In these and similar cases, the help of lactation consultants is recommended for continuous advice, under the Dr's supervision.
In the vast majority of such cases, the problem is finally resolved at this point. In few cases, a third treatment is needed – these require special coordination with the doctor and they are rare.

Dr. Roee Furer D.M.D Dental Surgeon
02-6236319 , 0547-424400 : 4 hama'alot st. ,Jerusalem

Some information for medical personnel: at a standard appointment we saw milk coming out of the baby’s nose – upon examination we discovered that the baby has no palate! (an undiagnosed cleft palate) – for your attention

Important note: literature on tongue-tie and its connection to nursing– but there is an absence of information regarding most of the results discussed above. At present, this information is at the stage of formal research, and is being proven and examined at real-time at our clinic.



Recommended breastfeeding sites:
www.drjaygordon.com www.lllisrael.org.il www.merkaz-hanaka.com
www.linok.net www.askdrsears.com www.kellymom.com
Ido’s tongue - tapuz forum
Brian Palmer DDS (older people with tongue-tie – an important slide presentation)
F.D.A. websites
Dr. Jack Newman, BreastfeedingOnline.com – articles, films and websites
British and Canadian health ministries in above-mentioned links

Keywords
Tongue-tie breastfeeding, lingual-frenulum, nipple pain, frenectomy, ankyloglossia