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131. Tongue Ties Part 3: Frenotomy Support As A Lactation Educator & Healthcare Provider

Lactation educators and healthcare providers, this episode is for you! (I'm talking doulas, dentists, midwives, and more) How can you find a reputable doctor t access and take care of ties? Can I use an ENT to help with a tongue tie? As an IBCLC, where can I get more training on recognizing oral restrictions? How long does it take for the latch to improve? These are the questions I'm answering for you today!

Dr Ghaheri's website
Agave Pediatrics


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Read the full transcript here:

Welcome to the Breezy Babies podcast, where we talk about all things boobs, babies and breastfeeding. This is episode 131. Tongue and Lip Ties Part Three. I'm Bree the IBCLC and I made Breezy Babies with you in mind to help ease your transition into parenthood. Becoming a parent changes your life and every way imaginable. Bumps in the road are going to come up as you move into your new role, but my goal is to help smooth out those bumps and help you become the most confident parent you can be. With good education and support, I know you can meet your breastfeeding and parenting goals. Let's do this together. Hello, my friends. Welcome to the Breezy Babies podcast. I am so happy to be talking with you today about tongue and lip ties. I know maybe you're sick of hearing about this topic, but if you are a lactation consultant may be a doctor or a midwife or a doula or a sleep consultant or a dentist or just some sort of educator or healthcare professional that works with breastfeeding families, then you are not going to want to miss today's podcast episode. This episode is for you. Now. I can't believe that this is the last episode to go live in the year 2022. The next episode that you're going to hear, we are in year 2023. Oh my gosh. I can't even believe it. I am excited for 2023. What's on the horizon? The possibilities? Just everything. There's something so exciting about a new year sometimes, right? Don't you think? I hope that you are crushing your goals in your life, whatever they may look like. And here's to a new year. Now, I recently did a poll on Instagram asking you what questions you had about navigating tongue ties. And most revolved most of the questions that came in revolved around professionals in this space or educators in this space. So I wrote those exact questions you had into this episode. Those are coming. Hold on tight. But first, I want to tell you that this episode is brought to you by the IBCLCs at Breezy Babies. Yes. Did you know that we have three IBCLCs on our team? That means that you can get help sooner. And sometimes your Lactation consultations can even be covered by insurance. The Lactation network does our billing and a handful of insurances such as Blue Cross, Blue Shield and Cigna are covered at 100% for at least six consultations with us. Yes, six no copay, no deductible. Those cover either a telehealth consultation, over secure video, or even an inperson consultation. If you happen to live in northern Utah, if you want to check to see if you are covered, there is always a link in the show notes. Or you can click the, just enter your name, some information about your insurance, and they will respond back with an email to us both with either a yes, you are covered or a no, you are not. And we'll send you some other options on how you can still work with us. Now, this is episode this is part three of this tongue tie series. If you want to go back to episode one and episode two, we did talk about tongue ties, and lip ties kind of laid the foundation. We heard from two different moms, and they're experiencing navigating. This road with tongue ties and lip ties today is going to be a little bit different. It's just going to be me. No guests. On this podcast episode. I'm going to be talking a little bit more about the professional side of tongue ties and lip ties, how to navigate all of that. And to give you a little bit of background information, I want to tell you that I worked in the hospital for five years as a nurse, and I'm kind of embarrassed to say this, but it's the truth. I had no idea what a tongue tie was. Now, I assessed babies day in and day out, every single shift. All the nurses, we assessed every mom and every baby head to toe. I listened to their heart and their lungs and their bowel sounds. I felt for a mom's fungus, which is the top of their uterus, and made sure it was firm and contracting down. And I checked their bleeding and made sure it was within normal limits. I assessed every baby that I was assigned to, and I counted fingers and toes and felt their soft spots and checked reflexes and made sure their belly was nice and soft. And I counted wet and poopy diapers. But I never, ever was taught to look under a baby's tongue and see how restricted it was, even if they were having trouble with latching and trouble with breastfeeding. We never looked at that. And I'm not saying that no pediatrician looks at that either. But most pediatricians are also not trained on this and also don't know how to look inside of a baby's mouth and check for restriction. So, as you can see, I did not know how to navigate tongue ties at all for those five years working in the hospital on a postpartum unit. And listen, I worked with hundreds of breastfeeding families, and I know now that there had to have been problems, but I just didn't even know to look for them. So that's one thing to consider. Don't assume that you're a nurse or you're a doctor or your midwife will be able to help you identify a tongue tie. Honestly, they probably can't because they don't have the training. And here's a hint for you. If your pediatrician, for example, says, oh, your baby can stick out her tongue past her gums, so you're good, there's no tongue tie, then guess what? If that's all they're looking at, then they are not tongue tie savvy, which PS. This is exactly what my pediatrician, who I had at the time, told me about my baby. Now, there is more to the situation than just that. A tongue needs to be able to elevate to the roof of the mouth. Your baby's tongue needs to be able to touch the right cheek and the left cheek. And all of that movement is important to be able to function properly at the breast. I want to pull in some information on this podcast episode from some of the experts who have really paved the way in the tongue Thai world. Some doctors who have put a lot of time and a lot of effort into educating others, because, listen, there's a whole group of people that don't believe that tongue ties are even a thing, that don't believe that tongue ties even exist. And they have their place and they have their opinion, and that's all good, and that's all fine. But I am telling you from personal experience that I have seen tongue tie releases save breastfeeding relationships. So I love learning from these doctors that have put in the time and the effort to really help educate others in this space about tongue ties, about phrenotomies, about all of that. So one of these professionals is Dr. Gahiri. I will link his website in the show notes, if you want to go and check it out. He's one of the top leaders in this space of tongue ties. He talks about how he sees so many people who come in to his office who are having trouble with breastfeeding. And what he explains, what he compares a tongue tie to, is he says this if I asked you to train for a marathon for three months, but during that three month period your shoes are tied together, you will develop a specific way of running the marathon. You might be able to eventually finish that marathon on race day in that fashion. But if I untie your shoes on the morning of the race day and ask you to run that marathon in a normal fashion, your training for three months won't help you much. You would have developed a different skill set and muscle strength to compensate. tonguetied children practice sucking against resistance up to the moment their ties are released. Often there is significant muscular discordination and habit that doesn't allow them to nurse efficiently. I don't think it is reasonable to expect a mom and a child to nurse normally right after a procedure. Unfortunately, despite my advice to see an international board certified lactation consultant, aka IBCLC, moms still often feel that it's an optional step. In my experience, there is a much higher percentage of babies who fail to improve after a phenotype when an Ivclc isn't involved in the aftercare. So he goes on to explain a little bit more about why it's important to see an Ivclc, why it's important to have body work done. He goes a little bit deeper into all that about suck training, which I talked about in last week's podcast episode. I'll talk a little bit more about it in this week's podcast episode, but go to his website if you want to read about all of the specifics. He's a great resource, not only for you as a professional, but also for the families that you've seen. So that's a really great one. Now I want to move into some of the questions that were asked in my Instagram poll. And one question was, how can you find a reputable doctor to access and take care of ties? Now I want to explain a little bit of what I do in this area. I often have my clients. First of all, I ask my clients if they are part of a local group or maybe even a local mommy Facebook group. Because I'm telling you, the local parents in your area, they know where the preferred providers are, especially if they have walked up this road before with a tonguetime, with their baby having a tongue time. Honestly, I rarely direct families to Facebook groups otherwise because I see some crazy information on mommy facebook groups that people share that is not research based and honestly, a lot of the time the complete opposite of what I would recommend. But I do find that Facebook groups can be helpful for directing families towards finding a preferred provider who works with tongue Thai families and does phenotypes day in and day out. I tell my clients, don't just go with the soonest available or the cheapest or the closest. This is a time when you want to be picky with experience. You want someone who does this procedure day in and day out because the person behind the instrument is most important. They need to know what they're doing. And then once you get to know the good ones in your area, make a list. I have a referral list for people in my area where I live. I live in Utah and I have a preferred provider list of all the good pediatric dentists who live in my area who do this procedure regularly. I'm talking they even have a waitlist for weeks most of the time for clients who want to come and have a phenoty done. Those are the good ones. And it's okay to get on a waiting list because again, in the meantime, you're going to be doing stuck training. You are going to be doing body work with these days, or instructing the families to do soccer training, to do body work. So it's okay if there is a waiting list. In fact, I had a client recently who lived in Wyoming and she drove to Utah, it was a couple hours drive to come and see a preferred provider because there was no one who lived by her. She lived in a pretty small town in Wyoming and she had a great experience at a preferred provider here in Utah. And who knows what she would have got in Wyoming. I have had some clients who have had not a great experience by going to someone who was just there and convenient. So I do recommend finding reputable doctors, getting to know the people in your area, making a list where you can refer families to. Now, another question that came in was can I use an ENT to help with a tongue tie? Yes, you can. Now, in my area where I live, it really is pediatric dentists who run the show here and they are the ones who just take care of tongue Thai releases and it's really not ents where I live. Now, that doesn't mean that's how it is everywhere. I'm in northern Utah, but babies all over the world can benefit from a phenomenon. So just know that where you live, your preferred provider may not be a pediatric dentist. Maybe it is an ENT. In fact, on Dr. Gehry's website, he talks about a client, someone that they should have on their team when navigating a tongue tie release is a ENT. So he actually has this listed on his website and he talks about who else should be involved in treating breastfeeding problems. Number one, he talks about chiropractors and cranialsacral therapists. Hello bodywork. We know how important taking care of muscle tension, muscle tightness alignment, all of that is so important because if a baby is restricted in her mouth, it is connected all the way down to the toes. So super important to have someone to do body work on your side. He also does mention specifically an ENT. He talks about how if your practitioner is not an ENT, than involving an ENT for potential issues in the mouth and throat that could be going on, could be addressed. He talks about how sometimes there can be a sub mucus cleft palette, maybe Laringo, Malaysia, which is that softening. That can happen, can also go hand in hand with a tongue tie. So again, having an ENT on your side in your area could be a great option. And hopefully here in Utah we can get some ENTs who are really experienced with tongue ties on our side as well. He also talks about speech and language pathologists and how they can be helpful, especially if down the road, if your baby's just having like really bad reflux, having trouble with breathing, having difficulty with solid foods, then that's someone else that you'll want in your corner as well. OK, the next question was as an Ibclz, where can I get more training on how to recognize oral restrictions? Again, you can start by getting in touch with preferred providers in your area, making a list, but not only add them to your list, ask them if you can go spend a day with them or even just a few hours observing what they do. That's what I did early on when I first was in IBCLC. I dedicated a few hours to visit a local pediatric dentist who's very well known for doing phenotypes day in and day out. In fact, this was one that had a waiting list that was weeks long and families travel from all over to come for a release. I went in with a group of a few other IBCLCs. Actually, we all went in together. We watched a handful of procedures. We got a real fill, a firsthand experience of what these families see and what they experience when they go in for procedures. We were there with them in the procedure room. We saw what the set up is like. We saw these tiny babies in these big giant dental chairs. And that's something you just can't fully explain without actually being there and seeing it with your own eyes. They actually swaddle these sweet little babies up. They put on tiny glasses to protect their eyes. They take special precaution, like applying a numbing gel under the tongue before coming in with a laser and doing the release. The mom with all of the procedures that I watched, the mom was right there next to baby. The whole thing took probably ten minutes tops. There was really no blood, no tears, just an upset baby that they had to hold their head still during the procedure. The babies really did not appreciate that. They did not like holding still and not being able to move about freely. But bam, right after the procedures, they would encourage mom to nurse right away. And it was just so great to go and experience that in real life. Talking to those families, talking with a pediatric dentist and his staff, that was so helpful. That was helpful information that I still use in my practice six years later. So that's tip number one. Connect with your local provider and go and observe. Spend a day with them. Tip number two, I want to tell you now, is follow along the journey with your client long term. OK, that's based on this question. The next question that came in was how long does it take for latch to improve? So for the majority of my years as an Ivclc, I did one and done consultations with my clients. Not because they didn't like me or because I didn't like followups or anything like that. It was simply because all my clients were SelfPay. And investing 100 plus dollars into a consultation was a stretch for pretty much every single family that I worked with. Fast forward to now. Over the last year and a half, I started taking a handful of insurances and most of the people that work with me are approved for six free consultations. That has been a game changer because most people need at least three visits with me and for sure at least three visits. But throw in a complex situation like needing a tongue tie release and all the work that goes into prepping for the release and for the aftercare, it's a lot. Those easily can fill up six consultations and often they do with the clients that I see. So since then I get now to see the big picture and I get to follow along on the journey way longer than I did before with my clients. I get to see the huge improvements that happen after. And what I've seen is clients who sometimes immediately after the phenotype, they do have huge improvements and the latch seems to be magically fixed really quick after the procedure. Now that's not the case for everyone, just like Dr. Kahari said. I also have a load of clients that still struggle, especially that first week after the release when that site is still very sore and some even regret having it done, especially as they are going through all the bodywork and all the stock training. But over time they see small improvements that slowly get better and better over weeks and maybe even months is how long it takes for things to get totally better. And of course I will say that my clients things do get better because we met beforehand, we saw that a frenotomy was going to be helpful. And I don't take that lately. I don't refer all my clients to have a frenotomy. Sometimes even when I do see restriction. I don't always send my clients to see a provider who can diagnose a tongue tie or a lip tie, which I cannot. And IBCLC, who is not also a doctor, cannot diagnose tongue ties or lip ties. But we work closely together to see if it's the right fit and when it is the right fit. So 100% this is not a onesize fits all. It's very, very individualized. Tip number three for you is never stop learning again. I have gone in person to learn. I have taken online conferences about tongue ties. I have even studied with professionals who have traveled here to Utah. I have taken a master class with Jennifer Tao who about the gut brain. She also has a master class that I want to take in the future. Things change over time. New research emerges, new techniques come out. I'm always learning. I am always learning new information about tongue ties and lip ties. Now I had a really cool experience where we'll call him Dr. A. Came in to Utah. He traveled here from Arizona is actually where he lives. He owns Agave Pediatrics. Again, he is another one who has really paved the way for tongue ties with professionals and is doing the hard work that it takes to spread good information about tongue ties and phenotypes. He traveled to Utah. Let's see, this had to have been a couple of years ago. It was precovid. Doesn't ever feel like sometimes that's how you separate your life. Like I know it was before COVID happened or I know it was during COVID So this was probably the year before, I'm guessing this was probably 2019 that he traveled to Utah and spoke with a small group of us lactation educators here in Utah, and he talked about some top some tips that I want to share with you. Here are some things that I learned from Dr. A. So first of all, he taught that if there is nipple damage that is going on, then a phrenctomy should happen sooner or later, and it can be done or sorry, sooner rather than later, and it can be done either with laser or scissors. Again, it doesn't really matter a whole lot. He also talked about how tongue ties cannot be diagnosed by just looking. You have to look at how the tongue is functioning at the breast. He taught us about how tongue ties are more common in boys rather than girls. He said there is a 21% occurrence with family history. There's really no racial bias. His numbers that he shared with us was that it occurs to five that tongue ties occur in five to 12% of newborns. Now, he thinks that this is a gross underestimation. He thinks it's closer to one in three. But studies have shown us that it's closer to five to 12%, and that's all we have to really go off at this point. I wish we had some better studies to pull from. He does talk about how the procedure is actually so simple to do, but it's really important to know when it should be done. It's kind of like a moving target, and function needs to be reevaluated as time goes on and really just working closely together with your IBCLC to know the right time to do a release. He talked about how 90% of pediatricians think tongue ties do not cause breastfeeding problems at all, which, of course, Tim and I would disagree with. He talks about how the mobility of the tongue is the most important part of effective milk removal. There was six random control studies that he talked to us about, which is the best study method, random control is the best study method, and all six of those studies showed that Fredectomies Do help. He talks about how you cannot diagnose a tongue tie until you assess both mom and baby. They're a dyad. They work closely together. You have to look at both. He talked about how most babies who are tongue tied are not able to take a bottle. Many issues can be fixed working with an IBCLC. And he talks about how IBCLC should never refer every client for for an ease, which I 100% stand behind. He talked about how breastfeeding is not going well. Rates of depression goes up. He talked about how if you don't see a tight frenulum, but you see the symptoms of a tongue tie, then it is a posterior tongue tie. He talked about how kids with tongue ties also have sucking Blisters flat heads, tortocolis. They have facial asymmetries, which means that their face is not exactly aligned. And the same on the right and the left side. He talked about how it's important to check for high palates and white tongues. A lot of times white tongues are actually not thresh at all. They are most of the time, tongue ties. He taught us about how when a baby is crying, you need to look at where is the tongue. Lips should be able to elevate without blanching of the gums, which means that the gums should not turn white when you flip open the tongue. He personally uses a CO2 laser. He finds that a laser has a much cleaner wound than scissors. He personally has an Ivclc on staff that helps moms breastfeed right after the procedure. And he talked about how a fernetomy does not touch the tongue muscle, just the fascia. And last, he uses silver nitrate for any bleeding that can happen with a phonicomy. So because of that silver nitrate, the wound often looks black and ugly, but really, it's really mostly a bloodless procedure. So I loved those tips that he shared with us when he came to visit Utah. So again, my top three tips if you are a professional or an educator in the lactation space, my top three tips for you are number one connect with your local providers and go and observe. Tip number two was follow along on the journey with your clients long term. And tip number three is never stop learning. I hope you enjoyed this podcast episode today. If you can think of another provider who helps breastfeeding families who would benefit from this podcast, could you do me a favor and share it with them? You can share it with them straight from Apple podcasts or at the Breezy Babies website. You can always search for any topic that you are looking for. If you type in Tongue Thai, this podcast episode will pop up. I am so excited to come back next week and talk to you about a new episode. This, however, concludes our three part series on tongue ties and lip ties. I hope you learned so much, I hope you enjoyed it. And of course I'm going to leave you. You are strong, you are smart, you are beautiful. Your good friend all by.

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