I’ve seen in a number of clients and friends that early breastfeeding problems can be related to the condition known as “tongue tie,” and that a simple procedure to correct the condition can make a huge difference. Diagnosing a tongue tie is outside of a doula’s scope of practice, but like so many things, we are often in a position to be the first to notice a red flag or a tip-off that referral to a specialist may be helpful. So I wanted to learn more about this condition. Richard Baxter’s book Tongue Tied (2018, Alabama Tongue Tie Center) offered a great, detailed introduction. I was even more interested when I learned that Dr. Baxter lives in Birmingham, Alabama just like me, and he founded the Alabama Tongue-Tie Center to help address this problem.

During our embryonic development, we have special tissues that help hold the developing body parts in place until the connecting structures are fully grown and developed. Inside the mouth, the tongue, lips, and cheeks are held in place by these tissues to make sure that the mouth forms in the correct shape around them. Normally, these tissues disappear once they have fulfilled their role, but sometimes parts of them remain at birth. When enough of this tissue remains, connecting the tongue, lip, or cheek to the jaw and gums, then the normal motion and function of these mouth parts is restricted. In infants, this can result in painful, inefficient nursing (and sometimes even bottle-feeding difficulties), reflux, choking, gassiness, colic, excessive spit-up, nasal congestion, and sleep problems. That’s a pretty long laundry list of newborn complaints, making it worth getting checked out to see if an oral tie may be at fault! If left uncorrected, tongue ties can cause additional problems in older children, including further feeding and speech problems.

The book is primarily aimed at professionals, but it would also be a useful guide for parents wanting to learn more about this condition and its diagnosis and treatment. One word of warning for parents – there are a lot of black-and-white photographs of oral ties before and after treatment, which can look a little frightening to the non-professional. The book includes extensive reviews of the medical research, as well as descriptions of diagnostic and treatment procedures (though hands-on training by a relevant professional would be a requirement to actually perform these procedures). Throughout the book, Dr. Baxter stresses that the procedures to release a tongue (or lip or cheek) tie are safe and straightforward, but they are a form of minor surgery and like any surgery will involve a healing process afterwards. Dr. Baxter’s preferred mode of treatment is CO₂ laser surgery, which he says can be performed in less than a minute. Following surgery many families have reported improved nursing even before leaving the office where the treatment took place. There are stretching exercises that must be performed with the baby for several weeks afterwards, to ensure that the tissues do not grow back together before they have healed, and these are described in the book. Throughout the book, Dr. Baxter and his co-contributors also stress the importance of diverse professionals – including International Board Certified Lactation Consultants (IBCLCs), pediatricians, dentists, and speech and language therapists – working together to identify, diagnose, treat, and provide aftercare for children with oral ties. I would love to see doulas added to this list, since it is often the doula who first is alerted to these types of difficulties and may recommend calling in a lactation consultant or other professional.

Tongue Tied is available on Amazon and Audible (paid link). I was also able to find the book at the Hoover Public Library. If you live anywhere in Jefferson County, Alabama, your local library is part of a collective that will allow you to request books from Hoover or any of the other locations. I’m a big fan of using my local library! I would definitely encourage any expecting or new parent to at least browse through this book to learn about the common but troublesome condition of tongue tie and how it can be helped.