Feeding Difficulties in Infants with Tongue Tie and Lip Tie

Ankyloglossia, also known as tongue tie, is a congenital condition that can affect infants and children due to having a short lingual frenulum that restricts tongue movement and impacts the function of the tongue. The incidence of tongue tie affects at least 4% of infants and is most commonly diagnosed in males by a 2-3:1 predominance.1 Around 50% of infants with ankyloglossia experience feeding difficulties because of the condition.2

There are two different types of tongue tie that can make feeding problematic for infants and young children. An infant can have a tongue tie that’s attached anteriorly toward the tip of the tongue, posteriorly at the base of the tongue, or both. Unlike an anterior tongue tie that is easiest to view because the frenulum attaches closer to the tip of the tongue, the posterior tongue tie is a form of akyloglossia that is less visible when the tongue is lifted. The frenulum may appear short and thick, or may not be visible because it’s often hidden by the mucosal covering of the tongue.3 This type of tongue tie may not look atypical upon first glance, but the tongue lacks the ability to lift from the floor of the mouth for proper feeding.4 Anterior tongue ties can be viewed more easily. The infant may appear to have a flat tongue that is heart-shaped at the tip, and it may only extend past the alveolar ridge slightly.3

Similar to tongue ties, lip ties can also be the cause of feeding difficulties for infants. Upper lip tie forms from a tight maxillary or labial frenum and can cause infants to have difficulty latching, because it limits the upper lip’s movement. The lip should be able to flange upward to latch along the upper portion of the areola and the nipple, or form a proper seal around a bottle. Lip ties of the maxillary or labial frenum can look like a small string attachment or fanned piece of tissue and sometimes, infants with the condition develop a callus on the upper lip.5,6

Caregivers may notice their child with tongue tie or lip tie is not meeting age appropriate feeding milestones or is exhibiting atypical feeding behaviors. Possible warning signs of these conditions include:

  • Difficulty latching and feeding-when infants breastfeed or bottle feed, their lower jaw is raised during suckling, and they use their top gum and the tip of the tongue (which rests on the lower gum) to hold the nipple/bottle in place. Tongue tie and lip tie may prevent the infant from taking enough breast tissue into the mouth to properly latch for feeding as the latch is often very shallow. Some infants may be able latch but are unable to achieve the proper suckling motions. Tongue tie may also inhibit peristaltic tongue movements—the tongue’s wave-like motion needed to move food from the front to the back of the mouth before swallowing. This can result a poor suck, swallow, breath pattern.4,5,7
  • Mother experiences pain while nursing-as a result of the restricted and atypical tongue movements or improper latch, the mother may experience additional friction while the infant nurses. This can result in pain and nipple soreness, and bleeding.4,6
  • Frequent pattern of feedings-occurs because the infant consumes less milk during each feeding than typically developing infants. The infant may also show signs of hunger shortly after a feeding. Another common warning sign is poor weight gain even though the infant feeds for extended periods of time.4,6
  • Fatigue during or immediately after feeding-the strained feeding experience requires the infant to expend more energy for milk removal. She may become frustrated during feedings or fall asleep within one to two minutes of beginning a feed. 4,6
  • Dimpling of cheeks or clicking sound while feeding-this is specific to tongue tie, and occurs as a result of the atypical latching and sucking motions. Jaw tremor may also be present. Infants with tongue tie are sometimes fussy and/or pull away from the breast or bottle frequently.4

If you suspect a child may have tongue tie or lip tie, referring to a specialist can help determine the proper treatment and support for the family. Specialists who evaluate these conditions and feeding issues include:

  • Lactation consultants
  • Speech language pathologists with specialized knowledge in tongue tie or lip tie
  • Nurse-midwives
  • Pediatric dentists
  • Oral surgeons or Otolaryngologists (ENTs) 3,4

After a diagnosis has been made, there are multiple treatment options for families to consider. A frenotomy is one form of treatment for tongue tie that involves snipping the short or tightened frenulum. Other surgical procedures involve using lasers to revise the frenulum. If surgery is not an appropriate form of treatment, a specialist can work with the mother and infant to adjust feeding techniques for either breast feeding or bottle feeding.  Caregivers must learn how to listen to their infant’s swallows and monitor the infant’s weight closely.4 Similar treatment options also exist for infants with lip tie, and for either condition, caregivers should always follow post treatment advice from their physician. If families are interested in learning more about tongue tie, they can read the Pathways.org blog on tongue tie. They can also view our feeding brochure to learn about feeding milestones and age appropriate foods.

[1] Brookes A, Bowley D. Tongue tie: The evidence for frentonomy. Early Human Development. Nov 2014; 90(12): 765-768

[2] Buryk, at el. Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics. Aug 2011; 128(2): 280-288.

[3] Potock Melanie. Tip Back that Tongue! The Posterior Tongue Tie and Feeding Challenges. The ASHA Leader Blog. 26 May 2015. www.asha.org.

[4] Henry Lydia, Hayman Rebecca. Ankyloglossia and Its Impact on Breastfeeding. Nursing for Women’s Health. Apr/May 2014; 18(2): 122-129.

[5] Kotlow, Lawrence. Diagnosing and Understanding the Maxillary Lip-tie (Superior Labial, the Maxillary Labial Frenum) as it Relates to Breastfeeding. Journal of Human Lactation. 2013; 29(4): 458-464.

[6] Potock Melanie. Just Flip the Lip! The Upper Lip-tie and Feeding Challenges. The ASHA Leader Blog. 10 March 2015. www.asha.org.

[7] Edmunds at el. Tongue-tie and breastfeeding: a review of the literature. Breastfeeding Review. Mar 2011; 19.1: 19.

Shop to Help Pathways.org

Help Pathways.org by shopping on Amazon Smile.

Do you shop on Amazon? What about Amazon Smile? In 2013, smile.amazon.com launched and it is the same great website, but adds a charitable twist. Amazon will donate .5% of all purchases made on Amazon Smile to a 501c3 non-for-profit at no additional cost to the shopper.

Now you can shop and help Pathways.org at the same time! Next time you shop at smile.amazon.com, select Pathways Foundation as your preferred charity and we will receive a gift!

  1. Go to “Your Account”
  2. Click “Change Your Charity”
  3. Then use the search feature to find Pathways Foundation

Visit smile.amazon.com today and your purchases will help impact the life of a child.
Don’t worry– Amazon Smile works with Prime too!

Shop to help Pathways.org

New Baby Milestone Videos

Want to See an Example of Baby’s Developmental Milestones?

Watch examples of baby’s developmental milestones here! Pathways.org has created milestone videos showing what milestones should look like. Baby milestone videos are separated by age and topics of development. They begin at birth and continue to 6 months old, and illustrate some of the early motor, sensory and communication milestones. Check out the video clips and compare your baby’s movements and actions to the baby in the video.  You can also find these educational and informative videos on related age pages.

First Year Baby Milestones playlist

Or find individual ages and topics below!

Watch Baby Milestone Videos: 

0-3 Month
Motor Milestones
0-3 Month
Sensory Milestones
0-3 Month
Communication Milestones

0-3 Month
Feeding Milestones
4-6 Month
Motor Milestones
4-6 Month
Sensory Milestones

 

4-6 Month Communication Milestones
4-6 Month
Feeding Milestones

 

 

Or see all our videos on our Video Page

Pathways.org is a 501(c)(3) Not For Profit that relies on donors like you to help us create new FREE material.  This material helps parents and health professionals around the world!
Donate Today to help us create more great info like these milestone videos

 

Helping Families Choose Age-Appropriate Extracurricular Activities

Many parents encourage their children to become involved in extracurricular activities as a way to promote their development. Extracurricular activities help children develop motor skills and improve physical fitness, while also building their cognitive and social skills, all of which can enhance children’s sense of wellbeing.1 To help children receive the most benefits from extracurricular activity involvement physically, emotionally, and socially, they should participate in the right amount of activity for their age level and abilities. Adults facilitating children’s extracurricular activities can learn how to make the activity more developmentally friendly and recognize when it may not be appropriate for a child. Continue reading

Bulletin Items for Inclusion Awareness Day

An Inclusion Awareness Day event is one way to focus on welcoming worshippers of all abilities. Please consider hosting an Inclusion Awareness Sunday celebration on the second weekend in October or another week in the year.

Celebrating the unique gifts of all members helps create a stronger and more inclusive faith community.

The following series of items can be used in bulletins, on websites or in newsletters to help spread awareness about how to help to create a more inclusive environment.

Click on the bulletin item to enlarge, then right-click and select Save image as… to save the file to your computer.

Bulletin Item 1

Inclusion Awareness Day

#1

Bulletin Item 2

People First Language

#2Bulletin

Bulletin Item 3

Mobility

#3Bulletin

Bulletin Item 4

Welcoming Worshippers
with Hearing Challenges

#4Bulletin

Bulletin Item 5

Welcoming Worshippers
with Intellectual Differences

#5Bulletin

Bulletin Item 6

Welcoming Worshippers
with Visual Challenges

#6Bulletin

To return to the Inclusion In Worship website click here.

Rehabilitation Institute of Chicago Announces Record Gift for New Research Hospital

Hospital to be named the Shirley Ryan AbilityLab; to integrate with Pathways

CHICAGO — (June 22, 2016) — The Rehabilitation Institute of Chicago (RIC) today announced that Patrick G. and Shirley W. Ryan have pledged a record gift to advance its revolutionary work. The gift — the amount of which is confidential — is the largest charitable investment in the organization’s 63-year history and will support AbilityLab, RIC’s state-of-the-art research hospital. When the new hospital opens in March 2017, it will be named the Shirley Ryan AbilityLab in recognition of this transformative gift.

As a result of this extraordinary gift and the significant boost it creates in RIC’s capital campaign, the organization will raise its goal to $350 million. The campaign is expected to close in December 2017.

With this gift, Pathways, the entrepreneurial organization founded by the Ryans more than 30 years ago, will join the RIC family immediately and the AbilityLab upon its opening. Pathways, with its clinic and web organization, is the leading resource in early detection and intervention tools that maximize children’s motor, sensory, and communication development.

“The integration between Pathways, RIC and the AbilityLab is historic — it makes possible a truly better future for children and adults from around the globe who need our support and services,” said Joanne C. Smith, M.D., RIC president and CEO. “We treasure Shirley and Pat’s trust, and we honor their innovative spirit, boundless compassion and determination to make a difference in the lives of so many people around the world. Through this transformational gift and the growth of the Pathways and AbilityLab family, we will build upon our collective strengths to advance the science, medical care and outcomes for patients everywhere.”

As part of the integration, Pathways will retain its leading brand, clinic and website. The organization’s awareness, messaging and reach will be expanded in coalition with AbilityLab.

“Both RIC and Pathways are so excited about this powerful union which joins two organizations with common values, purpose, vision and dreams,” said Shirley Ryan. We share a long-standing commitment to the advancement of abilities and, with this integration, AbilityLab and Pathways are poised to deepen knowledge, expand therapy and training, and spread global influence further and faster.”

A radical shift

The $550 million, 1.2-million-square-foot Shirley Ryan AbilityLab will be the first-ever “translational” research hospital in which clinicians, scientists, innovators and technologists will work together in the same space, applying (or “translating”) research real time. The AbilityLab will introduce its revolutionary model of care through five Innovation Centers focused on areas of biomedical science with extraordinary promise:

  • Brain Innovation Center
  • Spinal Cord Innovation Center
  • Nerve, Muscle & Bone Innovation Center
  • Pediatric Innovation Center
  • Cancer Rehabilitation Innovation Center

Central to applying research during care will be working human labs where interdisciplinary teams develop new research and insights to help patients gain more function, achieve better outcomes and enjoy greater ability and independence. Each lab will have a unique configuration based on the type of experimentation and functional purpose:

  • Think + Speak Lab
  • Legs + Walking Lab
  • Arms + Hands Lab
  • Strength + Endurance Lab
  • Pediatric Lab

An integration united by common values and vision

Pathways, a leader in raising awareness and spreading knowledge about early detection and intervention for pediatric motor, sensory and communication delays, will be integrated with the Shirley Ryan AbilityLab. The organization consists of both a state-of-the-art outpatient pediatric therapy clinic as well as an expansive educational website.

Shirley Ryan will join RIC’s Governing Board and continue as Chairwoman of Pathways.

A profile in ability

In addition to her work as Chair of Pathways, Shirley Ryan has been appointed by two presidents to the National Council on Disability, which advises Congress on disability issues. She serves on the Executive Committee of the Board of Directors of the Lyric Opera of Chicago, and on the Board of Directors of the University of Notre Dame, the Art Institute of Chicago, the Alain Locke Charter Academy, and the Chicago Council on Global Affairs. She has also received an honorary Doctor of Laws degree from the University of Notre Dame.

Pat Ryan founded and served for 41 years as CEO of Aon Corporation, the leading global provider of risk management, insurance and reinsurance brokerage, and human resources solutions and outsourcing services. At the time of his retirement, Aon had in excess of $7 billion in annual revenue with more than 500 offices in 120 countries. In 2010, Mr. Ryan founded Ryan Specialty Group, a global holding company which includes wholesale brokerage (the third largest in the country), highly specialized underwriting companies and specialty services designed specifically for agents, brokers and insurers; Mr. Ryan currently serves as Chairman and CEO. He is a member of the International Insurance Hall of Fame, the American Academy of Arts and Science and the Horatio Alger Association of Distinguished Americans. He has been a member of Northwestern University’s Board of Trustees for the last 38 years and presided for 14 years as its Chairman.

The Ryans have three adult sons, Pat, Rob and Corbett, a daughter-in-law, Lydia, and three grandchildren.

An unprecedented campaign

Given the monumental nature of the Ryans’ gift, RIC’s Board of Directors has taken action to increase the capital campaign from $300 million to $350 million. The campaign launched in July 2013 and extends through December 2017.

“We always felt confident in our ability to achieve significant philanthropic support for our new vision and campaign,” said Dr. Smith. “Now, we’re humbled and motivated by the opportunity to take the campaign even further and generate additional funds for the novel programs and research that will be pioneered in the new facility. The Ryans’ gift is not just a testament to the RIC vision; it’s a sign of great momentum as RIC is now poised to meet, and even potentially exceed, our new $350 million goal. This will have a profound impact on patients, on science and on the future of our field.”

Differences between Maternal and Paternal Book Reading to Children

Reading aloud helps children expand their vocabularies while also building their ability to think, analyze and ask questions. It can also inspire a love of reading and learning for life. A 2014 study published in the Journal of Fathering suggests fathers and mothers may have different styles of reading to their children and both can be beneficial for development. In the study, researchers observed mothers and fathers while reading to their children. The study showed mothers asked their children more factual questions while labeling and categorizing objects, whereas fathers used language to talk about concepts extending beyond the images and wording in the book.1 When parents use different styles of reading aloud to their child, they are providing a variety of learning experiences that foster language and cognitive development and can support literacy achievement in later years.2 To promote these positive outcomes, healthcare professionals can provide caregivers tips to make reading time an enjoyable and educational experience for children. Continue reading

4-6 Month Motor Milestone Video!

NEW! Our 4-6 month old baby motor milestones video has been posted!

4-6 Month Motor Milestones

The video above demonstrates 6 different motor milestones baby should be reaching by 6 months old.

  • Uses hands to support self while sitting
  • Rolls from back to tummy and tummy to back
  • While standing with support, accepts entire weight with legs
  • Reaches for nearby toys while on tummy
  • While lying on back, reaches both hands to play with feet
  • While lying on back, transfers a toy from one hand to the other

Use this video to see examples of what milestones look like and compare to your own baby’s progress.  To see more of our milestone videos visit our age pages or video page.

0-3 Month Motor Milestones
[one_half_last padding=”0 5px 0 5px”]0-3 Month Sensory Milestones[/one_half_last]

  4-6 Month Motor Milestones
[one_half_last padding=”0 5px 0 5px”]4-6 Month Sensory Milestones[/one_half_last]

If you notice your baby is not meeting their 4-6 months motor milestones, contact their health care provider.

Importance of Play in Children’s Development

Play is critical for children’s development because it providkids_playing_dress_upes time and space for children to explore and gain skills needed for adult life. Children’s playtime has steadily decreased due to limited access to play spaces, changes in the way children are expected to spend their time, parent concerns for safety, and digital media use. Between 1981 and 1997, the amount of time children spent playing dropped by 25 percent.1 During this same time period, children ages 3-11 lost 12 hours a week of free time and spent more time at school, completing homework, and shopping with parents.2Continue reading