In older babies, children and adults with a tongue tie, compensatory oral habits may be present. During pregnancy, a baby swallows amniotic fluid with a tongue tie, which means that hiccups may already be present. An older child and adults have exhibited compensatory behaviors for years as surrounding muscles and tissues compensate for the limited functional movement of the tongue. Think of moving food in the mouth from side to side, swallowing well without choking, wiping your teeth after eating and talking. Often the patient swallows with his tongue forward instead up and back, which is called a tongue thrust. This can affect the position of the teeth, jaws and the overall body posture.

The preparation for a treatment is therefore twofold:

1. Compensatory movements in the head and neck region can be quite “stuck” and therefore better checked and treated by a special therapist before a tongue tie release. We hear from patients that they have this done by a physiotherapist, manual therapist, orofacial therapist, chiropractor or osteopath for complaints such as incorrect posture, stiff neck, jaw clenching, grinding and headaches. Treating a tongue tie alone is not sufficient if the surrounding muscles keep the compensating behaviour and restrict functional movements.

2. Treatment also improves if the patient goes to a specialized speech therapist in OMT (oromyofunctional therapy) before and after the treatment. This can help to analyze incorrect oral habits and swallowing and train or unlearn these. If an OMT speech therapist is not available, the Kieferfreund app is an option to train and practice (see www.kieferfreund.com and https://www.tonguetieclinic.com/tongue-tie-therapy/https://www.tonguetieclinic.com/tongue-tie-therapy/)

This video shows in Dutch how a consultation at the Chiropractor’s office goes. The baby is four weeks old. And this video in English at the Tongue Tie Clinic.

Before the release the baby usually had to drink in a different and compensating way for a long time. The baby already drank the amniotic fluid in the womb with a tongue tie. Sometimes a baby has a lot of tension in the jaws, the baby seems to bite the breast or bottle. Possibly there is a quivering chin (because of the muscle tension) present and the baby could not open his mouth  to latch on. In this video (link) you can see how you can help the baby relax the jaws.

During feeding, a baby can also overstretch or have a preferred position. These sometimes very tense jaw muscles and other muscles in the mouth, throat, and neck area can be helped to relax. You want to give the baby a signal that compensation is no longer needed and that he or she can start drinking differently. Babies with colic or babies who cry extensively also benefit from the possible treatment of a professional such as a physiotherapist, chiropractor, osteopath or manual therapist who has completed a degree at the university. These therapists can help to overcome compensating behavior. Check if the therapist sees many babies and that they check the mouth / neck area especially.

Also look at this page of therapists for addresses of other care providers who use their expertise to further assist the baby in motor development such as the physiotherapist (fysiotherapeut) who teaches you how to apply therapy in your daily care at home, the speech therapist (logopedist) for further development of ​​use of the tongue and mouth with (bottle) drinking, eating solids and talking, the lactation consultant IBCLC (lactatiekundige) for further remediation of breastfeeding problems.

Case studies and research chiropractic and manual therapy:

Dutch case study, breastfeeding problems and chiropractic treatment.

http://www.enhancedentistry.com.au/wp-content/uploads/2015/02/Chiropractic-and-Breastfeeding.pdf 114 case studies.

More articles:

http://www.ncbi.nlm.nih.gov/pubmed/19836604

http://www.ncbi.nlm.nih.gov/pubmed/22014911

http://www.ncbi.nlm.nih.gov/pubmed/19066699

http://www.ncbi.nlm.nih.gov/pubmed/23158465

http://www.ncbi.nlm.nih.gov/pubmed/22675226

Here we added some links from colleagues who made the effort of recording and sharing aftercare! Watch them several times, you also see how you massage the jaw muscles and cheeks. Help your child to relax more and stop compensating behaviour.

The older baby resists more, so try to do it as playfull as you can. An older baby also had to compensate for much longer with other muscles to be able to drink, therapy to let go of the compensation behaviour is often needed. In addition, guidance from a lactation consultant IBCLC or a speech therapist is recommended to improve feeding.

Lactation consultant IBCLC, Melissa Cole. This video , and this video to.

Older baby video Lactation consultant IBCLC Jennifer Tow.

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.

The next video explains how a baby shows signs of compensating behaviour.

https://www.youtube.com/watch?v=Dk8tBl4q7Dg&t=29s