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Breastfeeding and bottle-feeding difficulties, poor weight gain, reflux, colic, gassiness, speech delay, slow eating, choking and gagging, poor sleep quality, snoring, and teeth grinding are related to tongue-ties and very often (84-89% in our study) see improvement once correctly released. When left untreated, adults may struggle with headaches, neck pain, shoulder tension, and poor sleep or speech.

The tongue-tie is comprised of a thick webbing of fascia (mainly type 1 collagen fibers) that stretches less than 1%. If left untreated, it will persist into adulthood, and although some children can remarkably compensate with a tight tongue, no child should have to miss out on proper development and struggle with daily activities because of a condition that is so easily treated.

Tongue-ties have been written about for thousands of years, and until the 20th century, were commonly released because it was clear that they impeded normal function. In the 1920s, treating tongue-ties fell out of favor. With renewed emphasis on breastfeeding, we are now seeing increased diagnosis as well as treatment. Because this condition has been virtually ignored for decades, many parents and professionals are not aware of the issues it may cause. It also seems to be increasing in incidence due to unknown factors, similar to the rise in autism. Treating autism is not a fad, and neither is treating tongue-ties.

A posterior tongue-tie is simply a symptomatic tongue restriction. Restricted fascia or webbing under the tongue is sometimes clearly visible, and other times it’s not easily seen. The baby or child who has no obvious string but has all the symptoms of a tongue-tie often has a posterior tongue-tie. When elevating the tongue with two index fingers from behind, the tight webbing of fascia will be visible. When released, patients see the same type of symptom improvement as those with a to-the-tip tie, since the posterior aspect of the tongue is finally able to elevate properly. This allows for improved swallowing, speech, and sleep as the resting posture of the tongue no longer falls into the airway.

Often a snip or clip leaves thick tissue behind. The patient often sees some improvement, but the standard “clip,” without post-op exercises, is likely to be incomplete or grow back. A full release of restricted fascia will allow better function and symptom resolution. The laser allows complete visualization of the surgical area, and with ultimate precision and typically no bleeding, we release all the tight tissue while protecting important structures under the tongue.

Many issues in pediatrics will improve with time. Telling a mother who is having toe-curling pain and struggling to nurse to “just give it time” is unhelpful. Bottle-fed babies who still struggle with excessive gas, slow feeding, milk leaking out of the mouth, and reflux often have a tongue-tie, and will continue to struggle. Children with difficulty eating solids or speech issues very often have a tie. Traditional speech therapy does not assess for ties. As a result, practitioners will try to have the child compensate to achieve normal-sounding speech, but incorrect tongue placement can lead to dental development issues and increased effort when speaking. It’s wise to remove the physical impediment if it can be easily released. In this case, inaction is often more harmful than action.

We are sure to thoroughly review each patient’s history, typically spending 30 minutes or more talking with the family before examining the patient. We conduct a careful examination from behind, with magnification and a headlamp, in order to accurately assess restrictions. We have a lengthy discussion with parents, so there is no misunderstanding or over-promising of results, and to set realistic expectations for the procedure. The procedure is quick (around 15 seconds), is no more traumatizing than a routine vaccine and much faster than circumcision. The CO2 laser is ultra-precise, removing the width of a human hair at a time, so it’s easily controlled and safer than scissors, scalpel, diode laser, or cautery, which can cause iatrogenic damage if the patient were to move. We only perform the procedure when a tie is significantly affecting the quality of life. If we determine, through exploration of symptoms and physical examination, that one or both areas (lip or tongue) are not in need of a release, we counsel patients not to pursue treatment. Our patients’ best interest is of primary concern to our entire team and our desire to see them thrive is what motivates our work.

We do this because it’s very rewarding.

Parents are so thankful when their baby can eat without getting frustrated or gains weight quickly, and when mom has less pain. Kids who are speech delayed often start talking more and with increased clarity. Kids who have struggled with poor sleep finally sleep deeply and, in turn, often display more positive behavior. Kids with eating issues can finally go out to eat at a restaurant with their families because it’s no longer a big struggle to eat. In our recent prospective IRB-approved study, at one month after the procedure, 89% of kids with speech issues had improved speech, 84% of those with eating issues had improved feeding, and 84% with sleeping trouble had improved sleep.