Manual Osteopathy for Babies: Supporting Feeding, Tongue Ties, and Latch Challenges

A couple of months ago, Dr. Ashley forwarded me an article shared by the College of Family Physicians of Canada titled “Trying Tongue-Tie Treatment – Does Frenotomy Fix Feeding Frustrations?”

The conclusion was, “maybe, sometimes, but often not really.”

The study referenced in the article showed that maternal nipple pain was reduced by ~2 points on a 10-point pain scale (uhh, ouch?). The effects on the babies’ weight gain and continued breastfeeding were unclear due to the high level of crossover in the control groups.

If you recently had a baby, you’ve probably heard “look out for the signs of a tongue tie” –- in addition to all the other things to “look out for”. But what is a tongue tie? And why does it matter?

Let’s dive in.

A “tongue tie”, technically known as an ankyloglossia, occurs when the lingual frenulum is shorter and thicker than it needs to be. The lingual frenulum is the piece of skin that attaches the bottom of your tongue to the bottom of your mouth. When this happens, the tongue cannot move freely which can affect the baby’s ability to feed easily.

But wait! There’s more!

There are actually seven frenula in the mouth, so there is more than one place for an oral tie. The less commonly recognized oral ties are lip and cheek (or buccal) ties.

A maxillary lip tie occurs when the skin of the upper lip is attached to the lower part of the gums between the two front teeth.

A cheek tie occurs when the frenulum inside the upper cheek is too tight and/or short.

Ok, now let’s get to the “why does this matter” part.

Oral ties affect the baby’s ability to achieve an airtight seal onto a nipple, whether breast or silicone, due to an increased amount of tension in the mouth. One of the first signs of an oral tie, therefore, is difficulty latching. The following are things that you may see if your baby has difficulty latching: a shallow latch, an inability to stay latched, getting tired before they are full, frustration when the nipple is close to their mouth, a clicking or smacking noise while they eat, or milk running out of the corners of their mouth while eating.

Oral ties are usually diagnosed by a healthcare professional or by a lactation consultant. Here’s the tricky part: some recommend surgical correction of the tie, some recommend against surgical correction of the tie. This rabbit hole is full of equal amounts of conflicting evidence both for and against a surgical release of oral ties.

So… what’s a parent to do?

In my clinical experience, oral ties do not exist in isolation. They are the end of a chain of tension that usually resides in the diaphragm, thoraco-lumbar junction (TLJ), shoulders, neck, throat, the base of the cranium and, of course, the mouth.

Releasing the oral tie does loosen the end of that chain, but it does not address tensional patterns. The following are tensional patterns you may notice: a head-rotational preference, moving one arm a lot more than the other, a newborn curling onto their side when sleeping, and/or a baby whose neck is often in extension (looking up).

In addition to tension patterns, oral ties can affect your baby’s digestive system and their ability to regulate. A “regulated” infant has predictable sleep/wake cycles, appropriate muscle tone (not too stiff, not too floppy), and calm breathing and heart rate.

Manual osteopathy has the opportunity to greatly reduce discomfort in your baby’s digestive system, help balance their nervous system, and support their movement patterns. 

There is a gap in the research: the essential addition of osteopathy to your baby’s care. A surgical correction can be more efficient if the baby’s tension patterns are released. Together, these two tools can provide relief for the whole family.

Integrating care from your primary care provider, lactation consultant, and osteopath is the best way to support your baby in their feeding journey.