Biting baby-
To my knowledge the biting reflex is elicited if the gums are stimulated in some way. During breastfeeding (and 
bottle feeding as well)  the gums are protected from stimulation by the presence of the tongue, but if the tongue is retracted as in tongue tie this protection will be compromised and the chewing will be elicited. I have also seen this in  severe retraction of the chin. The tongue that cannot protrude beyond the gum line will retract even more when the baby
opens up to grasp the nipple.
Poor results after tongue tie - 
I now prepare parents that release of the tongue tie is not a quick fix and that the tongue needs time to 
establish it's function.(I say 6 - 8 weeks)  I think it is normal that soon after the procedure there is some tightening up and healing, so things may even get a bit worse before it gets better. Babies start exploring with their tongues soon after tongue tie release - because they can. I am unconvinced that they will continue to feed with a poor pattern if their tongue
has more mobility.
As far as exercises are concerned I am a bit unsure. I guess getting the tongue to do things it could not
do before will not do harm, e.g. protrusion will be helpful (but babies do so themselves), getting the tongue to elevate more may be helpful, but we do not have evidence of what we need to do in order to support establishment of
a new motor pattern. I think it is similar to the oral motor exercises used in speech language therapy for which
the evidence is pretty sparse. Using the tongue in one way (e.g. stretching or lifting) is no guarantee that it will change
the motor pattern under other circumstances, e.g. in feeding. Studies are needed, but in my experience although
some immediate effect is often seen with nipple pain, improved endurance and function needs the elixir of time. 
So I the mother needs lots of reassurance and support.  

I think for these cases it is so important to have very specific observations documented about the feeding pattern.
How many sucks per burst, how long before the baby fatigues and sucks per burst decreases, how long before the
baby falls asleep during the feed. How long between feeds etc etc. 
Without these clearly documented it is difficult to gauge change. 

I recently saw a baby who took an hour to finish a 100 ml bottle feed. He had a very significant click and it
was clear that his suction just about stopped once he lost the contact between the tongue and bottle teat.
He battled to remove milk from the bottle and was falling asleep within minutes of starting to feed. 

4 Weeks after tongue tie release he took a 100 ml easily in 10-15  minutes and he was awake and alert
throughout the feed. Because he was still clicking his mother reported that nothing has changed and without
those measures (limited as they were) I had no way to prove that things have actually changed. 

Loraine Hamm
SLT/IBCLC
New Zealand

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