I want to address the issue of frequency of manual therapy for tied babies. I have been working with bodyworkers for 25 years, including chiropractors, osteopaths (both American and European), PTs, CSTs, CFTs, Rolfers, etc. While I agree that babies often do best with the opportunity to integrate bodywork, but it doesn't take weeks for that to happen. It is best optimized when parents are given oral exercises to facilitate the bodywork. IME, that's the biggest missing piece for most of these babies. Babies nurse 10-12 times per day. They are engaged either functionally or dysfunctionally in feeding every time. Oral exercises given by the IBCLC to be done 3-5x per day by parents make all the difference in most cases. Waiting 2 weeks between bodywork sessions for babies who are nursing poorly does not turn out to improve outcomes. If the bodywork is ineffective, then I agree that frequent, ineffective work is not a benefit. But, frequent, effective work is a benefit. In some cases, the best way to move babies past an impasse is daily bodywork for a few days. 

I would also say that most babies have periods post-release where they do worse than prior to release. When I lecture to dentists, I tell them that, while it feels inspiring to see that first great latch post-release, it is probably the last time they will see that for a long time. Babies need time for neuromuscular rewiring. That's where the oral exercises and manual therapy/bodywork are essential. Dentists/doctors who presume the release is all that is needed or tell patients to "see a bodyworker for follow up w the IBCLC if things don't get better" are drastically undermining care of the dyad. Oral exercises and bodywork both need to begin prior to release and continue post-release. Preparation is just as important as follow-up. 

Parents also need to be prepared with information. They need to know, for example, that the contraction period is often a period of regression. Parents need to be prepared for this eventuality and know that they need to continue their oral exercises through that period (usually 4-5 days post-release). Otherwise, they often give up, thinking there has been reattachment, when that isn't the case at all. Parents also need to know that babies will grow a new frenum, so they don't assume every new frenum is reattachment. 

The other significant factors that can impact function are inflammation and nervous system dysregulation. For babies who have adapted to restrictions, removing them can be initially dysregulating. I and many other adults who are released have experienced this ourselves. Lastly, I disagree with anyone who does not release all oral restrictions. I have seen the worst outcomes in those kids who only have a TT release while the other ties remain intact. I don't understand what causes someone to understand that one fascial restriction can impede function, while presuming others do not. Again, for those adults who have complete releases, as I have, it becomes evident quickly that lip and buccal ties are just as restrictive as labial ties. The most compelling outcomes are happening where the manual therapist holds the occiput of the patient and directs the dentist as to where the fascial strain originates, so that exactly those restrictions that impact function are released. 

What we need are more IBCLCs who understand fascia and the whole body impact of oral restrictions working collaboratively with bodyworkers who understand breastfeeding mechanics. I am fortunate to have been in such a collaborative relationship for decades and to have learned from our mistakes (such as doing only bodywork w/o releasing ties and in effect only supporting compensations, not doing bodywork consistently pre-release until about 8 years ago, not releasing all the ties until the past couple of years, and I am sure there will be others), and the benefits of correcting those mistakes, especially in releasing all ties, ensuring oral exercises are done in concert with bodywork, addressing inflammation and regulation and remembering that there is always more to learn.
Jennifer Tow, BFA, MA, IBCLC, RLC, OMT 

Intuitive Parenting Network, LLC

Holistic Lactation Consultant, Holistic Health Coach (focus in nutrition), founder Holistic Lactation Institute




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