Hi Everybody

Thought I would throw in my 2c re this hot topic. I am also currently in the process of trying to establish a 
better service for tongue tie release in our hospital. Great to see that services are being established around the 
world although not without it's frustrations.

I recently did an in service to members of my therapy team including PT's, OT's and me SLT/IBCLC.
I was surprised to learn that two people in the group had tongue tie (as did some of their offspring.)
At the same time I also had opportunity to speak to another adult with fairly significant tongue tie. 

From the discussion it was clear that although I guess from a 
medical perspective their issues may seem benign, from a personal perspective they all had
very real issues e.g. most were not able to breastfeed successfully, had speech difficulties, not severe 
but severe enough to affect self image. There were subtle later feeding difficulties and I am certainly adding picky eating
to the list of tongue tie effects. Difficulty chewing and therefore avoidance of certain foods were prevalent. I think a lot of these minor feeding issues are ignored, but they do not go away.
Another significant issue was cost of orthodontic treatment (huge) or the alternative of living with severe malocclusion.

I do not argue that we should explore optimal latching well when assessing feeding, but looking at these adults and
thinking that these issues may have been prevented through the simple low cost  procedure (mostly) that
we recommend I cannot help to feel justified in referring tongue ties that impact on feeding with confidence.

I am unconvinced that if feeding is going ok upon discharge from hospital that all is necessarily well. Research in this area would be great.  I see a lot of children when they are older presenting with speech and language difficulties (not necessarily tongue tie related) and I hear the the same story repeated again and again in taking feeding histories from mothers. The theme of difficulty breastfeeding due to tongue tie and weaning prematurely because of the frequent feeds, the pain etc. repeats itself again and again. 

I am also starting to see a bit of a tongue tie continuum due to my privileged position of working with the age group 0 - 3. It goes like this: Breastfeeding issues, started bottle feeding (not necessarily trouble free),later on mild to moderate feeding difficulties like poor backward transfer of food, difficulty chewing lumps, picky eating, coughing when drinking water i.e. not managing the fast flow well, drooling beyond the age appropriate age, speech difficulties (mild to moderate) and these are only the issues related to my field.   

From the perspective of speech language therapy there is huge preventative potential in ensuring that babies breastfeed.
There is little funding available today for treatment of minor speech defects and although they sound minor to the public 
funder they still have a significant impact on the self-image and personal development of the person who owes them.

If I can prolong breastfeeding even for a few weeks or months and thereby contribute to less risk for middle ear disease and subsequently delayed speech and language development AND prevent same patient from presenting with mild to moderate eating and speech difficulties I would think that tongue tie release was well justified and excellent use of the health dollar. 

Loraine Hamm
Speech Language Therapist/IBCLC

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