the problem with those tongue tie diagnosis checklists

There are 8 muscles in the tongue alone that all have to work correctly to achieve optimal milk transfer. Added to that, is the muscles of the upper lip, the jaw, the neck. The latch, the positioning of the babies' body, their tongue strength, the size of their mouth, the size of their jaw, their palate shape, their co-ordination and their stage of development. Then there are the mother's nipple length, shape, areola size, breast size, storage capacity, let down speed and intensity, supply. If you have been mixed feeding there is aslo the potenial for baby to be using different motor patterns, the size, shape and flow speed of the nipple can all affect sucess. 

In other words there are about 1000 variables that matter, and what the frenulums look like is only one variable, which may actually have little to no impact on sucessful feeding for that particular baby. 

Even if your baby looks like they have a category 4 tie, they may be able to breastfeed sucessfully because enough other variables are in thier favour. Likewise a category 1 tie, can cause major problems if there are enough other variables that are compounding the issue. ​

I just got back from a fantastic ABA meeting with guest speaker Bridget Ingle IBCLC who is known as the tongue and lip tie guru in South-East Queensland. 

SOO much to write about!!!!

But I am going to start with probably the two most important things she said. 
 

1: Tongue and mouth function, is far more important than what your babies frenulums look like or even feel like: every baby, every mother, every dyad is different. 


There are 8 muscles in the tongue alone that all have to work correctly to achieve optimal milk transfer. Added to that, is the muscles of the upper lip, the jaw, the neck. The latch, the positioning of the babies' body, their tongue strength, the size of their mouth, the size of their jaw, their palate shape, their co-ordination and their stage of development. Then there are the mother's nipple length, shape, areola size, breast size, storage capacity, let down speed and intensity, supply. If you have been mixed feeding there is aslo the potenial for baby to be using different motor patterns, the size, shape and flow speed of the nipple can all affect sucess. 

In other words there are about 1000 variables that matter, and what the frenulums look like is only one variable, which may actually have little to no impact on sucessful feeding for that particular baby. 

Even if your baby looks like they have a category 4 tie, they may be able to breastfeed sucessfully because enough other variables are in thier favour. Likewise a category 1 tie, can cause major problems if there are enough other variables that are compounding the issue. 

This means 2 things:


One: The clasification of Anterior/Posterior and pictures that compare the categories of ties (class/grade 1-4)  like this one by Real Food With Kids, are essentially usless. Because as the author points out
​

The problem is that you can have 10 kids that are tongue tied and they can each be having different symptoms or combinations of symptoms. Even children that have the same “class” of tie can compensate for them differently. Emery and Cooper have the exact same ties – Emery refused to nurse but could chew and swallow any solid foods efficiently. Cooper was a nursing champ but couldn’t chew and swallow most solids to save his life

(but the rest of the article is good; so worth reading)

​Two: not all ties that are causing problems now, need releasing now, likewise ties that are not causing problems now, may cause problems later on. The important thing is functionality.
​

If you’re a mama and you suspect a problem there probably is one. Tongue ties are not just about structure, they’re about function, and there is no one more qualified than you to determine if a baby’s latch feels “off. - Mummypotamus 

Sometimes functionality can be restored without a release, thanks to treating other variables. Sometimes you can have a release done, do all your aftercare exercises and still have problems and require revisions, because the tie is the primary problem. 

But one thing is clear. Unless your care provider does a thorough assement of anatomy and movement. Unless they look for any and all potential underlying issues. They are not doing a proper assesment and you are wasting your time.


2: The symptoms that are commonly associated with tongue and lip ties, are not only related to tongue and lip tie. 


You might have seen one of these lists of common symptoms floating around social media. 

Now there is nothing inherrently wrong with this list, or the simmilar one by Mummypotomus, in the link above. They are a good starting point. But the important thing to remember is not to get caught up in the DR Google effect. Just because you baby has gas does not mean s/he has a tie. Many babies experience one or more of the baby symptoms at some stage, just because they are babies. Likewise, many mother experience some of the mother symptoms at some stage in their breasfteeding journey. We would be better off labelling these lists 'potential symptoms of an undiagnosed feeding issue' because that covers the multiple different diagnosies that those symptoms could be an indicator of. 

It's like how if you look at a list of symptoms for the flu, and for meningitis and for lyme disease they all list the same things. Having a fever does not mean you have meningitis, it could just be the flu, it could be something else..... Having meningitis, doesn't mean you have a fever, you may only have one symptom, you may have all of them. 

So these checklists or symptom lists need to be looked at as starting points for further investigation. 

Unfortunately ties are a rapidly growing field, which means information that was current last year can be completly disproved next year, they also cross multiple medical and alternative health fields and the whole life span. So there is a lot we don't know yet at all. 

However the biggest barrier to getting an acurate assessment seems to be a lack of referal to people who actaully know what they are doing!!!! GP, LC's, Child Health Nurses, Dentists and Paediatricians who don't have the knowledge, don't have the skills and often don't even believe that ties can cause problems, or have a personal issue with breastfeeding; telling mothers that there is nothing wrong, that they have checked for ties, and the baby doesn't have one, that "the latch looks fine", that you "just need to supplement" etc etc. What these people should be doing, ethically - is referring you to an expert. 

At home-assesments, comparing pictures on the internet, forums and facebook, and symptom checklists can help parents to find potential answers, but these steps need to be followed up with a health professional who knows what they are doing. So the best use of the internet, is just to ask around for who the experts are in your area.