I recently brought my 4 month old in to the pediatrician. This provider is someone I’ve trusted for the last 7 years for the care of each of my 4 children. I appreciate his care and concern for our family, genuine nature and his willingness to listen to my concerns. All things we want in our health care provider.
I was really brave at this appointment. I took a quick moment to ask his opinion on “posterior tongue ties”. He knows my profession as a Speech Language Pathologist and someone well versed in oral development so I am sure he wasn’t terribly surprised. The moment I asked the question I shifted from being a patient’s mother and to a health care provider with a specialty. Diving into a controversial topic at a well child exam is not my norm. I also wanted to make my message clear and concise and be “ready” for the rebuttle… Playing out the conversation a million different ways before it starts.
My reasoning for bringing up posterior tongue ties at this visit was to get the conversation going that needs to get going. That all of us, medical professionals and parents, need to have a conversation. And really listen to parent observations and concerns as indicators. Maternal and infant symptoms are a major component in the current standard of practice when diagnosing tethered oral tissues but unfortunately not all health care providers are aware of this.
I have taken days on days of continuing education on swallowing, early feeding, oral development and airway and yet I was uncomfortable. I quickly found myself questioning what I know and what current research is indicating. My confidence in sharing what I know is growing, but how about parents who don’t have the background knowledge that I do? Parents are the number one first line of defense when it comes to our kids’ health. When a parent’s concern, lets say about potential tongue tie, gets dismissed, we’ve missed an opportunity. Providers who simply believe tongue ties don’t exist, believe dentists are just out for the cash, or sticking out the tongue is good enough, are closing the door on determining the cause of the symptom. There is a problem with over diagnosing tethered oral tissues. But there is also a problem with underdiagnosing tethered oral tissues. A problem with referring out to a skilled IBCLC, feeding specialist, SLP, Chiropractor, etc. These specialties exist for a reason; these providers are the individuals with the most knowledge of a given area. A problem with changing with the times.
I’ve recently heard that the standard medical care system will not change until the patient population demands it. Also, according to a 2021 study, 60% of moms do not breastfeed for as long as they’d like to. There are many factors that contribute to this but can we agree that lack of support might be part of the problem? In conversation with my pediatrician I got the anticipated response. That dentists are over treating this condition for the cash benefit. Which immediately makes me wonder what parent would ever choose to pursue a surgery, voluntarily, that was not based on symptoms. And I wonder what the conversation looked like for that parent in their pediatrician’s office in the days or weeks prior. I agree that there needs to be better research. Are there providers doing releases without proper rationale, proper pre and post operative care? Sure. But, at some point in that mother-baby dyad, they needed help and they sought it. Not every mother has the support or background knowledge to push for what she needs. What about all of the other moms and dads whose concerns are dismissed because of “the fad” or bias? Not all breast feeding difficulties are the result of tethered oral tissues. We know that traumatic pregnancies and deliveries heavily impact breastfeeding success but how are those mother baby dyads being supported in the first few days of life? Most often by a parent who is “brave” an pushes for the referral she needs.
In pediatric health care, this is what I’d like to see….
Pediatricians making quick referrals for specialists. Parents who have concerns can choose to pursue the referral or not. Worst case scenario there are no issues and the parents have peace of mind.
Airway screening at every. single. well child visit. A child who isn’t breathing well isn’t functioning well. A child who isn’t sleeping well isn’t living well.
Collaboration between all health care providers and insurance companies to recognize that oral health is health. Why are dental health care and medical health care divided? I’m really not sure. Could it be because dentists don’t work in hospitals?
Babies with nursing difficulties, early feeding issues, a family history for tethered oral tissues to be seen by a professional who knows oral facial development BEFORE the issues get worse. The Wait and See method is not helping anyone.
I am calling today a win. I shared how I look for tongue placement in infants. My feelings toward supporting mothers with symptoms were heard. I told him I’m concerned about the kids with open mouth postures; speech, feeding and sleep are all impacted very early. Posterior tongue ties are not just a fad. We agreed that there needs to be more research.
Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeedingexternal icon. Pediatrics. 2013;131(3):e726–732. Accessed August 24, 2021.