Tongue Tied on Tuesday – Episode 2 Tummy Time (and Why We Believe Anything)
Welcome to Episode 2 of ‘Tongue Tied on Tuesday’, a blog series where I will be fact-checking some of the claims that are made about Tongue Tie (and other oral ties) in an effort to help parents feel informed when they are making decisions about their child’s mouth (and possible surgery).
Before I dive in to today’s topic of tummy time, I wanted to take a moment to talk about why this whole TT topic is so emotive and stressful.
Whilst I haven’t lived the experience of having a child with TT, I have had the experience of having two (gorgeous) kids who had rotten gastrointestinal issues as babies. Both kids had different issues, both took time to be correctly diagnosed and treated, both took a toll on me. Parenting a baby who is miserable, crying, can’t / won’t sleep, can’t / won’t eat, can’t poop, can’t be a happy baby... it’s beyond exhausting. It’s an unhappy existence for everyone. Your relationship with your partner suffers, your mental health suffers, you become an empty husk of your former self. Sleep deprivation, anxiety, parenting expectations and hormones all come together to create a heady mix of “crazy mama” who keeps records of things like poop consistency, sleep cycles, gassiness levels, what you ate, how long baby fed for (and continue ad nauseum). All you can talk about is how many times you were woken up the night before, and how many hours baby has cluster fed for today (“Only 5!” you announce to the postman with a slightly hysterical giggle that’s just a little too high pitched).
You don’t recognise yourself in the mirror anymore. You start compulsively looking online for what the problem might be (“I ate that cream cheese bagel two days ago. Can cream cheese bagels cause colic? I should Google that”). You need some sleep. You take your baby to different health professionals, and no one can give you an instant answer or an instant fix. You start Googling more. You find online parent forums. You ask questions, you get responses and they make you cry (but not in a relieved way). You get given advice from literally anyone who meets you and your screaming baby. You start to seriously consider the advice from the lady stacking the apples at your local greengrocer. You snap at your partner when he gently suggests that maybe you should have a shower. You really need some sleep.
Having a ‘tricky baby’ sucks. They are hard work, and sometimes hard to love. And so it’s entirely understandable that when you have a baby that seems to cry more than others, vomits more than others, sleeps less than others, or feeds worse than others, you want to know if there’s a way to fix it. No one talks about what it’s like to have a ‘tricky baby’, and in the media (social media included) there are endless photos and videos and advertisements of all these sleepy, happy, chubby babies – it can make you start to feel like you’re missing something, or doing something wrong.
And the sleep deprivation doesn’t help. You lose all reason and rational thought. Logic becomes a luxury. And that desperate want for sleep, that desperate need to sleep, starts to turn in to a generalised sense of desperation. There were times where I was so desperate for sleep that if someone had said to me “Hey if you talk to your baby in Spanish they’ll be more settled” I would’ve been signing up for Spanish classes the next day. Desperation, combined with poor rational thinking, makes you do things that might appear silly to some. Amber teething necklaces are a great example of this. We know, on a rational level, that they don’t work. But when you have a teething baby who is keeping you up all night and your neighbour swears by it, you think “Well, what harm could it do?”
And so this leads me, in a very roundabout way, to talk about Tongue Tie again. All babies have a little bit of skin joining their tongue to the bottom of their mouth (called the lingual frenulum). Most babies also have a little bit of skin joining their lip to their gums (called the labial frenulum) (1). And Tongue Tie is everywhere at the moment. Mother’s groups, online forums, Facebook, Instagram, even antenatal classes – it is being talked about (and being worried about) seemingly everywhere. And if your baby has a Tongue Tie that you can get rid of somehow, it promises to fix almost any problem that a ‘tricky baby’ might present with. I even read the other day that there was a suggestion (on a parent forum) that Tongue Tie was related to childhood schizophrenia. We are putting a LOT of emphasis on a tiny bit of skin. It’s like a magic button that you press (or in the case of TT; snip or laser) and it will fix it all.
But you know what they say; if it sounds too good to be true, it probably is. And it’s different from an amber teething necklace. We’re talking surgery here. Even if it’s minor, it can have repercussions in ways that we can’t always envisage.
TT can absolutely affect babies. But not in all the ways that the internet says it does. So let’s start unpacking it.
What is the claim?
Tummy time. I’ve read in various places online that:
Tongue Tie can cause babies to have trouble with tummy time
Tongue Tie can be corrected by doing tummy time
After surgical correction of Tongue Tie you need to take your baby to see someone to have tummy time therapy
Now, let’s get one thing straight here. Tummy time is GREAT for babies. In fact, it’s kind of essential for their development. In the 1990s the SIDS safe sleeping guidelines came in to effect and babies stopped getting the naturally occurring tummy time that they would get during sleep. It’s good for head shape, motor development, neck strength, visual development, fine motor skills... and the list goes on.
So it irks me that there are people out there making money off vulnerable parents, touting their “tummy time programs” as being something unique or new that you couldn’t otherwise do at home. And it especially irks me when they claim that it can directly fix things like Tongue Tie, when we have no good evidence to show that’s the case at all.
Where has the claim come from?
I’ve heard that for some Bodyworkers (eg Osteopaths, Chiropractors, Craniosacral Therapists) they are working on the theory that the Tongue Tie is connected to the muscles and bones in the neck like a rubber band, including the hyoid bone, and that by doing tummy time therapy this stretches this tight 'rubber band' and helps to fix feeding problems and the Tongue Tie itself. It's true that the neck muscles strengthen with the help of tummy time. But I think it’s misleading to say that you can ‘stretch’ a Tongue Tie or the connection between the hyoid and the Tongue Tie, especially as we know that in infant anatomy the hyoid bone is not even a bony structure yet, and it sits in isolation from any other bones, and plays a minimal (almost negligible) role in infant feeding and swallowing (2). So paying someone to stretch your baby’s neck because of the suggestion that the hyoid bone is anchored tightly somehow is unnecessary. And there is research to suggest that the lingual frenulum doesn't stretch over the first 12 months of life (3). I would go so far as to suggest that if you see improvements in your baby’s feeding and development after doing tummy time therapy, that it is likely a combination of the positive effects of tummy time in the first place, maturity of your baby’s neurodevelopmental state, and possible placebo effects too.
Supporters of Bodywork are passionately supportive. Critics of Bodywork are passionately critical. Unfortunately for those in the Bodywork industries, there is not the same rigorous, gold standard, peer-reviewed evidence available as there is in other health professions such as Physiotherapy. Perhaps with time this will change. In the meantime, and I would recommend this to any parent looking into doing any kind of therapy with their child; don’t do anything that doesn’t feel ‘right’ or makes you or your child uncomfortable. If it feels risky to you, then it probably is. If it seems too good to be true, it probably is.
What’s the take home message?
So what’s the bottom line?
If you do tummy time with your baby, they will show all kinds of lovely developmental gains – regardless of any Tongue Tie.
For the general population, you can usually get by with just doing tummy time at home with no paid programs necessary
I haven’t gone in to the suggested link that babies who have been diagnosed with TT may also suffer from reflux or gastrointestinal discomfort and therefore do not enjoy tummy time very much... but TT and reflux is a topic for another day.
But my baby still has problems with this area. What should I do?
Talk to your Child Health Nurse about tummy time and see what they can suggest. They know babies inside and out, and have seen pretty much every variation of typical development out there.
If your baby really does not enjoy tummy time, or you want some more support on how to do it, then I would strongly recommend getting in touch with a Paediatric Physiotherapist. They have specialist skills in infant and child development and they will be able to show you lots of different ways to achieve tummy time without needing to plonk your poor screaming baby down on a mat. In Perth, WA, you can self-refer to a Paediatric Physiotherapist through the Health Department Child Development Services, to see one for free. The link to refer is here.
If your baby doesn’t like tummy time because of reflux, the Reflux Infants Support Association has some great information about it here.
Thanks for reading and don’t forget to comment below with any facts you want me to check up on! And stay tuned for the next episode, which will tackle TT and starting solids.
1. Flink, A., Paludan, A., Matsson, L., Holm, A.K., & Axelsson, I. (1994). Oral findings in a group of newborn Swedish children. International Journla of Paediatric Dentistry, 4(2)
2. Logermann, J. (1998). Evaluation and treatment of swallowing disorders. Pro-Ed
3. Lopes di Castro Martinelli, R., Queiroz Marchesan, I. & Berretin-Felix, G. (2014). Longitudinal study of the anatomical characteristics of the lingual frenulum and comparison to literature. Rev CEFAC, 16(4)