Tongue Tied on Tuesday - Eating Solids, Part 2
EDIT (11/05/17). This is a long blog post, and it's been garnering lots of interest which is great! But skim reading long posts can get the message muddled, so here is a visual summary I've made of the content to help simplify things. Because a picture paints a thousand words, and who doesn't love a good Venn diagram?! Original post starts after the image.
So, let's continue on from where we left off. Here’s another infographic I’ve seen doing the rounds.
Gosh from reading that list, my toddler would be a candidate for Tongue Tie. Except that he doesn’t have one.
Tongue Tie can absolutely affect babies. But not in all the ways that the internet says it does. So let’s keep unpacking it.
What is the claim?
That Tongue Tie (and for that matter of fact, Lip Tie) can cause;
Gagging when eating puree food
Gagging on lumpy purees
A hypersensitive gag reflex
Trouble with chewing
Now with all those claims, it’s a wonder that any child with a Tongue Tie ever learns to eat. And you’ll have to excuse me if I sound skeptical, but I can’t help it. I’m a Speech Pathologist and have specialised in the area of infant feeding for over a decade, and I haven’t ever come across a baby who had a Tongue Tie that was stopping them from learning to eat. But I know I am only one therapist, so I put the word out to other Speech Pathologists in Western Australia – nope, no one had seen it before*. So I asked some very experienced colleagues from the eastern states... nope, they hadn’t seen it either. The closest I came to hearing about Tongue Tie having a significantly negative impact on eating was of an older child who was described as a messy eater because of their Tongue Tie.
But just asking around ain’t good enough. Let’s check some FACTS. What does the evidence say? What does the research and science say?
Where has the claim come from?
I’m not sure where this originated. Interestingly, in many research articles chewing is listed off as one of the many things that Tongue Tie can affect. And I did come across two articles that mentioned Tongue Tie causing chewing problems – in a horse, and in a dog. Hmmm.
So is it true?
This is a tricky one. I’m leaning towards; no, it’s unlikely that Tongue Tie causes as many problems with eating solids as people claim it does. A severe Tongue Tie, yes. I could see that it may restrict some of the tongue movements needed for chewing, especially as the child gets older. But a severe Tongue Tie going undetected until a child is toddler aged is pretty rare these days.
Tongue Tie causing gagging on purees is not something I have come across before. The reality is, a lot of babies gag when they first start purees, regardless of any ties. And that is because of the physiological placement of the gag reflex in the 4-6 month old. It is much further forward on the tongue, and is more sensitive / easily triggered. This is for a reason – it’s to stop babies choking (not just on food, but on aaaallll the lovely things they like to find and cram into their mouths!). And when babies start eating purees, their tongue is still moving in a sucking back-forth motion, so if the baby has been breast or bottle feeding up until that point with a Tongue Tie, then they should be able to eat purees from an oral motor perspective.
When babies learn to chew, they are learning a very rudimentary version of chewing. What they basically learn to do is to start moving their tongue from side to side, rather than simply back and forth(1). Again, with a severe Tongue Tie I could see how hypothetically this might cause some restriction in the sideways movement of the tongue, but as I wrote earlier, the severe Tongue Ties tend to be corrected quite early on in the newborn period well before the baby starts solids.
Now, for older children, there is actually some research into this area. I found one study(2) that looked at some of the muscles of the mouth used for chewing and compared 7 year olds with Tongue Tie to those who didn’t. On the surface, the study looks good – electrodes were used to measure the muscle strength and they compared how the measurements changed over six months after the children with Tongue Tie had surgery and then did oral motor exercises each day. And the kids who had Tongue Tie showed improvements over six months, and the kids who did not have Tongue Tie didn’t show any change. But. There is one main problem with this study. We don’t know WHY the children got better over the six months. Was it because they had surgery? Or because of the exercises? The kids who didn’t need surgery also didn’t get told to do any exercises, which is a problem, because maybe they would have shown improvement too over six months if they had done exercises every day. And unfortunately no practical measures were taken (looking at function). Were the kids with Tongue Tie actually having trouble beforehand? Were they unable to eat things or chew things that the control group could? We don’t know. It’s a bit like telling me to do bicep curls over six months. I might get stronger muscles, but it doesn’t mean that beforehand I wasn’t able to pick up my kids or carry the shopping bags. It’s important to look at function as well as the numbers in the data.
Hypothetically I could see how a significant Tongue Tie might create a messy eater, because they wouldn’t have the same range of movement available in their tongue tip to control the food in their mouth, but again this is very anecdotal (based on one child I’ve heard about) and I haven’t actually seen it clinically. And older kids with Tongue Tie and dental caries (tooth decay) is another topic for another day.
What’s the take home message?
There are two take home messages today.
Please don’t believe everything you read in a meme or infographic. Just because someone has put it online does NOT mean that it’s based on anything at all. It could be completely made up.
Tongue Tie should not cause problems with starting solids, learning to eat lumpy foods or having a sensitive gag reflex, apart from possibly the babies with a severe tie that has gone undetected. Older kids should be able to eat a full range of foods, although some might be messy at times.
But my baby still has problems with this area. What should I do?
In many cases, babies improve with their gagging and chewing with the passage of time. However, if your baby is struggling with learning how to eat (whether you think they have a tongue tie or not) please seek professional advice.
A good rule of thumb:
If they are still gagging on purees at 7 months old
Disliking finger foods by 8 months old
Not able to eat soft lumps of food by 9 months old
...then it’s probably worth getting some help with their oral motor development.
In the first instance, approach your Child Health Nurse, and if you are looking for additional specific help then approach a paediatric Speech Pathologist who specialises in feeding. Often a few simple strategies and a little bit of therapy can help your baby catch up with their eating skills and it means NO surgery or trauma for your little one, which is what we all want at the end of the day.
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!
*Edit: since publishing this post, I have been approached by a Speech Pathologist locally who recently saw a toddler who had a significant tongue tie that had not been diagnosed, and the child was having difficulty with eating solid food. Which is great to hear about, because it means that it's less of a hypothesis that significant tongue tie can affect feeding, and more of a likelihood.
Evans-Morris, S. & Dunn Klein, M. (2000). Pre-Feeding Skills: A comprehensive resource for mealtime development, 2nd Ed. Pro-Ed, Texas.
Tecco, S., Baldini, A., Mummolo, S., Marchetti, E., Giuca, M. Et al. (2015). Frenulectomy of the tongue and the influence of rehabilitation exercises on the sEMG activity of masticatory muscles. Journal of Electromyography and Kinesiology, 25