HOW TO CHOOSE A SERVICE PROVIDER FOR TONGUE +/- LIP TIE DIVISION
With so many options of care available and conflicting advice, below are some things to consider when choosing a provider for your child’s treatment.
1. HOW EXTENSIVE IS THE TRAINING THE PROVIDER HAS HAD?
There has been lot of development in recent years in the area of oral restrictions and subsequent impact on health over a lifetime. As tongue tie is becoming more widely recognised there are also more practitioners offering a service and there is great variation in the level of care and experience. In order to be up to date with the latest best practise they will have needed to have travelled to conferences and courses to have kept abreast of these advances in care.
2. IS YOUR PROVIDER ASSESSING FOR ALL POTENTIAL SEQUELAE OF YOUR BABY'S/CHILD'S ORAL TIE(S) OR JUST THOSE CONCERNED WITH FEEDING?
A provider who is up to date with current research and thinking will also assess your baby/child giving consideration to breathing habits, sleep quality, resting mouth posture, palate shape, orofacial growth pattern and airway patency. Treating ties should no longer be only about a baby’s immediate feeding issues but about optimising craniofacial growth and function over a lifetime.
3. HOW LONG IS THE APPOINTMENT?
The level of service offered by tongue-tie practitioners varies greatly.
Oral ties can contribute to issues with breastfeeding, bottle feeding, sleep, speech, behaviour, posture etc. In order to address these adequately, time is needed not only to assess and divide the restriction but to also devise an individualised treatment plan in consultation with each family.
A holistic practice, where a multi-disciplinary team approach to oral restrictions is taken, will involve longer time and subsequent follow-up appointments. This is in contrast to practitioners who are unable to offer supporting therapies at their location.
4. CAN MY SERVICE PROVIDER PRESCRIBE PAIN RELIEF TO ENSURE MY BABY/CHILD REMAINS COMFORTABLE IN THE DAYS FOLLOWING SURGERY?
All surgery, whether by scissors or laser, causes discomfort during the days following division, peaking at 36 hours post procedure.
To ensure optimum comfort your baby/child needs to be weighed and their specific dose of pain relief medication calculated. For safety, over the counter medications can only advise for the lowest possible weight at any given age.
It is very important once the tongue/lip has been released that movement is not compromised due to discomfort. Therefore, pain relief is essential for all children and babies regardless of age. This ensures your baby/child can feed well and most importantly be comfortable.
5. WHAT ASSESSMENT TOOL IS THE PROVIDER USING?
Assessing for oral restrictions is all about function not simply the appearance of the frenulum.
To fully assess oral restrictions they should also be able to assess the upper lip, lower lip and buccal (cheek) frenulums to see if they are contributing to tension around the oral cavity.
6. WHAT TOOL IS USED FOR SURGERY?
The expertise of the provider is widely acknowledged to be the most important consideration in selecting a service but the tool is also important as it has the potential to influence the surgical outcome. There is a lot of confusion around laser surgery due to the wide variety of lasers. Use of a diode laser is not classed as laser surgery because the laser energy is trapped in the tip and the resultant heat is what cuts, so in effect is the same as electrocautery. Further information can be found here:
7. WHAT FOLLOW UP CARE IS PROVIDED?
Good surgical care should involve follow up to see how your baby/child is doing in the days/weeks after a procedure.
This includes monitoring of the surgical site and assessing the functional outcome following surgery.
In order that new movement patterns are learned correctly, it is important that ongoing support, which include therapeutic interventions where necessary, are provided. Also the plan of care may need to be adapted depending on the baby’s/child’s progress. Two babies may have similar presentations and yet respond very differently following division and thus their plan of care needs to be adjusted to reflect their response.
8. WHAT SUPPORTING SERVICES ARE OFFERED BY THE PROVIDER?
Treatment of oral ties requires a holistic approach. Your child/baby will have developed compensations due to these restrictions as their oral habits are formed from around 17-22 weeks gestation when infants start sucking and swallowing amniotic fluid in utero.
Release of the tie(s) is just one piece of a jigsaw puzzle in a journey towards optimal function over a lifetime.
Practitioners who offer a number of services at their location, can communicate with the team members and can adapt your individual child’s/baby’s treatment plan accordingly.
9. WILL I NEED TO TRAVEL?
In Ireland, we do not have the population numbers to secure specialist services in multiple locations. For this reason, to attend a centre of excellence, you may have to travel outside your locality. Alternatively, you will need to build your child’s team from local therapists, lactation consultants and support groups.