Food for thought: Tongue-tied infants (and an easy cheese souffle)


I will give you a recipe eventually but first I want to  give you some food for thought.

I couldn’t resist the opportunity to use this blog as a bully pulpit to alert you to a fairly common problem in newborns that is easily diagnosed and easily fixed—but for whatever reason in our crazy medical system often isn’t. If you’re planning to have children or grandchildren or know anyone who is, this could be very useful information.

Many babies are born tongue-tied, which means something way different than awkward with words. Others have a related problem, lip tie. These ties are thin cords of tissue connecting the bottom of the tongue to the floor of the mouth or the upper or lower lip to the gum. If the ties are short  and tight or in the wrong place they can interfere with feeding. Later in life they can cause eating, speech and dental problems.

A crash course for grandma

I feel like a minor expert now because my four-month-old granddaughter was born with a tongue and a lip tie. The tongue tie was noticed in the hospital but no one felt the need to do anything about it because the baby seemed to be nursing well.

Unfortunately, she wasn’t nursing properly. She wasn’t getting enough milk. Because her anatomy forced her to work extra hard and misuse some of her facial muscles, she would get fatigued easily and fall asleep halfway through a feed. With the baby demanding less, my daughter wasn’t producing as much milk as she should have been. And since she wasn’t getting sufficient milk at each feed, the baby wanted to eat every few hours. My poor daughter was completely exhausted and at her wits’ end.

The doctors’ first thought, as usual, was to suggest bottle-feeding. In my granddaughter’s case, this wasn’t suggested until the baby was three months old, by which time she had zero interest in a bottle. She wouldn’t suck on or swallow anything that didn’t come directly from mama.

My granddaughter was born on the small side — 6 lb., 11 oz. — and both her parents are small, so no one expected her to be in the 90th percentile for weight. At first she gained slowly but surely, but at three months, she simply stopped gaining weight. Her parents knew something was wrong but had not idea what it was.

My daughter found the solution almost by accident. She had gone to a lactation consultant in her insurance network, who recommended using a “supplemental nursing system.”  This involves putting pumped breast milk or formula into a small bottle that the nursing mother clips to her top; a very thin tube leading from the bottle is taped next to the mother’s nipple, so that the baby can take in extra food while she’s nursing.

A chance meeting and a diagnosis

The only place to get the supplemental nursing system was from another lactation consultant. The second lactation consultant asked my daughter why she needed the system. After she heard my daughter’s story, and asked a few more questions, she said, “I don’t want to mix in, but this really sounds like a tongue tie to me, and it can easily be fixed.”

The next day, when she looked at my granddaughter, she could immediately see a tongue tie and a lip tie, which were preventing her from getting a good “latch” on the breast.

The lactation consultant referred my daughter to a dentist who uses a water laser to cut the ties, and three days later we were in the dentist’s office. The procedure was fast and painless.

My son-in-law was skeptical; how do you know it’s painless? he asked. They know because they also do this procedure on adults, without anesthesia; the adult patients report some minor discomfort but no pain.

My granddaughter was immediately able to get a better latch on her mom and started eating better. She quickly started to gain weight again: more than 3 ounces in a week! It doesn’t sound like much, but when you weigh only 9 pounds, every ounce counts.

Why a dentist? The lactation consultant told us dentists are at the forefront of developing effective ways to treat oral ties because they see the ongoing problems ties can cause in older children and adults. Many have trouble eating, and prefer only soft foods. Some have trouble controlling saliva. Some ENT physicians do the procedure, but most use a scalpel, which requires anesthesia, rather than the laser.

Lawrence Kotlow, a pediatric dentist in Albany, N.Y., is one of the leaders in the movement to identify and treat tongue tie.

Speech pathologists are also strong advocates for better treatment because they work with children and adults with speech impediments and swallowing disorders that can be traced to tongue ties.

Easy to diagnose

Tongue tie very easy to diagnose. I was easily able to see my granddaughter’s ties myself. And as her experience shows, the condition is easy to treat. So why isn’t it diagnosed more promptly and treated more often?

The lactation consultant told us that before 1950 or so, snipping ties was common. By then, bottle feeding was becoming increasingly popular. Bottle-fed babies with ties often  don’t have the same problems as breastfed infants, because sucking on a bottle is so much easier. It’s quite possible that with tongue-tied babies eating well on the bottle and gaining weight, the health care practitioners didn’t see any need to treat the ties. If nursing moms had a problem, physicians simply suggested switching to the bottle.

This article provides a good historical overview.The International Affiliation of Tongue-Tie Professionals’ website also has good information, particularly in the FAQ section.

Frenotomy, as the tie snip is called medically, is not taught in most medical schools, and most pediatricians pooh-pooh the idea of correcting ties in infancy, even though it’s such a simple procedure. A friend of my daughter’s, whose child has a lip tie (and speech problems), was actually told by her pediatrician not to worry, that the child would one day fall down and rip the tie. The lactation consultant told us this is a common “solution” — though of course the child might not fall down and rip the tie, or the tie might rip in the wrong place, or the ripped tie might grow back.

As I said, food for thought.

And now, in honor of anyone who prefers soft and easy-to-swallow food for whatever reason, I offer this recipe for an easy cheese souffle made with stale bread.

I usually decide to make this a few days before I actually do. I make the bread cubes first and keep them in a large bowl, tossing them occasionally until they dry out. If I have bread that’s getting stale, I often make it into bread cubes and keep them until a purpose reveals itself – this souffle, or a bread pudding, or bread stuffing. The bread cubes will keep for many weeks as long as they don’t get wet!