The IBCLC Side of Treating Oral Ties w/ Allison Alexander LPN, IBCLC

In this episode, Jacqueline is joined by Allison Alexander from Skilled Lactation Solutions as they chat about treating oral ties and what that looks like. Together, they help navigate what can often be a confusing process of tongue ties and what the best path is when you think your baby has one. 

They also discuss some signs and symptoms of ties, and who should be on your baby’s care team if you suspect your baby has ties. Allison gives her perspective as a lactation consultant who works with families with tied babies. 

In this episode, you’ll hear:

• Some key things to look for if you suspect your baby has ties
• Who you should reach out to and who should be on your care team
• What kind of tools and procedures are available if your baby has ties
• How ties can affect your baby and breastfeeding

A glance at this episode:

• [5:16] Foundational things to look at while breastfeeding 
• [13:11] What to look for in an IBCLC if you suspect your baby has a tie
• [18:43] How often to see an IBCLC
• [28:50] Who should do the procedure and why you should find the right specialist for your child
• [30:40] The best tools to perform tie corrections and who has them available
• [40:30] Why ties affect breastfeeding so much

Related Links:

• Skilled Lactation Solutions Website
• Skilled Lactation Solutions Instagram
• View the original IG Live
• Holistic Lactation Website
• Follow Holistic Lactation on Instagram

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Transcript

Jacqueline Kincer  0:03  

Welcome back to the Breastfeeding Talk podcast. I'm your host, Jacqueline Kincer. And today's episode is one that I actually meant to share a long time ago. It's from March 1, 2022, so almost a year ago. And it's actually a recording of a joint Instagram Live that I did with an incredible colleague of mine, Alison Alexander. She is also an IBCLC. And she is the owner of skilled lactation solutions. She posts some great info on her account, which we've got linked up in the show notes here for you. And we did a joint live on treating oral ties and what that looks like. So it was more of a deep dive of navigating what can often be the confusing process of tongue ties and what the best path forward is when you think your baby has one. We also discussed some of the signs and symptoms and who should be on your baby's care team. And really what we shared in this live recording here was our perspective as lactation consultants who work with families with tide babies, there's a lot of things that are very frustrating for us quite often and obviously very frustrating for the families that we work with. And I really love to hear her perspective on things and be able to have this back-and-forth discussion. And because it was live, you know, we obviously were looking at some of the comments as they rolled in. So the original post, if you want to watch the video version of it and go read any of the comments, we have that linked up in the show notes for you as well. But it's just a great discussion that I felt like would be a wonderful thing to share here on the podcast with you. So without further ado, here's my discussion with Allison.

Allison Alexander  2:24  

Welcome to our talk about I think my baby has a tongue tie. Jacqueline from holistic lactation is going to be joining us today. And we're going to be answering some of the questions that we got earlier in the week, as well as just talking about how to navigate this really confusing process where there's a lot of opinions and parents are kind of left not knowing what to do if they think their baby has a tongue tie or if they've been diagnosed but told things were fine, and they don't really feel like things are fine. So really excited for you to join us today. Hi,

Jacqueline Kincer  2:56  

hello, how are you? Good. How are you? Good. Thank you so much for having me.

Allison Alexander  3:02  

Yeah, no, I'm really excited. One of the things I love about seeing your feed and your practice is that similar to mine and that we look at, like the whole dyad. So dyad, meaning parent, baby, and how everything is working together. So I think this comes up a lot where maybe one person is experiencing problems and the other person is not. So maybe the baby is gaining weight, but it's the parent having problems. So because there's two members of this feeding team, it gets really confusing, and there's a lot of opinions out there. So just helping parents navigate a super confusing process. I think having like two people that know what they're talking about, can be really helpful. So one of the first questions we got was just like what should I even be looking for? What is a sign that my baby has a tongue tie or that that's something that we're dealing with? Now? What's something that you see because you work virtually you so you're assessing things with telehealth, what is something that you see often?

Jacqueline Kincer  4:04  

Yeah, absolutely. And you know, and just to be fair, like the only reason why we're great at telehealth is because we have so much in-person experience and I've worked really closely as well as one of my other team members with a local dentist that's very skilled and treating ties, we've assisted with those procedures and things so we have that really in-depth understanding. Right. But yeah, it can be a lot of things and it's not, you know, it's kind of a mix-and-match bag of symptoms, right. You could have breastfeeding pain, you could not have breastfeeding pain. You could have an oversupply, you could have an undersupply. You know, you could have trouble latching someone could tell you the latch looks great, but there are always things that are going wrong, right. The baby might split up because they're swallowing air. They might have hiccups very often. They might be gassy. They might be colicky, they might not be any of those things. So it's funny because it's like how do we tease out you know, getting that information to parents like, Hey, these are some right have flags and someone will say, Well, my baby doesn't have that. So they couldn't possibly have a tie. And we're like, no, no, they can still have a tie. But also, not every baby has a tie. We're not trying, we're not trying to tell you your baby is tied if they're not. So it's one of those funny questions. But you know, some really some really great things to look out that I would say that are really foundational, is if you know, deep down as a mom that breastfeeding is not going well, then it's not. And you should listen to that. And you should trust that you shouldn't be sort of gaslit in a way by someone telling you well, your baby's gaining weight fine. So there's no problem, or breastfeeding doesn't hurt. So it's fine. That is the bare minimum requirement for breastfeeding to go, you know, decently it does not mean that breastfeeding is going optimally, if you're not enjoying breastfeeding. And I mean, like you dread nursing all of the time. Either breastfeeding is not for you. But more likely than not, it's because there's some underlying problem going on,

Allison Alexander  6:03  

or the baby's not having a good time.

Jacqueline Kincer  6:04  

And I guess if the baby hates breastfeeding, why that's not in their DNA, or their biological programming. They're programmed to survive and be able to nourish themselves through breastfeeding. So huge red flag

Allison Alexander  6:19  

for that. And that's what I hear I see a lot is like, it's just stressful. My baby hates breastfeeding, I feel like I'm forcing them to or they'll only breastfeed peacefully at night. During the day. It's just this battle. And they're fighting and arguing. And it's like I'm fighting them to get them to eat. So like you and your baby should be having a decent time. Like it's not easy, but it shouldn't be terrible, every single feeding either.

Jacqueline Kincer  6:42  

Right? Absolutely. Yeah, I think, you know, is there that learning curve to breastfeeding in the beginning? Yes, absolutely. Especially if you've never done it before. But even if you have, this is a different baby. Right. But if you're if things aren't progressively getting easier, you know, after the first couple of weeks, that's definitely a sign that something's not going right could be a tie, it could be something else. But more often than not, I see these lingering issues that are really caused by ties. And I'm sure you do too.

Allison Alexander  7:09  

Yeah, or like, the latch is perfect. But I'm having ABC and D. And so why is that happening. And then I'm looking at things and assessing and pointing out like, maybe the last is not as perfect as we've been led to believe like it, just because the baby's mouth is open and on tissue, that doesn't necessarily mean that a baby's not doing a lot of extra work to stay there. So that's not anything a parent would necessarily see. But it's something that you need somebody skilled enough to maybe spot those things that are off just because like the lips look like fish lips doesn't necessarily mean the baby's not working really hard to get that milk out. And that that was another question to have. Like,

Jacqueline Kincer  7:50  

I've already seen a lactation consultant who said there wasn't one, but I still feel like something's not right. I'm sure you you get those like second and third opinions as often as I do. Oh, yeah, that's primarily what we do actually is see people who have seen an IBCLC seen someone that's dismissed their concerns or has not been able to give them one an explanation to why things aren't going well and to a real path forward on how to fix those things. They're often just told, Well, this is just the way it is. Or maybe breastfeeding is not for you, or, you know, some other kind of solution, you know, I think, to my core and one of our values that we have, and our practice is that there's hardly a breastfeeding problem that's not fixable. Like, it's so incredibly rare. But it's just about getting the right expertise, the right team, the right support, and we don't pretend to do at all, but certainly, you know, a role like us these IBCLCs who are like us that know how to properly assess and play that detective role in finding out, you know, what's really going on here? Why is the baby doing this? Why are your breasts doing this? And then once we understand that, then we can suggest interventions, if we see how those interventions go, and that they don't work out the way we like, then we know there's a deeper issue going on. And so it's like this layers of the onion approach that we're taking when we look at breastfeeding, or bottle feeding or whatever it is right to just determine, hey, like, you know, is this something that we can fix as lactation consultants? Or is this something that we need someone else to come in here and be a part of this team to which you know in this discussion would be someone to go in and surgically release those ties or to perform bodywork related to the tension created by those ties.

Allison Alexander  9:34  

bodywork was another question that came up to like how do I even know what the baby needs? Or what what bodywork I should seek out? Like my answer to that is that the baby tells me like the baby is the one that dictates what kind of body work they need, and they don't all need the same, the same like sometimes it's, you know, parents can do things at home to really facilitate that tension working itself out and sometimes they need more help. But usually just look You know, what's this baby doing to compensate for this tie? And what is their body struggling with? Like, personally, that's just what usually leads me down the road of like, oh, a physical therapist might be the best for them, or a really skilled infant chiropractor might be the best for them, like helping to match what the baby's needing with the type of body work that

Jacqueline Kincer  10:19  

would be best for that problem. Right? Well, and I think, you know, kind of the real answer to that question that if if someone is asking us, how do we know what kind of body work the baby needs, the answer that you basically just described, is ask your IBCLC. Because we are trained to know that right? We don't do the body work, but we understand when the body work is needed, what type of body work is needed, and to your post that you just posted, and I just shared to our stories, you know, there's this, there's this mountain, that you climb the sort of path through treatment, right. And it starts with the IBCLC. That skilled in ties, because if you go to the chiropractor, well, of course, the chiropractor is going to tell you the baby needs chiropractic, and they're going to set up all these visits and things. And it's not that it won't necessarily be helpful, although in many cases, I see it's not if it's the wrong type of bodywork, the frequency that you're taking the baby is not correct. So you know, there's all these things, and they're going to try and help because, you know, that's why they got into this business anyway, right? They want to help people. But that person is not equipped to help you with breastfeeding itself, right? They're only treating the baby. Same with going to, you know, the tongue tie release provider and saying, you know, I want you to tell me if my baby's tight or not, well, they can't functionally assess breastfeeding, or bottle feeding. You know, they cannot assess what's going on with your baby's sleep with their milk transfer all of those things, they can simply look at tongue range of motion when not feeding, and then they can look at the anatomy and they can do a procedure. So if you're jumping into physical treatment options, before you've gotten an assessment to know what is actually needed, you may actually be spending a lot more money than you needed to in the long run. Which is really unfortunate, right? I'll have parents say, Well, I've been to the chiropractor 12 times, and I spent $700 on the tongue tie release, and nothing's gotten better. And I'm like, But why don't you just spend $200 With IBCLC, who probably do some oral exercises, right could have directed you to a provider that maybe doesn't even charge as much and does a better job or, you know, like those things like we're always trying to, at least I am. And I know I'm sure you're the same way as trying to minimize and streamline that path. Because Holy Moly, like postpartum is already a lot. So as breastfeeding. Now, you tack ties and your baby on top of that, and treatment of that. We've got to be really careful about how hard we're pushing families to pursue treatment. Like do we give you, you know, everything you should possibly be doing? Yes, but it's also your IBCLCs job to tell you like, here's what's absolutely necessary, these things are kind of fluff, they're kind of optional, it's like, we're not going to tell you to buy three different breast pumps, right? They might all be good breast pumps, that would work great for you. But we're typically going to go with the one that would work best for you. So that's the same idea when we're talking about ties. And I don't,

Allison Alexander  13:10  

I don't like hearing that an IBCLC has sent a family on this wild goose chase of occupational therapy, speech therapy, feeding therapy, physical therapy, two different senses, three different chiropractors. And then I see them and like, okay, let's just, again, streamline the process, focus on what specifically this baby needs. And the problem with all those other providers is that none of them have been educated to take care of the dyad, which is both sides, they are only focusing on your baby. And if they don't focus on the other half, you are not going to see the same progress because you can't do something to one without doing something to the other. You have to treat both at the same time. Yeah, like if we're messing with the baby, we could be messing with the milk and not even knowing it if we're ignoring the parents eye. And so the problem with the wild goose chase is that you spend time and money and you don't get this full, you know holistic sense of of both sides being treated and improving. Then, like you said, starting with the IBCLC we don't do it all. But we we should have the skills to know what is necessary to see progress. And if not 12 visits with the chiropractor. It's not, you know, this long, drawn out process that takes a whole maternity leave just to get through. And then the parents are going back to work. You know, in a lot of cases, it's like they spent 12 weeks trying to breastfeed their baby just to hand them off to somebody else to bottle feed. So it's it's extremely frustrating to hear that wasted time wasted money wasted energy. So you mentioned like an IBCLC, who specializes in Thai is so that that isn't all of them. And that's okay. But I think that's important for parents to know too, that I don't see like NICU babies, extremely premature babies, not my area, not something I'm comfortable navigating. And if someone came to me with that situation I would I would refer them to an IBCLC that specializes in that particular case. Yep. So I think as a profession, we need to get a little bit better about knowing what we're good at and what our specialty is, and referring out if that's not eyes. So, in the case of ties, though, it's not a one size fits all, not everyone has pursued additional skills and education to not just identify that there might be one but actually help. So like, do you do and you said, you find that you're a second or third opinion and a lot of cases for people who haven't gotten answers. What do you tell people to look for in terms of like, if you're looking for an IBCLC to work with, if you suspect that tongue tie? Like, what are some questions you should be asking?

Jacqueline Kincer  15:46  

Yeah, absolutely. I love that. You said that. It's one of the biggest reasons why I have grown my team and now five lactation consultants like, like, I've got Nicole. She's a registered dietitian, she works in the Children's Hospital, and she is an amazing expert on diet and food intolerances. Now, I know a lot about that stuff. And I've definitely done those cases and incredibly given a course on that. But I would much rather have Nicole where that's like her wheelhouse to do that, right? But she know how to work with like, you know, a three month old baby who's struggling to breastfeed as well as someone like me or someone else in the team? No, absolutely not. So when you pick a provider on my team, they're specialized. Like, if you, if you want an oral Thai assessment, you're gonna work with Kate, like, or or me if I'm doing appointments at the moment. So it's really, really important to know that and what do you want to look for? Well, first of all, you want to know, like, that this person, you know, either it could be from, you know, if you're doing kind of a passive investigation, right? If you're looking at their website, if you're looking at their social media, let's say, like, do they talk about ties? Right, it's one of my sort of requisites, when I'm looking at potential providers to treat ties, do you have like, under your services section? Like, do you have ton dyes on there? If not, if you're telling, you know, all this story about how you do Invisalign, and whatever, and maybe I don't even know, if you work with infants, like may not be a good fit, right? To be fair, a lot of people don't update their websites. But if you're doing a passive investigation, like, hopefully, there's a mention of time, somewhere there, right. And, you know, everybody's like I said, they're gonna be eager to help you, right? These are people that are in professions where they want to help you and whatnot. But just you could ask them questions like, you know, what frequency Do you see ties in your clients that you work with, because if someone says really rarely, almost never, I'm going to say that they probably don't know how to properly properly assess for ties. It's not the vast majority of babies that have ties, but it's certainly a threshold where if you are working with people that have breastfeeding problems, you're seeing ties a lot. And so if you're saying all only once a month, and I see so many patients, like, probably want to go somewhere else is my suggestion. And then just ask them, like, you know, do what do you do when you find you know, ties during your assessment? And just asking that question, like, see what they say, right? If things go well, I never recommend treating them. Again, that's like a red flag for provider, you wouldn't want to go see I mean, it's, it's an anatomical congenital defect that isn't going to be corrected with stretching, or any amount of body work if it's truly a tie. So I think those are a good couple of starting points, you know, there's a lot of nuances you could get into, but I would say any provider, like your i has an IBCLC that really focuses on and specializes and works with ties, like if you come to us with questions, like we're going to have an answer for you. So, you know, just, I would say just, you know, ask questions, you know, just kind of do a little interview rather than text or an email or phone call or something like that.

Allison Alexander  18:42  

Yeah, you're usually talking with someone before you set up an appointment. So those two questions are really good, like, how often do you see them? And what do you do when you find one, it's also a red flag. If they say like, oh, I refer you to this dentist and they do laser, I refer you to a person and they flip it. That is not what we want to do. Like that's, and that's a big part of it, too, that there are plenty of IBCLCs who can find a tie, but they may not understand the process to get the best results in the fullest function for both of you. And the timeline is something that we focus on really heavily. And I know you do, too, of helping parents to understand that a procedure does not give your baby any skills to feed any better than they had the day before. So it doesn't teach them how to feed any better. It just gives them more room to work with their tongue. So that's something that I think not enough parents get that education of like you can help your baby day one after seeing an IBCLC because we can give you ways to build these feedings skills that don't involve immediately running to someone to cut it. Some of the worst outcomes I see are the people who have had it lasered or clipped or whatever. And their baby refuses the breast or goes on strike or you know that because they've had this procedure and Like the rug got pulled out from under them, they don't even have the way that they had to feed that was comfortable for them to rely on anymore. And they've got no new skills to work with. So there's not like an exact time period, like, I can't say, oh, we'll work for two weeks. And then you'll have the procedure and work for two weeks, because every baby is different. But I can tell you that we're going to do some work before in some work after to make sure your baby's in a really good place to benefit from a procedure or else why do it?

Jacqueline Kincer  20:26  

Absolutely. I couldn't agree more. I mean, you know what, one of the, you know, for specific examples, like, let's say a baby has like total breast diversion and won't latch, the last thing you should be doing is going and getting a frenectomy for that baby, because they're gonna now have pain in their mouth, you're gonna be, you know, putting your fingers in their mouth, creating some more discomfort for them multiple times a day. Do you think that baby wants to lash at the press now? Heck, no, absolutely not. And so you, you put false hope into, you know, a procedure that was never going to do that for you. So I like to get babies back to the breast, you know, at least part time, at least partially that there's some familiarity there, even if it has to be a nipple shield or something before you go. And the other thing too, is, I cannot tell you how many moms just honestly have a terrible lash technique. And it's not their fault. No one's ever shown them, right. If you latch that baby, right after that procedure, which 99% of the time you're going to do, and you have that crappy lash technique, and they get a shallow lash right ever, you are re imprinting and solidifying the negative patterns that have gotten you to where you are today, you are not doing this in any way, by continuing or positioning, poor latch technique, especially now once they have full range of motion. So you've given them the gift of full range of motion, and you've given them no ability to use that for both of your benefit.

Allison Alexander  21:54  

So good, huge, absolutely. And then, just knowing I think parents think that the procedure itself is like a magic bullet, it's going to solve all of our problems. But you can do so much to help before that, and like you said, actually having a functional latch where they can remove milk more effectively, where it doesn't hurt you every single time like that is possible to get to without a procedure. A lot of it is teaching a baby what they need to be doing. Sometimes it is body work, to let their body relax and be able to latch effectively. So the timeline is really important. Not that you can't have a decent outcome if you don't do these things. But it's those babies have to work a lot harder for a lot longer, it tends to be more stressful on both parties, because like they just they kind of weren't prepared, and then they get the rug pulled out from under them and they don't know what to do at that point. Very true. And then I have parents ask me sometimes, like, I go into detail about what it's going to look like the healing process afterwards. And what we need to do afterwards to make sure that they get the most benefit from this procedure like again, or why do it if we do like a hip or a knee replacement and then we don't do physical therapy afterwards. Are you going to get the most benefit? No, like your your body's still going to struggle. So parents if they're honest with me and say like I don't plan to do anything afterwards. I would just assume have them not do it then to put their baby through it and then not do the work afterwards because that is so important to healing under percent.

Jacqueline Kincer  23:26  

So yeah, totally provider in pain and the waste of everyone's energy everybody is and can potentially make breastfeeding worse. You know, I think to your point oh yeah. If you do not do the aftercare, and we don't just mean stretching the wounds or lifting the tongue or the lip or whatever. If you do not do proper aftercare, the rate and likelihood of reattachment is very high. And most of the time when I see significant reattachment because the aftercare wasn't done properly, the bodywork wasn't addressed or, you know, the breastfeeding wasn't managed, well, that reattachment actually makes your baby worse off than before they have the ties released. So I mean, I've seen babies just completely lose the ability to even latch at the breast and can hardly even transfer milk from a bottle. Now it's an emergency situation and you're running to the Children's Hospital get a feeding tube on the weekend, because the dentist isn't open. I mean, like and that's, you know, I don't want to like scare anybody. But these are real life scenarios that I've seen multiple times, like with clients who have called me in a panic. They didn't work with us ahead of time and they're like, my baby won't take food. And I'm like, This is not an emergency triage send her like you but you have got to get the baby food first, right? And then this is where pediatricians you know, kind of get this confirmation bias and they go we'll see treating, cutting a baby's tongue makes them well, and I'm like, Yeah, but you never referred for appropriate treatments. Right? So just cutting just lasering it's not enough. There are all these other pieces. And the other thing that's really, really important that I feel like we're assessing as lactation consultants, because we treat the diet of the mother and the baby. And the whole family is we assessed for, do you have support in your home to manage the care that this process requires? Do you have the financial resources to even access all of this treatment? Do you have, you know, the ability with your employments to you know, you know, do the aftercare that's required? You know, and if you don't like, is the daycare center God willing to do this for you? Are you going to be able to take time out? Like, there's all these things that we're considering your mental health? Like? Is this is this going to throw you over the edge, because you are already like hanging on by a thread? You know, maybe we need to adjust the timing of these other suggested interventions, based on your unique situation, you know, I've had a lot of clients say, Well, I really need to talk to my husband, they're not supportive and whatnot. Well, when your baby is crying when you're doing the wound care, or you know that three to five hour period after the procedure, when they're generally going to be fussy. And your unsupportive partner throws it in your face and says, See, I told you, we shouldn't have done it, what kind of outcome is that going

Allison Alexander  26:15  

to create for you and your child, not a good one. And so we don't ever have gotten to how to get to this position where we've been stressed because of our recommendations. And a lot of providers don't look at that, right? Because they're not looking at both sides. So they're not looking at like the full picture, they're looking at, you know, a tongue or mouth if they find it at all. And I like I've talked to pediatricians before and have good relationships with them. And they're saying, like, they don't teach us this, this is not anything we go into in detail, you know, and even pediatric EMTs, and pediatric dentist like, it depends on their education in the background that they chose. But that may not be something that they've gotten a good evidence base up to date education on. And it's not something they're required to go back and get if they've been practicing 20 years and they didn't get it then like it's there's no requirement for them to stay up to date with things like that. So, you know, going to your pediatrician to ask them if your baby has a tongue tie is really not the recommended path. And that because your pediatrician may not be amazing, but it's just not something that they have the skills to assess. And again, they're not looking at both sides, they're just looking at a mouth. And if they don't have the skills to assess how that mouth functions, it's just not going to give you an answer that is going to work well for for your situation, starting with the IBCLC, who knows how to assess both of you needs to be the way to go. Not that we're not going to involve your pediatrician. But that pediatrician shouldn't be stopped one if you're concerned about your baby having a sound sigh.

Jacqueline Kincer  27:48  

Yes, yes, I think you so thoughtfully explained that. And, you know, they're they're generalists. Right? And I would say if they're going to specialize in anything, it's, you know, looking at growth and development of children and infectious diseases of children. Beyond that, they're not feeding specialists, right? And they're certainly not going to do, you know, they're not safe psychiatric evaluation special, there's a lot of things they don't specialize in. And, you know, quite honestly, they should just be referring out to, right. But a lot of the times, it's just looking at a whole child's you know, they're they're kind of just, you know, covering a lot of ground and a single interaction with that patient, right. So there's a lot of other things that you can look at, and consider when it comes to your whole child, your whole baby. And it's a lot to expect your pediatrician to know all the things quite honestly. So if you do have concerns, find the right specialist for those concerns. Because we exist, and it's, you know, all the plans, right?

Allison Alexander  28:49  

So you talked a little bit about this earlier, and just like who should who should do the procedure, and I hear a lot like, Well, cool, my pediatrician offers it. I'll just go there. And it's hard when you have a really good trusting relationship with your pediatrician what like, why wouldn't you want this person to do this? It's like a one stop shop. That sounds convenient for everyone. I know, they take my insurance. Sounds great. Like personally, I had a pediatrician do my son's as an IBCLC. And then I'm sitting there going, okay, but this isn't better. Like, why isn't this better? Which like, started me down the whole, like, functional oral assessment rabbit hole because I knew enough to knew my son had a tie. And my pediatrician said he clip it. I was like, Okay, sounds good. Everybody's happy, but it didn't fix our problems. Yeah. So in the event that the pediatrician does offer it or that's where the parents want to go, what how do you how do you navigate that situation?

Jacqueline Kincer  29:45  

Good question. You know what I I really tell families and and every one of my team approaches this in a similar way and it's that you want to go to the person who's going to do it right the first time because remember, like you are sending your infant for a surgery, a surgical procedure. And you want to minimize the trauma and the pain that your baby undergoes related to that, not just during the procedure, but also to make sure that they don't now need a second procedure because something wasn't done right the first time. So you absolutely even if your baby doesn't have buckle ties, which no one knows what that is, those are the little ties on the sides here. So you have a tongue tie, lip tight upper lip tie, there can be lower lip ties, it's really rare. But then there's buckle ties on the side, you want to go to provider that willingly treats buckle ties, if they exist. Why is that? Because it's pretty much a guarantee that they know what they're doing. You do not want to choose a provider based on the tool that they use. Is co2 laser, the best tool to perform frenectomy? Yes, absolutely. Because of the way that it app bleeds the tissue, it doesn't charge, it doesn't make direct contact with a hot tip. It's it minimizes bleeding all of those things. But just because someone can afford a multi $100,000 laser does not mean that they know how to use it properly. There are settings and surgical techniques that need to be taken into account, I would much rather you see someone that's highly skilled with scissors and electrocautery. Even if maybe those are not the best tools for the job, but they have the right surgical technique. Now you're not going to know that as the parents. So I think a good way to know is do they treat buckle ties? And also will they treat all of the ties at the same time? Because why would you take your baby? I mean, there are some fringe cases where you want to space it out. But for the most part, why would you want to take your baby for a lip or tongue tie release and then come back two weeks later and do it all over again, and prolong the healing prolong the pain only fix half of the problem at a time. Like that is cruel to babies, I think. And so I just would say I really don't advocate that. So for a couple of things to look for. But generally speaking, dentists, pediatric dentists tend to have the most training tend to be the most motivated to get continuing education in this field. Second to that, I would say, you know, I see pediatricians actually stepping up to the plate a lot of the time. But keep in mind, for a pediatrician, it's typically not worth it for them to pursue also doing procedures, like they're not going to remove a skin tag on your child, they're going to refer to a dermatologist. And there's a reason for that, right is that it just interrupts their whole patient flow, you know, may not be very financially viable with everything else that they're doing in the practice. It's kind of like too much context switching and a lot of ways. So many times, they're not going to do that they also generally can't afford fancy lasers, pediatricians actually don't make a lot of money. So if they do procedures, that what they have to pay for malpractice is so much higher, that a lot of them don't do it because they don't want to have to care for the malpractice. So be able to do surgical procedures in the office, they're already not getting paid as much as a specialist. Go see the people that make more money than me go have them do it for most procedures, but sometimes they'll still do do Mantis can use a laser for other dental procedures. So it makes a lot of sense for them to kind of already have the laser. And also add on this procedure because they've already got the tool, they already have that sort of malpractice, liability insurance in place. Right? So laser safety protocols. I mean, there's a whole thing and then, you know, just going to say EMTs, they will some often do the procedure. Most of the time, they don't have the proper training, though. And Dr. Gary says this because he's an EMT, and he's like, your nose and throat. He was like there was nothing about mouth in that acronym. And he's right, because yes, they can remove tonsils and adenoids and work on turbinates and do all these other things. But when it comes to the tongue or the lips, it's really not their area. And so some of them do have, you know, the proper training, but most of them do incomplete releases, most of them will deny that ties cause problems, they will deny the existence of them even worse, many of them will recommend that you put your child under meaning using general anesthesia to knock them out, which is incredibly risky and dangerous. I mean, there are some high risk cases where it's necessary, but these are older babies that we're talking about, not, you know, three week old three month olds. And so there's a huge problem, you know, and then there's other kinds of, you know, fringe nurse practitioners that can practice independently and do this and midwives and whatnot. So, most part, I would say a dentist is usually a good bet. For

Allison Alexander  34:27  

the most part. Yeah, there we have one EMT who has has pursued training and has, you know, perfected a surgical technique and it's nice to have both options, but like we say, Hey, you can see him but no, he's a unicorn like you can't just see any EMT and expect them to have these skills but he is an airway specialist. So that's how that rabbit hole kind of habit if you understand the implication of tongue tie and a healthy airway, so your your generic EMT who does like ear tubes and tonsils that's really not something that they've they've done a lot of a lot of educate You should end training. And then the last question we got is like, what happens if a baby seems like they're doing fine? And then all of a sudden starts to have problems? If it's a tie, like why wouldn't that have existed? Why would they have had problems from day one? Like they didn't just grow a tie halfway through? So like, why at three or four months might have baby suddenly be having issues when they seem fine? Before? If, if it's a tongue tie that's causing the problem?

Jacqueline Kincer  35:23  

Such a good question. So I see the symptoms and and the baby's way of compensating for those. Those limitations physically change over time. So that will never be consistent. And the reason why we see a change is that the ties, you know, they create tension. And so if the tongue is constantly being pulled down to the floor of the mouth, and the baby is constantly trying to work against its own anatomy to elevate the tongue to generate pressure in the mouth, you know, a couple of things can happen. One is they can develop a tighter jaw over time. So they're overworking that TMJ muscle and all the other accessory muscles related to that. And over time, tension builds up, and those muscles become tighter and shorter, and now the lash is more shallow than it was. The other thing to look at is if we're talking about like that three month mark, when you're when lactation switches from this endocrine driven, hormonally driven process to an auto crinan. One that's dependent on how well your baby is able to extract milk from the breast. And they never really, really great at it to begin with. And now all of a sudden your milk supply lowers Well, now there's problems, right? Because your breasts hasn't really been getting the correct stimulation and whatnot from your baby, because they're lacking in that oral function. So it becomes more apparent, more visually obvious, you know, and there's other things as well, right? I mean, babies, babies can go one of two ways. And I see this as newborns where you know, maybe they're, they're nursing, okay, you know, your milk came in all the things, maybe you have some advantageous breast anatomy, you know, you have very inverted nipples that are a nice size, and whatever. So things were going, okay, maybe you're very elastic tissue, so you didn't experience much breastfeeding pain. But then as time goes on, and there's these other symptoms that sort of rear their ugly head, like the baby who's having to expend more energy to get the same amount of milk as a baby who is able to nurse efficiently, they become cranky, they may actually not want to be at the breast for a very long time, they might nurse to get just enough milk. And then they're like, Man, this is just too hard, because this is exhausting, right, and they just don't want to do it. Because their brain is always always in this decision making process. It's very, very reptilian, very lizard like, right, that's the part of their brain that's functioning. And the brain is taking in this information, this input, and then deciding what kind of output to do. If I have to expend too much energy, I'm actually expending too many calories, and I'm gonna put myself in a deficit. So I'm going to do the bare minimum, and then I'm going to sleep or I'm going to, you know, not do that behavior, or I'm going to prefer the bottle that's easier so that I can minimize that calorie expenditure and maximize the calorie intake. And this is just a trade off that the baby's brain makes, it's not a conscious decision, it's not a personal preference that that baby has. But that can change over time as well. So a lot of parents are very confused by their babies signals. That's why you need to work with an IBCLC, who can tease out what's going on and go, That baby's not lazy, that baby is going to sleep, because breastfeeding or bottle feeding is too hard for that baby, you know, and so you can compensate by increasing the flow, you can do other things. But if you constantly have to do those compensations to make breastfeeding work, breastfeeding is not working, right. And that's so many times the parent is jumping in like, well, if I hold it perfectly, and if I position them perfectly, and you know, I do all these things, then then breastfeeding is going great, but you're having to do like you should have to like, support your baby and make the milk like, that's your job. That's it everything else your baby should be capable of doing on their own. And if you're having to do like 75% of the work, and you know that baby's only doing 25% It's not because like you said they're not lazy. If they're not doing the work, it's because they cannot do the work. It should be the easiest thing in the world for them to do their survival depends on it. And if they can, huge red flag that their survival is at stake. So yes, other feeding methods exist. And yes, other alternative milks exist.

Allison Alexander  39:25  

But you know, 1000 years ago, they did not breastfeeding as a survival skill. And if they can't do that, well, it's a really big red flag that there could be other things in their life later on. They may not be able to do well either. So I'm not a let's treat a tongue tie just in case there's a speech impediment later. That's not why we do any procedure. But if I can tell that a baby physically can't get their tongue to the side and then back then how are they supposed to chew food how are they supposed to take food in their mouth and get it to their their teeth and then put it back in the middle and move it back to their throat like if they Can't do it. Now, they're definitely not going to be able to do it later if they're physically unable to when there's nothing but liquid in their mouth. So I don't have to have a crystal ball to know like, your baby's probably going to struggle with textures and solids, because they can't move their mouth to move it safely around and swallow. So I don't like that. Well, let's just clip it in case there's beats or solid problems down the line like your baby's struggling today, what can we do to help them now?

Jacqueline Kincer  40:25  

Yep, absolutely. And I also would like to point out that I think that ties obviously they affect breastfeeding on a very core level, and they affect all of these other things. But the reason why a lot of the time that we see it affect breastfeeding so drastically is because it affects the airway, and it affects breathing. A baby has to suck, swallow and breathe every time that they are nursing, right? They're breathing every moment of the day. And if they're not, that's a huge concern, right. So you can hold your breath for, you know, however many number of seconds, right, you can go many, many hours without having anything to drink or eat days for food right now your baby can't but you know, they can go a lot longer without eating or drinking than they can breathing. If your baby struggles to stay lash at the breast, it's because they can't breathe and nurse very well at the same time. Right. So there's, there's all these things that we want to look out. Like if your baby is swallowing error when they're feeding, there's there's a, you know, an interrupt an interruption in that pattern. They're right, they shouldn't be swallowing air at the same time, they're swallowing milk. So babies get defensive and protect their airway in different ways. Oftentimes, they're sleeping and breathing through their mouth, which they should be obligate nose breathers. And if we're seeing those problems now, what we need to understand is that Miss breathing affects your child, whole body, their brain development, their ability to emotionally regulate themselves to self soothe, right, if your baby can never handle being put down, but they nurse, great. There's something going on. And so airway is the foundation to feeding issues to neurological issues, to psychiatric issues, to you know, body tone, intention issues and all of these things, right, it can be the foundation of you know how well your baby eliminate stools, and so many other things. And so, when we're observing what's happening with breastfeeding, maybe the baby can get milk, and maybe they can do it without causing you pain. But is this baby able to maintain a functional airway while doing that? And that's another huge consideration that impacts your baby today. Now, does that mean they have sleep apnea today? No, it means they might have it when they're 30. But if they can't breathe well, today, they are not doing well, overall. And so that's another big consideration to take into account. And this may be something really hard for you to be able to tell as a parent, but it is one of those like, this is an immediate issue. And we need to make sure this baby can optimally nose breathe without over breathing and being at a super fast pace and never being able to sleep deeply and all those things.

Allison Alexander  43:05  

Yep. And airway is obviously like that. That's life, you know. So it's like literally being okay, eating. We're talking about, like, the basic hierarchy of like, human needs to function stay alive. And some function impacts those really, really big things. So, like, I was told that by a provider that I don't revise, if the only issue is maternal pain, so that's the mindset bill and a lot of people in

Jacqueline Kincer  43:31  

health care right there. Right, right. Right.

Allison Alexander  43:35  

So, you know, talking about gaslighting, but like

Jacqueline Kincer  43:38  

counters, that's all I'm gonna say, right?

Allison Alexander  43:41  

But what were so like, first of all, thank you for that, but I'll just be in pain 12 times a day, I guess. But you've ignored the fact that my son is mouth breathing, you've ignored the fact that he's reflux D but he's never settled that, you know, the, all these other things that that are an issue now, like you're looking at a growth chart in that fit. And, you know, he's he's more than a growth chart. He's a whole person, and he's got this whole life ahead of him and he deserves to be set up for lifelong health. And, you know, his diabetics, sleep apnea, tongue tied father did not get that same, you know, same trajectory, you know, there's so many things that can be impacted by airway health. And we have the privilege of being able to address them, and help parents with them early. And parents just need to know I think, how to how to navigate a really confusing process a little better. So I really appreciate you I have seen some of this out and hopefully, people have felt like they've had a little bit more clarity and how to navigate.

Jacqueline Kincer  44:41  

Yes, absolutely. I love that you have this level of expertise and knowledge and experience to know how to help families who are in these very difficult situations because people like you are rare, and I'm just so grateful that you're willing to talk about this and get this information out there to more families because they really need to hear it. And for a lot of people, what you've said is very affirming, right? And they're, they're like, Oh, my goodness, someone actually recognizes what I'm going through. I'm not crazy. I am not, you know, overblowing what's going on? Right? And so when you can eliminate that self doubt for someone, and you can build their confidence, and you can help them, you know, sort of readjust their their path through motherhood and you know, mothering their infants, I think it's very, very powerful. So thank you for this conversation today. Oh, you're so welcome. It was great. Bye, bye.