Tongue Ties & Lip Ties: Do These Affect Baby's Ability to Self-Feed with Dr. Shaina Holman, DDS, PhD

Shaina Holman (1s):

If you are in a situation where you've already had a tongue-tie release, and you've already worked through that, you can definitely have a little peace of mind of knowing that you've made it through a huge obstacle, a huge developmental period of time in your baby's life.

Katie Ferraro (15s):

Hey, there I'm Katie Ferraro, registered dietitian, college nutrition professor and mama of seven specializing in baby-led weaning. Here on the Baby-Led Weaning Made Easy Podcast I help you strip out all the noise and nonsense about feeding leaving with the confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. Hey guys, welcome back to another episode of the Baby-Led Weaning Made Easy Podcast. I'm your host, Katie Ferraro. And today I'm being joined by a very special guest, who's going to talk to us all about tongue-ties and lip-ties and how they do or do not affect your baby's ability to self feed when it comes time to start solid foods.

Katie Ferraro (1m 2s):

So, my guest today is Shaina Holman. She's a DDS PhD, so she's a dentist, but she's also done her PhD work in research in infant suckling. And she knows a lot more about feeding than your typical dentist does. She runs an infant feeding clinic. She works very closely with speech language pathologists who specialize in feeding as well as lactation consultants. She even has a baby massage therapist on her team. So a really unique approach to helping to identify if there is a tongue-tie and then whether or not they decide to treat it. And she's also going to talk to us a little bit about, okay, what consideration should we make if you've had the tongue-tie released, or if you haven't had the tongue-tie release, but maybe you're considering it, or, you know what, if you need to do this for older baby, she'll explain why that's really not a good idea.

Katie Ferraro (1m 47s):

I think you guys are going to love this episode again, her name is Dr. Shiana Holman, and she's here to talk about tongue-ties and lip-ties and whether or not these affect our baby's ability to self feed solid foods. All right, well, hello, Shaina. Thank you so much for joining me today on the podcast.

Shaina Holman (2m 3s):

Happy to be here.

Katie Ferraro (2m 4s):

Alrighty. So you have very interesting background. You are a dentist, but you also have a background. You have a PhD and you know, a bit more about infant feeding than I would say most dentists do. So could you share just a little bit about your background and the type of work that you are currently doing with infants as it pertains to feeding?

Shaina Holman (2m 20s):

Yes, absolutely. So I am a dentist spaced in Chapel Hill. I went to university of Maryland for dental school where I did a DDS PhD. So, I basically did two years of dental school. Then I left and worked on my PhD work and then came back and finished dental school. My PhD is in biomedical sciences and my dissertation project was all about infant sucking and the physiology behind it. And the role of specifically of oral sensation, which usually people in the field of swallowing do not fully appreciate. They tend to appreciate more of the pharyngeal swallow and sensory and the oral pharynx. So I was trying to show them that the oral sensory information is also important in this swallow. And I then did a one-year residency in a more advanced dental procedures.

Shaina Holman (3m 4s):

And then I moved back home to Chapel Hill, North Carolina. I've started my own practice about two and a half years ago now. And a big part of my practice revolves around the airway and treatment of tongue-ties and sleep apnea appliances. So, on Mondays we run an infant feeding clinic. It's a multidisciplinary clinic where I have an infant massage therapist and an infant lactation consultant. The three of us do assessments for babies that are referred because they're suspected of having a tongue-tie. We pride ourselves on being very conservative in our approach and very thorough in our conversations and evaluation. And if we all think there's a tongue-tie present, then we can release it with a laser.

Shaina Holman (3m 45s):

And sometimes we don't think there's a tongue-tie or we think there's other things we need to try first or rule out first. So we make those referrals.

Katie Ferraro (3m 52s):

You said you're very conservative. And I just noticed that word because I feel like a lot of other parents would agree that tongue-ties or something that they never heard of until they struggled with breastfeeding. And then all of a sudden you look around and it's like, it feels like every single baby has a tongue-tie. Do you think that there are practitioners who are less conservative and perhaps unnecessarily treating tongue-ties that maybe aren't truly problematic or even existence?

Shaina Holman (4m 14s):

Absolutely. I think a lot of those people tend to be dentists. I think a lot of dentists don't really do their own assessment. They are just getting notes from a lactation consultant and doing a forklift under the tongue and looking and saying, okay, there's something there and I can remove it. And they're not really understanding the infant feeding physiology and really taking a step back. One thing we see pretty routinely in my practice is that the infant massage therapist will often find things going on with a baby that could explain a lot of their feeding difficulties or they're seeing things and I'm seeing things. So that's a piece that's often completely missed. I mean, the pediatrician doesn't even notice the things that a massage therapist can notice until a child is much older.

Shaina Holman (4m 59s):

But yeah, so things like when I say that, I mean, things like torticollis, plagiocephaly like when the head is not shaped properly, often we see problems in nerve compression in the back of the head. So sometimes when I'm doing my second exam, maybe there's a tongue-tie, but the whole rhythm and reflexes around the suck are off. And often when we step aside and we discuss that and I say, you know, this just doesn't seem right. The massage therapist goes, oh yeah, there's a lot of nerve compression there. And it's like, oh, okay. That makes sense. So, you know, having that multidisciplinary approach is really important. Like I really couldn't imagine even making a diagnosis without having them there.

Katie Ferraro (5m 37s):

I think it's really cool that you have a multidisciplinary approach. Like I go to a typical pediatric dentists, like I've never seen a, an infant massage specialist or an IBCLC there. So, I think it's really important that we do have the different disciplines involved. And I was curious if you could tell us a little bit more about how do tongue-ties or lip-ties or even heard of cheek-ties, how do they occur? Are they do all babies, have them? What's your take on that?

Shaina Holman (6m 1s):

Yeah, a few different thoughts on that. I mean, I think there's a lot of debate about the prevalence because no one's screening for them at all. Like in the hospital, pediatricians don't know how to diagnose them. So they are just often missed by, I've heard estimates somewhere around like 5% or so. It's a common enough that you're going to routinely see them. And then there's what looks like a tongue-tie and what's actually functionally causing a problem. And those two things are different. Sometimes you can have one that looks really tired, but there's no functional problems. So again, it kind of makes this whole thing much more complicated as far as where they come from. They are thought to be genetically dominant. So there often is a parent that also has a tongue-tie. So sometimes getting that history from a parent is helpful about they had maybe speech therapy or they had feeding therapy, or they have a severe gag reflex or some of the other symptoms that you might see in an adult.

Shaina Holman (6m 51s):

Or maybe they say, oh yeah, at birth I had mine clipped as well. Or my mom told me that, or my mom never breastfed me cause she said it was too painful. So sometimes there's a little clue in there that it might be from one of the parents.

Katie Ferraro (7m 2s):

Now, you mentioned breastfeeding. And we know that, of course, a baby that has a tongue-tie is it's going to be more challenging for breastfeeding. So a lot of our audience, there are parents of babies who are probably they've figured out breastfeeding or bottle feeding. The baby is thriving on formula and or breast milk. But now we're moving into a new phase when it's time to start solid foods. And so I was curious if you could talk a little bit about considerations that parents and caregivers of children who have a tongue-tie that's either been released or not released. And I know that the answer is kind of different there. What should they take into mind as they start this next phase, which is starting solid foods?

Shaina Holman (7m 37s):

Yeah. A few different things. So sometimes I hear from parents that they know their child has a tongue-tied, but their breastfeeding never bothered them. Or the baby's been able to gain weight. And they just never really thought it was something to be addressed. And they come to see me because now they're starting solid foods. And now they're having trouble. Some of the signs that your child might have a tongue-tie that you might be noticing when introducing solid foods would be preferences for softer foods versus foods that require more chewing.

Katie Ferraro (8m 6s):

Could you explain why that is? Because I think, you know a lot about the anatomy of the mouth, but I'm like, but why would that be? Because if we only give our babies one texture that we don't really know what their preferences are, we encourage parents give a lot of variety of different tastes and textures. And you're saying there might be an anatomical reason why they're preferring just the softer textures.

Shaina Holman (8m 22s):

Exactly. So when you get food in your mouth and you go to chew it, the roll of the tongue is that your tongue is going to deposit the food onto your teeth and then your teeth, they're going to chew the food. And then your teeth are going to your tongue is going to move that food back into the center of the tongue. And then the tongue collects and forms of bolus. So like a little mushy blob of food on your tongue. And then that bolus is swallowed. So the trouble that babies will run into, or, and again, not even babies, but even honestly, children, adults, all ages that have tongue-ties is that when ask them to chew food and then you have them open their mouth and show you, there's no bolus, it's just food scattered all around their mouth.

Shaina Holman (9m 3s):

That makes it really hard to initiate a swallow. It makes it hard to chew without gagging on your food. So you have trouble like that. So the ability of the tongue to move side to side is called lateralization. And if you have a tongue-tie, it's very difficult for your tongue to lateralize enough to really chew food. So some parents think their child is a picky eater. And then you really start to ask questions about what they're eating and you realize it's like Mac and cheese and potatoes and just really soft foods that don't require almost any chewing. And that would be a reason to may be suspect a tongue-tie, especially if you ran into any of the issues with the breastfeeding or bottle feeding as well, or maybe someone's already put this in your ear a little bit, that there might be a problem.

Shaina Holman (9m 46s):

You also just see a lot of gagging in kids that have tongue-ties that haven't been released already and are trying to eat solid foods, the proper rest position of your tongue, just when you're not eating any food at all is to have your lips closed and your tongue resting across the roof of your mouth. So if your tongue can't naturally rest in that area, it's going to make your mouth just really prone to gagging because your mouth is not used to anything, touching it, like your tongue resting against the roof of your mouth like that. So you tend to see, again, all ages. I have adults that are tongue-tied, that can't swallow pills, that can't take multiple gulps of water in a row, but just makes us gag reflex really strong.

Shaina Holman (10m 28s):

So that might also be a reason to get something checked out. You might've even noticed a gag reflex when bottle feeding your baby or even breastfeeding or reflux. So those are all these kind of signs. And maybe there is something anatomical going on here.

Katie Ferraro (10m 42s):

And our audience knows that gagging is a natural and necessary part of learning how to eat. So they're anticipating and expecting some gagging, but you're saying that really a tongue-tie can cause the baby to have a very sensitive gag reflex. And of course that that's a subjective measurement of, but is that the correct interpretation of what you're saying?

Shaina Holman (11m 1s):

Yeah. Parents have often noticed this kind of thing already. By the time they see me, like when I give my baby a pacifier, they just gag on it. Or they've had a really hard time trying to find the correct bottle to use or a bottle of the baby can take because every bottle, since you just make them gag, people say they can tell there's more, there's a lot of reflux, babies constantly spitting up. But a lot of times it's pretty distinct. It's not just going to be occasional gagging and not the gagging after chewing. It's going to be really anything enters in their mouth. And they're gagging to even tell you what that looks like in an older child with a tongue-tie. I recently had a five-year-old that was throwing up multiple times during the week. And like, it found it so hard to just eat regular meals because there's continuously gagging

Katie Ferraro (11m 42s):

Did that. Five-year-old have a tongue-tie?

Shaina Holman (11m 44s):

Yeah. And once released, it took a few weeks after the release, but stopped gagging, completely.

Katie Ferraro (11m 49s):

You were talking. I know from speaking with you previously that there is the potential, sometimes we're older babies need a tongue-tie release, but you were telling me that it's much more advisable to have that tongue-tie released prior to age one. Is that correct?

Shaina Holman (12m 3s):

If you're looking for benefits with, with nursing, it's ideal to do it before three months, there's kind of diminishing returns on that after three months, but before age one, you're going to not be dealing with such a large baby. You're not going to be dealing with back teeth. And after you do the release, you need to do stretches of the wound area to make sure it heals well. So it's really difficult to do that if a child has molars. Definitely, If you're talking about toddlers and doing tongue-tie releases, that can really cause an oral aversion. In addition, you're not going to be able to stretch it well. So the chance that's going to reattach itself is really high. So I feel like the, the risk benefit of that is kind of tricky when you're in the toddler phase.

Shaina Holman (12m 45s):

So it's just so much easier when they're really little and they can jump into doing the right thing and you can stretch it and make sure it heals well. And then I did, I pick out, we're doing a lot of tongue-tie releases starting again around age four, cause that's a child that's old enough to work first with the SLP and to have a full feeding assessment. And they're old enough to have anesthetic given where you can really talk to them about what to expect and how this is going to work. And they can be a participant with their own therapy afterwards to make sure their tongue can regain its function and learn to rest on the roof of its mouth. And lips can learn to stay close and they can learn how to articulate certain sounds and how to do and how to eat solid foods and swallow properly.

Shaina Holman (13m 25s):

So there's a lot more that goes into it when you're older. So it tends to be selling just as so easy and minor to do as a baby. And then you don't have to worry about all this stuff later on.

Katie Ferraro (13m 35s):

I'm not laughing, but you say like so easy and minor to do. And like as a parent of a child who had a tongue-tie and I had a terrible, it was my oldest that she had just was so frustrated. She couldn't breastfeed. She latched perfectly, but she wouldn't transfer. And it turns out she'd had some nerve damage from during the delivery. And we had our tongue-tie released even that was probably unnecessary. And it was not done by a dentist with a laser. It was done by a very non-compassionate medical doctor with a pair of scissors. And there was a ton of blood and it was literally like the most traumatic part of parenting. I have seven kids now, and I can still cite that as the most traumatic thing I've ever had to do with my child. So it's so routine, but it's nice to be with a practitioner for whom, oh gosh, this is running the mill. This is common. Like, I know you're speaking a little bit off the cuff, but I appreciate your confidence with it because I would have needed that as a first-time mom, which I did want to ask because there's a lot of parents listening who have babies who have already had their tongue-tie release.

Katie Ferraro (14m 28s):

They're concerned. They want to know what should they be on the lookout for, as they now transitioned from breastfeeding and or bottle feeding to solid foods, they've already had the tongue-tie release.

Shaina Holman (14m 37s):

Yeah. What I would say there is when babies are really little and have their tongue-tie release, they tend to jump into doing all the chronic correct things really easily. But especially if your baby had their tongue-tie release, at least after three months old, you should be especially looking out for signs. The things that you want to be seeing in a baby that after having the tongue-tie released is that they're sleeping with their mouth closed. The nasal breathing should be good. There should be no snoring, no issues like that. That should all show you good signs that they're tongue is functioning like it should. If you giving that baby a bottle, the most of the nipple should be in the baby's mouth. There should not be any chewing motion being seen, no chomping with the jaw. And those are signs that your tongue is doing what it needs to do.

Shaina Holman (15m 20s):

But sometimes you do have a situation where a baby's had a tongue-tie release and they are still mouth breathing and they are still not able to feed very well or nurse very well or eat a bottle very well, like there's other things going on. And those babies sometimes even though their tongues released just are not lateralizing their tongue very well. And that would be also a reason to see an SLP or speech language pathologist. If you're feeling like, Hey, I had this tongue-tie release, but it really didn't fix any of these problems. Then they might need to actually work with someone to do more exercises and training of the tongue.

Katie Ferraro (15m 54s):

And I've heard you say, I've heard you say that for every anterior tongue-tie, there's usually a posterior component. So, could parents sometimes assume maybe it wasn't all taken care of the one time it was released is do you see that?

Shaina Holman (16m 9s):

Absolutely. I treat a lot of tongue-tied babies that have already had releases that either reattached or were not fully released in the first place, or just due to normal growth and development, or maybe dealing with an unrelated issue of muscle tension. There's more tissue there that needs to be released

Katie Ferraro (16m 28s):

As a mom of two children. I know you told me that you did do baby-led weaning with your kids. So you're familiar with the baby-led approach to feeding and as a practitioner, then working with parents who have had babies that have had their tongue-ties release. If there aren't these secondary problems, like it was, it was you who did it, you did a great job five and a half months later, the mom comes back and the baby's ready to start solid foods. If they haven't had complications with a tongue-tie release, is there anything they need to take into consideration as they start solid foods?

Shaina Holman (16m 56s):

Not really that they should be really good to go.

Katie Ferraro (17m 1s):

And they can eat of all variety of textures?

Shaina Holman (17m 4s):

Absolutely.

Katie Ferraro (17m 4s):

Okay. So Dr. Shaina, if we have parents and caregivers listening and they have had a baby with a tongue-tie, some of who maybe hadn't released or some who decided not to, is there any parting words of wisdom that you can give them as they transition into this period where they're starting solid foods with their baby?

Shaina Holman (17m 20s):

Yeah. Few thoughts. If you are in a situation where you've already had a tongue-tie release and you've already worked through that, you can definitely have a little peace of mind of knowing that you've made it through a huge obstacle, a huge developmental period of time in your baby's life. And you really have set them up for success with transitioning to solid foods. You know, you're much less likely to run into some of these issues than someone who has not had that path and already had it released. Your baby is much less likely to have sleep apnea or speech issues. And so this should be a much smoother experience from here on out. And if you haven't had the tongue-tie released and you suspect there might be one, or someone's maybe already told you there is one and you haven't really felt like you want to dress it yet, has the competence in knowing that it there's still plenty of time here.

Shaina Holman (18m 8s):

And if you can do it before age one, again, you're just going to save yourself a lot of headache down the road. And babies tend to jump into doing the right thing pretty well. And even if they need to work with a feeding specialist or feeding therapist, it's all relatively pretty minor and there'll be honor again, kind of on a road to success, not to be dramatic about it, but it's going to save a lot of headache down the road of having to involve a lot more specialists and deal with a much more complicated situation.

Katie Ferraro (18m 33s):

And I appreciate that cause I think there's a lot of parents for whom that they kind of breathing a sigh of relief. Okay. The worst is behind me. Breastfeeding was challenging. We either figured out how to make it work, or we decided to do bottle feeding. The baby is thriving. As we move into this next phase, even with a tongue-tie or having had the tongue-tie release, you can succeed with your baby trying a variety of different textures as part of starting solids. And Dr. Shaina was curious if for parents who they maybe don't know, they suspect that their baby might have a tongue-tied, seems like something everyone always talks about, but you don't want to speculate. You do want to get a diagnosis. What do you recommend for parents who suspect a tongue-tie? What team member in the health care team should they see to kind of start this process of maybe figuring out if it's something that does need to be addressed?

Shaina Holman (19m 17s):

Yeah, that's a great question because I think this becomes a big frustration for parents is that their dentist is not looking for it. They're pediatricians not looking for it. And then when they mentioned they trying to advocate for themselves, they're again, talking to someone, not very well, even educated. And sometimes those people very confidently will say, there's no tongue-tie instead of saying, Hey, I, this isn't really something I have training in. So the type of person that's going to be the most helpful is a speech and language pathologist that is specifically trained to work with babies and with feeding issues. So that could be with solid foods or even with bottles. SLPs can be great with different trying to figure out a bottle that will work for you as well. And they they're the specialist of the tongue.

Shaina Holman (19m 58s):

They have to deal. They deal with all functions of the tongue so they can strengthen those muscles and encourage the tongue to move more. And they can notice when the tongue physically is unable to do the things they're trying to teach it to do. Now, even some SLPs are taught that tongue-ties and that diagnosis is outside of their field. There's even SLPs as the school system that will get in trouble for mentioning that a child might have a tongue-tie. So you also have to be understanding of that fact, there's a specific training in orofacial myology that some SLPs have done and that kind of training will give them a lot more background in tongue-ties. So looking for something, some kind of continuing education or training an orofacial myology might end up helping you point help point you to somebody that might be able to help a little bit better.

Shaina Holman (20m 48s):

They at least know how to do the fullest functional assessment and give that to a provider does reason for concern about a tongue-tie, even if they can't technically say that that baby has a tongue-tie.

Katie Ferraro (20m 58s):

And I liked that suggestion because I think parents always want to get a second opinion, but if like a healthcare provider tells you really definitively now your baby's cool. You don't have a tongue-tie. And you're like, all right, I got the word is we don't have a tongue-tie. You know, that might not actually be the situation. And even for parents, who've already had a tongue-tie release. They're sometimes surprised to know that, oh gosh, maybe there was a posterior component or the scar tissue. It did reattach. So sometimes a second opinion is helpful. I know with my own, my sixth and seventh babies were twins. And so I had, I had my first one with this traumatic experience with a tongue-tie and the using the scissors and lots of blood and not able to breastfeed. And then the last two, I was worried cause I was like just looking and looking at pictures and you know, go to the tongue-tie clinic. And I loved the doctor there because she looked at both of them. She goes, Nope, they're fine.

Katie Ferraro (21m 39s):

She was like, you probably go to five other doctors who would tell you that, that baby has a tongue-tie and would need to have it released. But I do 30 of these a day or whatever it was. And she gave me the confidence in. Sometimes you're looking for a problem. That's not really there. And I left, I appreciated hearing that as well. Cause I didn't want to have to deal with that again. So I just want to say thank you for being here and sharing this information because it is a confusing situation to parents and they're not sure what to do. And sometimes the onus is on the parents to make the decision. So being educated from a variety of different healthcare providers who are involved in this. I love that you have IBCLCs that work with you to help you identify if there might be a problem with the infant massage therapist that you work with, SLPs who are specializing in feeding that you're on a podcast with a registered dietitian who specializes in baby-led weaning.

Katie Ferraro (22m 22s):

I think that this is, you know, how we take that whole body approach for babies because there is no one healthcare professional or credential that is, you know, authorized to, or even has the skillset to deal with all of this. And as a dietitian, I teach in medical schools as well. And I love to remind parents that 90% of physicians in this country have never had a dedicated nutrition class. So parents get just as frustrated when they go to the doctor and the pediatrician asks questions about feeding and they kind of get blown off. It's not because the question's not important. It's because the person you're asking the question doesn't necessarily know the answer. So knowing where to get the answer, I think is helpful in fly, being able to share expertise like yours on a podcast, it's so beneficial to our audience. And in closing, if you don't mind, could you tell us where the audience could go to learn more about you and your practice?

Katie Ferraro (23m 6s):

I know you guys are on Instagram. I think the services that you offer in North Carolina are really unique. Where can we learn more about you, Dr. Shaina?

Shaina Holman (23m 20s):

You can go to my website, which is holmanforfamilydentalcare.com. And that website, we have a page about infant feeding and it describes kind of the setup of our clinic. So that would be a good resource and you can feel free to email me. I've tried to do good about staying on top of my emails.

Katie Ferraro (23m 31s):

You're amazing at email. I just want to point that out. She actually responds I'll go ahead and put all of the links that you're mentioning by the way on the show notes page for this podcast episode, which is blwpodcast.com/52. What about your Instagram?

Shaina Holman (23m 46s):

Yeah, and Instagram is @holmanfamilydentalcare and Holman in is H-O-L-M-A-N.

Katie Ferraro (23m 50s):

Wonderful. Well, thank you again so much for being here. I really appreciate it. If you guys want to check out all of the resources that Dr. Shaina was mentioning again, it's on the show notes for this episode, which is at blwpodcast.com/52. Thank you again so much. I really appreciate it. Okay. Well, I hope you guys enjoyed that episode with Dr. Shaina Holman. She has such a unique perspective on feeding that I think many, Nope, like no other healthcare professionals really have like most dentists don't do anything about infant feeding. She has the background with having done all the research and feeding, and she works with such a unique team of professionals to really help that whole, whole body approach when it comes to things like a tongue-tie, because there's not just one credentialed professional who has the skillset and the expertise to even know if there's a problem and exactly what to do, and then how to help the baby recover and then transition to different phases.

Katie Ferraro (24m 42s):

So this was an episode idea that a mom of a baby who just had a tongue-tie released, gave me, she wrote me a review on apple podcasts, and that's where I go to get all of my new episode ideas. So if you guys have any ideas for more episodes that you would like to hear on this podcast, if you're enjoying the podcast, please do leave me a written review on apple podcasts. It means the world to me, it really helps the podcast get found. I do read every single review. Actually just had a birthday party for my oldest daughter. And we did this like little teepee sleepover for the cousin, the girl cousins in the sisters. And when she was cleaning up, the lady who runs the business was like, can you please leave me a review? And I was like, oh yeah. She was like, no, no, no, no people always say they're going to leave a review.

Katie Ferraro (25m 25s):

And then they never do. And I was like, oh my gosh, you're totally right. So that definitely went to my computer and left her a review. So if you guys are liking the podcast, please, would you leave me a review on apple podcasts? And then let me know what your episode idea is. I would love to bring you more guests like Dr. Shaina Holman and talking about things that are related to feeding. Like how can my baby with a lip-tie or a tongue-tie do baby-led weaning. So thanks again for listening guys, have a great day and I'll see you next time. Bye now.