Josh Thompson     about     blog

Tongue Ties: What, So What, What To Do

tag(s): • •
Reading time: 22 mins

Article Table of Contents

“tongue tied” (my first time hearing the word, my newborn’s experience) #

A ‘tongue tie’ was something I’d heard discussed (the little bit of fiber under a tongue) as the kid we now know as Eden was en route and not yet born. I didn’t think much of it then.

Cut forward to 5 days post-birth, Eden and her mom get the first at-home lactation consultant visit, from a lactation consultant affiliated with The Mama’ hood. That entire organization is super cool, they introduced us to our doula, too.

Something that’s common knowledge about babies, and was new to me then was that whatever weight a baby is born at, its normal for its weight to go down by up to 10%, as it’s metabolism changes over from ‘being fed via umbilical cord from mom’ to ‘being fed via milk and digesting and eliminating waste’. It’s fascinating. thus, weight would be lost and that it’s not good to lose too much.

Eden had lost 10%, the max weight that ought to be lost before going back up again.

The hospital lactation consultant had checked in on Kristi and Eden and pronounced all as fine.

The at-home lactation consultant said:

I’m technically not allowed to make a formal diagnoses. and, by my estimate, Eden has a severe tongue tie, and probably a lip tie, and it’s interfering with her ability to generate suction, which is why it seems that Kristi’s milk hasn’t come in, because her body doesn’t know anyone’s requesting milk.

That’s something of an emergency state, as you could imagine. So, they began “triple feedings”, which means:

  1. Eden and Kristi, nursing as usual (feeding 1)
  2. After eden would finish a defined few minutes of nursing, I’d bottle feed milk from other mothers, obtained via friend networks and online mothers-supporting-mothers groups
  3. Kristi’s milk needed nursing to come in, so using a electric pump, she’d pump. We’d freeze it to later give to Eden.

And all of this happens every two hours, start-to-start. We’d spend an hour feeding, rest a bit, and then another hour would pass and we’d start it all over again. Slowly but surely, she drank lots of donated milk from other nursing moms, she began more then eventually suffient nutrition from her mom (because post tongue-tie-release, her entire mouth could suck correctly, so her mom’s body was getting all the helpful signals to generate milk, which it did.)

We tracked everything to the nearest 5 or 10 ml, at the very beginning. After a weekend of this, and a weigh-in at the pediatrician’s office, we could see that Eden was gaining weight, and we all collectively breathed a sigh of relief.

At the pediatrician’s office, I said something about the proposed tongue tie. (“someone else was looking at her feeding and said she thinks eden might have a tongue tie, what do you think?”)

he said:

Yeah, maybe, no biggie either way. As long as her weight is going up, all good. If not, she’ll need to go on formula. We’ll re-weigh her in a week.

author’s note, I just for the first time ever lost a bunch of the text I’d written! I had this whole story typed out, saved it, gone. I’m sorta not willing to re-do the whole thing now, pardon the brevity, I’m typing out a summarized version of the story

We of course wanted Eden to be able to work her own mouth and contribute to the system generating nutrition, and it would be much easier on everyone if she could. The next morning, we visited our dentist who referred us to their favorite pediatric dentist.

We spent a morning driving around and talking to doctors, dentists, surgeons, but by the end, had what we wanted and what eden needed - the tongue tie and lip tie release.

Her mouth and lips opened up so much more, she was able to finally generate an obvious and proper seal when nursing.

Her mouth opened so much more than it was able to before the procedure. Her cry was different, stronger. Everyone commented on it, the nurses holding her, her grandma later that day. Her tongue could move up and around, in a normal way, making it obvious but only in hindsight how restricted it was before.

The procedure looked relatively straight forward, the pediatric dentist removed upper lip tie, lower lip tie, and tongue tie. The last ‘tie’ wasnt wasn’t just the thin mid-line fiber visible inside her mouth, but it was actually removing quite a lot of material from the mid-line to the outer edges of her tongue, deeper into the throat than I’d originally expected.

She was in great hands throughout the procedure! The staff at the clinic had their own kids, and of course it’s so rare to see so small of a kid. She was held gently and cried during the procedure yet was quickly at peace again after. The surgeon was very efficient, quick, and gentle.

I watched the whole procedure from over his shoulder, looking at her mouth or the camera he sometimes used that sent video to a monitor. As soon as he was done, I remember thinking to myself “why was this not instantly diagnosed in the hospital as soon as she was born?”

It was sooooo obvious. For a simple example, it’s reasonable for ones upper lip to be able to ‘unfold’ away from the teeth and flip up over the nose, sorta covering the tip of the nose. her lip tie was so tight that her upper (and lower) lip could hardly move away from where they were, most of the time, near her teeth. That was just the lip ties! The tongue was similarly restricted.

Life carried onward, I didn’t really think about tongue ties again.

Tongue Tied (the book, and my adult experience) #

Skip forward a few years. Other than the story of how inadequate the American medical system is, I didn’t think about the tongue tie thing for a year or so. then I remembered, in the conversations with various people about it, several times someone saying “it’s heritable”.

I looked up a some functional tests, for myself, and on all of them, failed the ‘test’ hard. Most notably:

  1. look straight up and swallow - can you swallow without pain in your neck, or bending your neck to accommodate the movement of the throat/hyoid bone? I felt pulling all the way into my sternum, and had to sorta dip my chin/jaw with some of the movement.
  2. holding your lips close, open your jaw as wide as you can. keeping the lips closed, can the tongue reach the roof of the mouth? pre-release, my tongue couldn’t reach the roof of my mouth. Now, there’s plenty of room to spare.

Here’s an example self-assessment youtube video. Also google tongue tie self-assessment and hunt around. There’s different ways the tongue and lips can have extra tissue hanging out, and as you explore you’ll find those ways.

Tongue Tie Test: Quick Self-Test to see if you are secretly Tongue Tied! (FOR SINGERS)

I obviously had one, so I next got from the library the book Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More.

After reading that, I was fully committed to the procedure, just needed to line up the details. It’s not trivial, but not difficult or complicated.

I called around American dentists, to see if they did it, and wasn’t inspired to confidence.

Eventually I found the Colorado Tongue Tie center and was instantly onboard. They’re trustworthy, you can read the reviews. They said:

we don’t do the procedure until it’s recommended by the myofunctional therapist you’re working with. here’s some we recommend…

I ended up calling and working with Megan Dewalt, who is exceptional. Megan is based in Denver, thus the recommendation by the Colorado Tongue Tie Center, but all communication is zoom/email/text, it was great to not have to leave my house and travel somewhere to do the therapy.

If all you do is read this blog post, read the book, and then set up a intake/evaluation call with her, and do what she tells you, and you have a tongue tie, your life is about to be transformed. :)

at some point, out of curiosity, I’d contacted my dentist to see what notes/records they had on this tongue tie thing.

They have spent plenty of time looking in my mouth, and I’ve had a LOT of dental work done, tons of cavities, despite being rather attentive with oral hygiene. as a kid I had braces twice bc my pallet wasn’t shaped right because my tongue wasn’t working right. I also ground my teeth in my sleep, and wore a night guard. I was a little disappointed no one had uttered the words, or mentioned the possibility, in all like 35 years of my life.

I didn’t expect them to say anything, but they gave me a Formal Letter on Formal Letterhead:

Based on our notes, we agree that the patient might have a tongue tie that might benefit from release, obviously up to the wisdom of the involved medical professional, we refuse/are unable to make an assessment.

Each time I saw someone in person about this, they said “oh, yeah, that’s an intense tongue tie, no doubt.”

My personal life is full of stories of things like:

  • some stuff that sounds like sleep apnea (minor snoring, sometimes nighttime airway obstructions)
  • night time teeth grinding
  • braces (and pallet expanders) as a kid
  • adhd? sleep issues, for sure, in various ways.
  • sometimes sounding like I’m choking in my sleep (reported to me, and I wouldn’t note the episodes well enough or at all, so I wouldn’t remember or note it when I woke up.)
  • obviously limited tongue mobility
  • lower back pain issues

BuuUUuut… I also “seemed fine”. I can eat, I can talk, I sleep, blah blah blah…

I spent time recently in Asia and thought about getting the procedure done there when I was passing through Thailand, without doing any myofunctional therapy. Thankfully my sister convinced me to consider a wiser path instead of only getting the release done.

The reasoning makes tons of sense, as soon as she says it:

Your oral anatomy has been constrained, massively, so you’ve learned compensatory movement patterns. If your tongue gets unstuck from the bottom of the mouth, and you don’t know what new movements to do with it, you’ll only partially benefit from the new options.

(My paraphrase of her words)

Right she was. By then, I made it back to colorado, and found Colorado Tongue Tie Center

I live in google maps, here’s their listing/the reviews

I called them up to see what it was like doing the procedure with them. They said they book the procedure once the person has been given a go-ahead by a myofunctional therapist. I worked with one of the ones they recommended, Megan Dewalt, did a few weeks of tongue strengthening exercises and drills, given by her, and then got the procedure done, then did a few more weeks of tongue strengthening exercises and drills.

✨ My Post-surgery experience ✨ #

As the procedure was happening, I giggled to myself the first time I noticed my tongue touch the top of my mouth while my mouth was wide open. I’d never felt that before, I had been looking forward to that moment for a while, and I finally got it, though my mouth was full of local anesthesia, so I was feeling it only in some ways.

even sitting in the chair afterwards, I noticed that my head turned better, more easily, to the left and the right. It makes sense, turns out my tongue was basically… stuck to my hyoid bone. (If you can look straight up and swallow without pain or tight pulling from your throat to your sternum, congrats! No tongue tie for you!) Here’s the wikipedia for the hyoid bone, look at all the muscles that attach to it.

My throat (‘hyoid bone’) had been turning when my head would turn to full extension - because it was uncomfortable, my head either wouldn’t turn farther, or it would hurt.

Post-op, no pain. It was amazing.

Next I noticed indeed that my head sat a bit higher/differently on my neck. The tongue tie (in my mind) caused a bit of tugging on the top of my spine, so to keep things comfortable I was compensating in posture. This was plainly visible to the therapist/doctor, but I’d never noticed and couldn’t really see it, until after the procedure.

i felt differences in my sternum, diaphragm. shoulders. neck. throat. voice. swallowing became less burdensome.

And this was all still while my tongue and mouth was in quite a bit of pain, because it had just gotten rather er… opened up.

So, I did what any normal person would do and drove to Rifle for three days, where I proceeded to have a LOVELY trip, climbed a bunch of moderates, and did (and sent!) harder-for-me things.

My climbing #

My climbing is different.

Turns out my head wasn’t rotating freely on the end of my neck, so, because one spends a lot of time looking up the wall while rock climbing, I was changing the posture of my contact with the rock, often enough, to accommodate the needs of looking up/around. With better mobility/de-linked neck/head rotation, my movement is different. I can pause in “restier” stances, still breath deeply, and simultaneously look around/up/behind me.

I’ve always been able to climb smoothly, and I don’t know if this difference is visible from an observer’s perspective, but I can easily feel a difference in comfort, just looking around and finding various positions relative to holds.

My posture #

I stand differently, and I’ve had a HORRIBLE lingering back issue for a while, that was exacerbated by my head being incorrectly tilted forward. I’d compensate in my shoulders somehow, and then compensate again in my lower back. Now, everything ‘stacks’ nicely, and I can stand vertically without effort. I would have said I could stand without effort before, but I was wrong. Now I know, it was very effortful.

My tongue #

After six weeks of tongue strengthening and stretching, I’m very aware of my own mouth. I spend SO MUCH time now exploring the inside of my own mouth with my tongue, or exploring the movement of my throat, soft pallet, throat/hyoid bone, and tongue, all in relation to each other. I notice that I can open my throat in a different way, that is much more comfortable.

Driving and scooting #

My head sits differently on top of my spine, and I can turn my head easily, farther, as I mentioned. This manifests in more ease while driving and scooting. I can easily feel the difference. A helmet is heavy, so a slight correction to head posture lets the weight of the helmet be more easily carried on top of my spine. It’s comfy. I can quickly turn my head far too the side to check blind spots, as needed.

Some of my frisbee throwing changed #

I sorta got a new throw unlocked. I can point my head at wherever I’m throwing a backhand to, and with some hip hinging, using that extra extension of my neck, I can do a pretty powerful backhand throw while keeping my destination fully in sight, through the entire arm motion.

The disk doesn’t come out flat, the only reason it works is because it doesn’t travel flat - the arc of the arm+disk uses a bit of the natural slicing ‘fall’ of the parabolic arc of the disc as it gets thrown across the space.

This wasn’t a combination of options that was available to me, pre-tongue-tie-release, or at least not one I’d noticed. Getting a few extra degrees of rotation available to me, between where my shoulders are pointed and where my head can be pointed, absolutely opened up some new options for my throwing. I felt immediately improved across all of my backhands, which had always been my weaker frisbee throw, relative to my forehand.

Now that I’m skilled with the throw, though, I note that it’s possible that maybe I could have thrown like this pre-release. I’ve showed it to a few folks, who have indeed noticed that it’s an interesting variation of the backhand. A skillful version of the movement does not demand a huge range of motion, and can be used in subtle ways. who knows.

My emotional state #

Pete Walker says, basically,

emotional flashbacks tend to happen when we assign emotional meaning to physical sensations. Stopping the flashback is to first engage in thought-stopping behaviors, then try to localize where/what the physical sensation is in the body, and hold space/honor/work through that physical thing.

I now know in a way that is clearest once the ‘strings have been cut’ that I carried substantial tension (think… muscle tension, fascia tension, whatever) in my throat, connecting my tongue, the top of my spine, my hyoid bone, and more. That physical knotted-up-ness would contribute to a turbulent emotional state, AND would limit my rest-and-digest systems from fully getting online.

If my sleep is compromised, I’m getting less restored, and if I’m less restored, things seem incrementally harder and more dim, rinse and repeat.

I could say more but this was written in a single session, and i lost a bunch of what I’d had due to minor computer errors. I’m a write-it-now kind of person.

I’ve gone all the way around with depression, need to do an update to that post, but would posit that an emotional state and inner physical tension can have a relationship. I prefer the version of my body post-tongue-tie-release than pre.

My climbing partner was subjected to near endless exclamations to myself about my own mouth. “I love my new mouth!” “I love taking my new mouth rock climbing!” “wow, that thing I said earlier about breathing and my diaphragm applies to breathing while climbing, too! Amazing!”

I could say more.

How I proceeded to the tongue tie release, 5 days ago #

I’m writing this whole damn post because I want to write down the profound and many differences I feel, inside my own body, often in shocking and beautiful ways. If you have a tongue tie, and can get the work done (myofunctional therapy, tongue tie release, more myofunctional therapy, and body work) you might find your body a drastically friendlier space to inhabit. I’ve had tears come to my eyes, more than once, as I’ve noticed new forms of relief or relaxation settle in.

There’s been cascading things unfolding across days, weeks.

Colorado Tongue Tie Center #

The procedure was done by Dr. Chad, he was exceptional, it was chill, easy, pain was non-existent (during the procedure) and minimal during the post-procedure repair time.

It was like an hour in the office, and 30 minutes in the chair. It felt akin to some minor dental work. I rode my scooter back home after, and other than being ginger with my mouth, there wasn’t any issues.

I ended up with six sutures after the procedure, so went heavy on ibuprofen and tylenol for a few days, and took a light dose of narcotics the first night to sleep, drank TONS of salty broth.

It’s ~$1500 on a credit card, some health insurance agencies will reimburse you, and if the health insurance company won’t, the dental insurance company might. Or no one might.

Megan Dewalt, OMT #

Megan was (is) my guide through the whole process. We did a few pre-procedure meetings, a few weeks apart, where I’d get exercises to build tongue strength and proprioception so I can know where my tongue is/isn’t. To make sure I mouth breath, etc. Then I did the procedure, she’d given me notes ahead of time with the stretches to do throughout the rehab. (super light immediately after, light/medium until sutures dissolve, then go hard after)

Dr. Chad at the Tongue Tie Center said it was easy to do my procedure, as it’s always easy to do the procedures for Megan’s clients, because I had plenty of musculature in my tongue, which made it easy for him to find the tissue to remove, vs. the tissue to not remove.

I spent ~$1k on the pre-op prep, and about $1k on the post-op rehab, spread across six weeks each, with 2-4x/daily strength building exercises, paid/scheduled right after the intake call.

The obvious book, Tongue Tied #

Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. Get it, read it.

Bodywork from Daniel Lopez #

Daniel Lopez, DO. My first time ever getting ‘body work’ done, but I was so thrilled for the nudge. Turns out the tongue connects to the soft pallet which moves up and down in coordination with the hyoid bone. That thing feels connected to the top of the spine, and all this can be incorrectly bound together, and when the tongue is released, there’s so much new movement potential. Dr. Lopez did grand work on me, from the cranium through the sternum (and even worked on a back injury that is now dramatically better, bc my head sits on my spine differently, so i don’t have to compensate/over-compensate elsewhere in the spinal column)

I did my first appointment ($300) the day after my release. I kept having nearly tears in my eyes as I could feel the ‘unclenching’ of various portions of my body and musculature, in the days following the release. I sorta wish I had done one session before the release, and one after. Alas, it was all exceptional, none the less.

Nasal Breathing #

A big part of a tongue tie is it’s contribution to things like sleep apnea. A big part of sleep apnea is snoring.

It’s ‘super unhealthy’ to breath through the mouth exclusively, or majority, or much at all. Oops, RIP my entire childhood. Tongue ties also relate to cavaties, because an open-at-night mouth is more prone to cavities. teeth grinding, which I did, so I wore a mouth guard, which pushed my mouth open even more, so I was 100% mouth breathing when I slept, even though when awake I’m aware of how dry the air in denver is and would close my mouth.

As soon as I read the book below, Breath, I began taping my lips at night. A thin little strip, vertically, right under the center of the nostrils. I could still mouth breath if I wanted, too, the tape simply prevented the lips from popping open on their own. My sleep changed, perceivably. For the better.

So much sleep issues can be fixed, just with that bit of tape. the first tape I was using was too sticky, left a residue, but I found better stuff and enjoyed being able to look forward to waking up with the inside of my mouth feeling rested instead of dried out.

Consider reading Breath: The New Science of a Lost Art by James Nestor. It’s sorta pop-sciencey, yet it nudged me into mouth taping most nights (certainly not 100%), and I certainly upped my percent-of-the-day nasal breathing when awake, too. It was already pretty high, now its quite close to 100%.

Misc Sources #

Here’s some internet rabbit trails to follow:

Want to stay up to date on these projects? Enter your email below, and you'll get an approximately-monthly newsletter from me.

If you don't see the subscribe form above, click here.

Readers have rated these messages from me as variations of 'interesting-enough', 'thought-provoking', and 'worthwhile'. It's also easy to unsubscribe from.