Alison Hazelbaker, PhD, IBCLC, FILCA, CST, RCST

spiritofhealingllc@gmail.com (614) 326-3504

Dr. Hazelbaker specializes in cross-disciplinary treatment and to that end has taken training in several modalities to best assist her clients. She is a certified Craniosacral Therapist, a Lymph Drainage Therapy practitioner, and an International Board Certified Lactation Consultant.

See a Bully. Stop a Bully. Make a Difference!

By now, you have either heard about or read both the Breastfeeding Today Blog Post and the protest letter that was published nearly immediately after its release.

The blog post can be found at www.Breastfeedingtoday-llli.org/tongue-tie-lip-tie-diagnosis-treatment-aftercare/ and the letter could previously be found at www.facebook.com/groups/lactnet/ (23rd Nov.) and www.facebook.com/kellymomdotcom/?fref=ts (23rd Nov.) However, I can no longer find the letter on either site.

The protest letter is another example (out of many) of the bullying that accompanies any attempted rational discussion regarding tongue-tie and other oral restrictions, and their proper assessment and treatment. The signers take exception to it because the blog does not conform to their particular rhetoric. Some of the signers you will recognize as people who have a low tolerance for anyone who disagrees with them. The others have surprisingly chosen strange bedfellows!

I think if one is going to criticize someone else in scientific circles, they ought to have solid methodological and research ground on which to stand. In this case, the ground on which these signers stand cannot support their collective ego weight.

For those of you who doubt that I have done my research, and for those of you who simply want more background information for the blog post and my other writings, please find my list of references below.

Before you go, let me just share a few stories that prompted the writing of the blog post:

Hundreds of babies have undergone both lingual and maxillary frenectomy to resolve breastfeeding problems only to experience no resolution. The stories of these babies are the garden variety stories. The stories I tell here are not so garden variety. I daily receive emails from scared, disillusioned and angry parents.

A woman brought her baby into our free bodywork clinic and told us her baby had been refusing the breast for weeks. She had heard that craniosacral therapy would finally resolve her breastfeeding problems. She wanted us to check her baby to see if his frenulum had “regrown.” I checked his tongue underside and examined him for tongue function: he had massive scarring attaching his tongue to the floor of his mouth and significantly compromised tongue function. I asked her what had happened. Her baby had received not one, but four lingual frenectomies and one labial frenectomy! Each frenectomy was followed by excessive new scarring. Had she been doing the aftercare protocol? You bet she had!

She reported he screamed each time she did the “exercises,” especially when she rubbed the wound the way the dentist showed her to. With every new frenectomy, he became more and more orally defensive until he just stopped going to breast…

She showed me the before pictures and video. He had a normal maxillary frenum before revision with perfect range of motion. His tongue was retracted making his lingual frenum appear tight. What was his real problem? He had a severe torticollis that no one ever assessed let alone addressed.

What did we do? We did craniosacral therapy, chiropractic, OT, and some PT. The baby eventually latched on again but his willingness was still reserved. Did we treat the scar tissue? Yes, with a scissors frenotomy; No diamond-shaped wound; No aftercare stretches; No new scar tissue and we were able to normalize his suck.

In an Eastern state, a mom took her baby for both maxillary and lingual revision. The baby aspirated her blood and ended up in a medically induced coma. When she posted on Facebook for support, her posts were removed and she was accused of fraud.

In a Western state, a mother took her baby to see a local lactation consultant who took a quick look at her baby and told her the baby had both a tongue-tie and a maxillary lip “tie.” No history was taken, no care plan other than frenectomy by laser was recommended. When the IBCLC found out the mom took the baby for a second opinion, she called the mom and browbeat her for not getting the frenectomies done, as she had told her to do.

A baby in Canada received 6 frenectomies with no change in his suck-swallow-breathe coordination.

A mom in my practice brought her baby in for assessment and treatment. Her baby was popping on and off the breast and not gaining sufficiently. The baby had an obvious anterior-tie and what the dentist classified as a class 4 maxillary tie. The baby underwent laser revision for both tongue and lip. The mom brought the baby in for her second visit with me directly after the revisions. The baby’s upper lip was so swollen she could not close her lips. She certainly couldn’t breastfeed. We tried everything to get the baby as comfortable as possible and keep her fed. We ended up dropping expressed breastmilk into the baby’s mouth one drop at a time. It took more than an hour to get the baby to calm down. The mom continued the dropper feeds for 36 hours!

Why did the lip swell so badly? The dentist accidentally lasered the lip muscle. This was the last baby I sent for maxillary lip revision.

The stories I have in my archives exceed the number of signers on this ridiculous protest letter. The stories many of my colleagues have to tell do as well. To the signers I say: Pull your heads out of your collective arse: there’s harm being done!

Stay tuned for my upcoming blogs on maxillary lip “tie,” wound healing and torticollis! Until then, keep protecting our babies!



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Messner, A.H., & Lalakea, M.L. (2002). The effect of ankyloglossia on speech in children. Otolaryngology-Head and Neck Surgery, 127, 539-545.

Meyer Palmer, M.,  & VandenBerg,  K.A. (1998). A closer look at neonatal sucking. Neonatal Network, 17, 77-78.

Meyer Palmer, M. (2002). Recognizing and resolving infant suck difficulties. Journal of Human Lactation, 18, 166.

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Miller, M.J., Martin, R.J., Carlo, W.A., Fouke, J. M., Strohl, K.P., & Fanaroff, A.A. (1985). Oral breathing in newborn infants. Journal of Pediatrics, 107, 465-469.

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Pransky, S.M., Lago, D. & Hong, P. (2015). Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties. International Journal of Pediatric Otorhinolaryngology, http://dx.doi.org/10.1016/j.ijporl.2015.07.033

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Thomas, J. & McClay, J.E. (2015). Breastfeeding: what to do about ankyloglossia, lip-tie. AAP News, 36(6):11

Todd, D. (2014). Tongue ties: Divide and conquer? To divide and prevent an interruption in breastfeeding. Australian Breastfeeding Association Seminars for Health Professionals.

Todd, D., & Hogan, M.J. (2015). Tongue tie in the newborn: early diagnosis and division prevents poor breastfeeding outcomes. Breastfeeding Review, 23(1):11-6.

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Woolridge, M. W. (1986).  Aetiology of sore nipples.  Midwifery, 2, 164-171.

Woolridge, M. W. (1986).  The anatomy of infant sucking.  Midwifery, 2, 164-171.

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Infant Trauma

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Karen, R. (1998). Becoming attached. New York: Oxford University Press.

Levine, P. & Kline, M. (2007). Trauma through a child’s eyes. Berkeley: North Atlantic Books.

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Page, G.G. (2004). Are there long-term consequences of pain in newborn or very young infants? The Journal of Perinatal Education, 13(3): 10-17.

Porges, S. (2011). The Polyvagal theory: Neurophysiological foundations of emotions, attachment, communication and self-regulation. New York: W.W. Norton & Company.

Rothschild, B. (2000). The body remembers. New York: W.W. Norton & Company.

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Siegel, D. (2012). The developing mind. New York: Guilford Press

LASER

Cobb, C.M., & Vitruk, P.(2015). Microbial decontamination of three different implant surfaces using a super-pulsed CO2 (10,600) laser: An in vitro study. The Academy of Laser Dentistry Meeting, Feb. 5-7, Palm Springs, CA.

Convissar, R. (2011). Principles and Practice of Laser Dentistry. St. Louis: Mosby Elsevier.

Kaplan, M., Hazelbaker, A.K. & Vitruk, P. (2015). Infant frenectomy with 10,600 nm dental co2 laser. WAGD Newsletter, April.

Vitruk, P. (2014). Oral soft tissue laser ablative & coagulation efficiencies spectra. Implant Practice US, November.

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Waynant, R.W. (2001). Lasers in Medicine.  Boca Raton:CRC Press.

Zeinoun, T., et al. (2001). Myofibroblasts in healing laser excision wounds. Lasers in Surgery and Medicine, 28:74-79.

Maxillary Frenum and Lip tie

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Chan, L., & Hodes, D. (2003). When is an abnormal frenulum a sign of child abuse? Arch Dis Child. Doi: 10.1136/adc.2003.031534.

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De Carvalho Stroppa, S., et al. (2014). Surgery management of rare hypertrophic frenum in an infant: a case report. Case Reports in Dentistry. http://dx.doi.org/10.1155/2014/168192.

De Morais, J. F., et al. (2014). Postrentention stability after orthodontic closure of maxillary interincisor diastemas. Journal of Applied Oral Science, 22(5):409-15.

Delli, K., Livas, C., Sculean, A., Katsaros, C., & Bornstein, M. (2013). Facts and myths regarding the maxillary miline frenum and its treatment: A systematic review of the literature. Germany Quintessence International, 44(22):177-87.

Desai, A.J., et al. (2015). Bilateral pedicle approach for esthetic management of upper labial frenum. Journal of Interdisciplinary Dentistry. 5(1): 27-30.

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Dewel, B.F. (1966). The labial frenum, midline diastema, and palatine papilla: A clinical analysis. Dent Clin North Am. 10:175-84.

Diaz-Pizan, M.E., & Lagraverere, M. O. (2006). Midline diastema and frenum morphology in primary dentition. J Dent Child, 73: 11-14.

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Flinck, A., Paludan, A.,  Matsson, L., Holm, A.K. & Axelsson, I. (1994). Oral findings in a group of newborn Swedish children. Int J Paediatr 4(2):67-73

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Hazelbaker, A. (2010). Tongue-tie: morphogenesis, impact, assessment and treatment. Columbus: Aidan and Eva Press.

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Jenista, J.A. (2001) Mandibular frenulum as a sign of infantile hypertrophic pyloric stenosis. 2001;138:447. J Pediatr.138:447–7. 

Kaimenyi, J.T. (1998). Occurrence of midline diastema and frenum attachments amongst school children in Nairobi, Kenya. Indian J Dent Res. 9:67-71. 

Kakodkar, T., et al. (2008). Clinical assessment of diverse frenum morphology in permanent dentition. The Internet Journal of Dental Science. 7(2). http://ispub.com/IJDS/7/2/4074.

Kotlow, L.A. (2004). Oral diagnosis of abnormal frenum attachments in neonates and infants: Evaluation and treatment of maxillary frenum using the Erbium YAG Laser. J Pediatr Dent Care. 10:11–4.

Kotlow, L.A. (2010). The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: Prevention, diagnosis, and treatment. Journal of Human Lactation, 26(3):304-08.

Kotlow, L.A. (2013).  Diagnosing and Understanding the Maxillary Lip-tie (Superior Labial, the Maxillary Labial Frenum) as it Relates to Breastfeeding.J Hum Lact . 29(4): 4458-464.

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Maguire, S., et al. (2007). Diagnosing abuse: A systematic review of torn frenum and other intra-oral injuries. Arch Dis Child. 92:1113-7.  

Martin, R.A., & Jones, K.L. (1998). Absence of the superior labial frenulum in holoprosencephaly: A new diagnostic sign. J Pediatr. 133:151–3. 

Mazzocchi, A,& Clini, F. (1992). Indications for therapy of labial frenum. La Pediatria Medica e Chirurgica, 14(6):637-40.

Mintz, S.M., Siegel, M.A., Seide,r P.J. (2005). An overview of oral frena and their association with multiple syndromes and nonsyndromic conditions. Oral Surg Oral Med Oral Pathol Oral RadiolEndod. 99:321–4.

Mohan, R., et al. (2014). Proposed classification of medial maxillary labial frenum based on morphology. Dent Hypotheses; 5:16-20.

Nagavini, N.B. & Umashankara, K. V. (2014). Morphology of maxillary labial frenum in primary, mixed, and permanent dentition of Indian children. J Cranio Max Dis, 3:5-10.

Noyes, H.J. (1935). The anatomy of the frenum labia in newborn infants. Angle Orthod, 1:3-8.

Paramala, B.K., & Prithviraj, D.R. (2012). A comparative study of mandibular incisor relation to the lingual frenum in natural dentition and in complete denture wearers. J Indian Prosthodont Soc. 12(4):208-15.

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Priyanka, M., Srithi, R., & Ambalavanan, N. (2013). An overview of frenal attachments. J Indian Soc Periodontal. 17(1):12-15.

Pushpavathi, N., & Nayak, R.P. (1997). The effect of mouth breathing, upper lip coverage, lip seal and frenal attachment on the gingiva of 11-14 year old Indian school children. J Indian Soc Pedod Prev Den. 15:100-3.  

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Suter, V.G., et al. (2014). Does the midline diastema close after frenectomy? Quintessence Int. 45(1):57-66.

Teece, S. (2004). Torn frenulum and non-accidental injury in children. EMJonline. Doi: 10.1136/emj.2004.022079.

Townsend, J. A., et al. (2013). Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population. General Dentistry. March/April; 57-60.

White, J.A., Bond, I.P., & Jagger, D.C. (2013). A novel solution to the fraenal notch of maxillary dentures. Eur J Prosthodont Restor Dent. 21(3):120-6.

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Torticollis, Plagiocephaly and Brachycephaly

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Ardran, G. M., Kemp, F. H., & Linda, J. (1958).  A cineradiographic study of breastfeeding.  British Journal of Radiology,  31, 156-162.

Arvedson, J.C., & Brodsky, L. (2002). Pediatric swallowing and feeding: Assessment and management. (2nd ed.). Albany: Singular Publishing Group/Thomson Learning, Inc.

Atmosukarto, I., et al. (2009). Automatic 3D shape severity quantification and localization for deformational plagiocephaly. Proc SPIE, Jan1, 7259(725952): doi:10.1117/12.810871.

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Boiron, M., Da Nobrega, L., Roux, S., Henrot, A., & Saliba, E. (2007). Effects of oral stimulation and oral support on non-nutritive sucking and feeding performance in infants. Developmental Medicine & Child Neurology, 49, 439-444.

Bosma, J.F. (1985). Postnatal ontogeny of performance of the pharynx, larynx, and mouth. American Review of respiratory Disease, 131 (supplement), S10-S15.

Bosma, J.F., Hepburn, L.G., Josell, S.D., & Baker, K. (1990). Ultrasound demonstrations of tongue motions during suckle feeding. Developmental Medicine and Child Neurology, 32, 223-229.

Breastfeeding and birthing: do birthing practices affect breastfeeding?  (2007). INFACT Newsletter, Winter, 1-2.

Brookes, M., & Zeitman, A. (1998). Clinical embryology: a color atlas and text. Boca Raton: CRC Press.

Broussard, D.L.; & Altschuler, S.M. (2000). Central integration of swallow and airway-protective reflexes. American Journal of Medicine, 108, 62S-67S.

Bruneteau, R. J. &Mulliken, J. B. (1992). Frontal plagiocephaly: synostotic, compensational or deformational. Plast Reconstr Surg: Jan: 89(1): 21-31.

Bystrova, K. et al. (2007). The effect of Russian home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Hum Dev, Jan:83(1): 29-39.

Cabrera-Martos, I., et al. (2013). Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv Syst: Oct: 29(10): 1893-1898.

Cavalier, A., et al. (2011). Prevention of deformational plagiocephaly in neonates. Early Hum Dev, Aug: 87(8): 537-543.

Collett, B., et al. (2005). Neurodevelopmental implications of “deformational” plagiocephaly. J Dev Behav Pediatr: Oct: 26(5): 379-389.

Collett, B., et al. (2011). Development in toddlers with and without deformational plagiocephaly. Arch Pediatr Adoles Med: July: 165(7): 653-658.

Collett, B., et al. (2012). Brain volume and shape in infants with deformational plagiocephaly. Childs Nerv Syst: Jul: 28(7): 1083-1090.

Collett, B., et al. (2013). Development at age 36 months in children with deformational plagiocephaly. Pediatrics: Jan: 131(1): e109-e115.

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