For the Record:
I grow increasingly confused and distressed by the growing misrepresentation of my thinking appearing on Facebook pages. Granted, Facebook was created by two college-aged boys wanting a gossip rag and therefore it is designed to conjure up teenage-like angst and drama, but the sheer number of venomous and downright mistaken commentary about me and aimed at me deserves an “on the record” response.
So, for the record:
1. I absolutely think that truly tongue-tied babies need to receive surgical treatment as soon as they are accurately diagnosed with the condition. I don’t care if it is by scissors, scalpel, laser or electrocautery. What I care about is that the right tool is used for the type of tie, the age of the baby and wielded by a skilled surgeon who knows how to properly use their surgical tool and how to properly treat the baby in the process.
2. I think ALL babies should once again be screened for tongue-tie and other oral issues within a week of birth. That is one of the main reasons I created the Assessment Tool for Lingual Frenulum Function©™ (ATLFF), which, by the way, is valid, reliable, sensitive and specific. It does work, as proven by numerous studies, and it works very, very, well.
Since I was the only researcher 25 years ago who cared to jump through all the methodological hoops to create a screening tool, I have the unique privilege and the responsibility of having done it first. As a result, any new tool must be measured against the ATLFF©™ to establish validity.(1) I didn’t make up the rules, the methodologists did. So far, no one has accomplished this task. That’s just the way it is.
3. So what do I mean by truly tongue-tied? Because I developed some and formalized and codified all of the diagnostic criteria for tongue-tie (Yep, that’s right. I am the one responsible for today’s diagnostic criteria) a truly tongue-tied baby requiring surgery is one who scores <11 on the ATLFF©™ function itmes and <8 on the appearance items. These screening items were very carefully researched and crafted over a three year period back in the early 1990s.
4. The above brings us to the issue of the faux tie. Many people have butchered this concept despite its simplicity. Faux tie babies are those who score borderline on the ATLFF©™. That means they scored 10, 11 or 12 on the function items and 8 or 9 on the appearance items. Faux tie is a specific term that no one has a right to co-opt. I coined it specific to and in relationship to ATLFF©™ scores.
What might cause a baby to score borderline on the ATLFF©™? Here is a partial list:
Asynclitic presentation at birth
Intrauterine lie compromises
Operative delivery like c-section, vacuum extraction or forceps
Cord wraps around neck or body
Rapid or very slow descent
Failure to complete cardinal movements
Plagiocephaly, brachycephaly, scaphocephaly, etc.
How do I know? We track this at our clinic.
Because the tongue organ inside the mouth box has limited ways to compensate for restrictions of any kind, it makes sense that functional deficits from acquired restrictions will be nearly identical to those caused by the congenital anomaly we call tongue-tie. That’s why differential diagnosis is so very important.
5. That brings me to the next item. Bodywork is a rubric under which all manner of manual therapies fall: occupational therapy, physical therapy, chiropractic, rolfing, craniosacral therapy, osteopathy (as practiced outside the US), etc. There are over a hundred ( and maybe more) modalities that are considered bodywork. Critics claim that there is no evidence to support the use of bodywork. Clearly, that is not factual.
When it comes to craniosacral therapy, the US government funded multiple studies to demonstrate its efficacy. The US armed forces use CST to treat veterans. As to its efficacy in treating infant sucking issues, there are three studies, one of which I designed and performed. As you read this blog, a multi-center, multi-country trial is being designed.
Should bodywork be used to resolve a true tie? The answer is a resounding NO! Can bodywork be used as an adjunct to surgical intervention? Yes, it can. Should it? That is a matter for continued discussion and research. The anecdotal evidence of its efficacy is mounting especially when the tongue-tied baby has a co-morbid acquired structural compromise.
Should bodywork be used to resolve acquired structural issues like torticollis, operative delivery injury, plagiocephaly and the like? It has been for decades. Physical therapy has long been used for torticollis; chiropractic has long been used to address subluxations and nerve impingement. I could cite many more examples but I won’t because everyone of you most likely has some positive experience with one or another bodywork modality.
Is bodywork the magic bullet? Absolutely not! Not every baby is a candidate. One must know whom and when to refer and to whom to refer.
Now let’s get to the really controversial stuff!
6. Do I believe in posterior tie? Let me answer by asking questions of my own:
What does belief have to do with it? Aren’t we supposed to be scientists?
Why does nearly everyone use the general term posterior tie when what they really mean is sub-mucosal tie?
The ATLFF©™ has always picked up on posterior ties so, for the record, I have always known they are a manifestation. The issue I have is with the sub-mucosal tie theory. (Yes, folks, it is only a theory, one that is yet unproven.) I have consistently and publicly been a skeptic. In the absence of solid evidence, I have a right to remain a skeptic until more data becomes available.
Why am I a skeptic? In my personal and extensive experience working with infant sucking compromises , the type of tongue restriction labelled a sub-mucosal tie has resolved with craniosacral therapy 100% of the time. I eschew surgery for these babies in my practice because I have an alternative to it. I would rather use a gentle hand than a beam or a blade.
7. What about the thing called a maxillary lip “tie”? Do I think it exists? Yes, I do. Do I think it’s wrong to cut on every baby who has a tongue-tie, presuming they all have lip ties as well in the absence of valid diagnostic criteria? Yes, I do. Why? Because the literature on the subject is very clear:
The tectolabial maxillary frenum is a normal morphological manifestation in infants. 93.3% of all babies have one.(2) This normal presentation is what Kotlow refers to as a class III or class IV maxillary lip tie. His classification schema is what many, many people use as their diagnostic criteria. Two well-done studies with very large samples sizes prove that the lip frena change significantly with growth and development: they get smaller, thinner and “rise” on the gumline as the teeth erupt. This process only completes with the eruption of the permanent teeth. (3,4)
So, what most people describe as a lip tie is actually a normal manifestation in infants. No surgery required. Only people in the US have their bowels in an uproar over maxillary lip tie. I speak all over the world. No where else in the world where I have been has this become an issue. Are they all wrong?
I will go into greater detail on the literature in a future blog on maxillary and mandibular frena soon.
Simply put, we have no diagnostic criteria for maxillary lip tie and breastfeeding. In the current state of lack of knowledge on the subject, what ethical side of the issue do you want to be on?
8. And last, but not least: Do you think it is OK to steal someone else’s intellectual property? If you do then you probably ought to take a course on copyright law and professional ethics. It is plain wrong to steal intellectual property and pass it off as one’s own. It is plain wrong to criticize, publicly or otherwise, the owner of that intellectual property when they defend their rights according to the law.
If you want to know what I think about tongue, lip and buccal tie, ask me directly. If you want to say something bad about me, have the courage to say it to my face. Here’s how to contact me:
If you are interested in participating in a safe, professional and respectful discussion about tongue-tie and other oral issues that impact breastfeeding then join us in the Tongue-tie and Other Oral Issues and Breastfeeding group on Linked-In. No bullying, no libel, no defamation and no drama allowed!
1. Greenhalgh, T. (2014) 5th edition. How to read a paper. Oxford: John Wiley and Sons, Ltd.
2. 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
3. Boutsi, E.A. (2014). The maxillary labial frenum. J Cranio Max Dis, 3:1-2.
4. 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.