There is no such thing as a mild lip or tongue tie, NO SUCH THING!!!
So WHY did my provider diagnose my son/daughter/self with a class III or a class IV tongue tie? The method of classifying a tongue tie as a class I, II, III, IV is a method developed by Lawrence Kotlow, DDS and refers to where the insertion point is on either the lip or the tie. Which is important for the provider team to keep in mind but does not indicate severity. You should note which scale you are referencing if using classification as there are multiple scales out there these days.
OR maybe…you were told your child has a mild tongue/lip tie and does not warrant a release? That would be SO confusing! I get it. Let’s clarify WHAT it means to have a diagnosed tongue and/or lip tie.
Structure and Function
When diagnosing whether or not someone has a tongue and/or lip tie, we are looking not only at the structure (is there a tight frenum under the tongue and/or lip) but also function. HOW is the tongue/lip FUNCTIONING, is the presence of tight tissue impacting feeding, speech, sleep, etc.
To put it another way, for a tongue and/or lip tie to be present and warrant a diagnosis, the provider MUST find that there is a negative impact on function. For example, we may see a tight frenum under the tongue AND ALSO see any of the following symptoms (not an exhaustive list): excessive gas, colic, poor latch if breastfeeding, open mouth posture, low & forward tongue position at rest, sleep disorders, behavioral challenges, etc.
Bottom line? There is no such thing as a mild tongue tie. It’s either present or it isn’t. AND a provider should NOT be diagnosing the presence of a tongue and/or lip tie without advanced training in tethered oral tissues (tongue ties) and the completion of a functional evaluation!!
When should you be concerned that a tongue and/or lip tie may be making a functional impact that needs to be assessed? Check out these common signs and symptoms below.
Signs and symptoms of a tongue and/or lip tie:
- crying/screaming infant, unable to soothe them
- excessive drooling
- difficulty latching if nursing
- lack of weight gain
- weak suck
- open mouth posture
- tongue low/forward in mouth
- high, narrow palate
- sleep issues
- neck/back pain
- inappropriate feeding behaviors
- digestive issues, GERD
IF you’ve been diagnosed with a mild tongue tie but you continue to have any of the symptoms listed above, don’t hesitate to get a second opinion from a provider trained in completing a functional assessment for tethered oral tissues. For children under cognitive age 4 years of age a functional feeding assessment with an SLP or OT who is properly trained is recommended; see a list here. For children age 4 (cognitively) through adulthood, find a provider here under our myo directory.