Tongue Tie A-to-Z

Jacqueline Kincer: 0:39

Welcome back to the Breastfeeding Talk podcast. I'm your host, Jacqueline Kincer, and today's episode is actually a joint or collaborative episode with Katherine Bakke from Fitness Mama. If you have not listened to her podcast, I would highly recommend it. It's all about pregnancy, birth, and recovery, and this episode is actually one where she interviews me and we discuss the connection between tongue ties and breastfeeding.

Jacqueline Kincer: 1:08

So it's really cool because most of this information was pretty new to Kath and she had some lightbulb moments and really what I love about this episode and why I wanted to include it here on the Breastfeeding Talk podcast, was that it's a quick and dirty question and answer session. So the basics about what you'd want to know about how tongue tie affects breastfeeding what are signs and symptoms of a tongue tie in babies, how is it diagnosed, who should you consult with for an evaluation? What are the treatment options and how does that work. So we get into all of those things. This is going to be an episode that I referenced quite a bit with our clients, with people on social media who have questions, and I absolutely think that if you're an IBCLC or other professional, this would be a great episode to share as just a great summary and rundown of how tongue tie affects breastfeeding. So, without further ado, here is the episode that I did with Catherine Bakke at Fitnest Mama.

Katherine Baquie: 2:11

Hello and welcome back to another episode of the FitNest Mama podcast. Today's episode is all about tongue tie and I speak to Jacqueline Kincer, who is a passionate advocate for breastfeeding and founder and CEO of Holistic Lactation, and she also has a podcast herself called Breastfeeding Talk. So this conversation about tongue tie, just it actually blew didn't mind. didn't the effect that it could have in a baby and adult's life, and I have. Actually, after finishing this podcast episode with Jacqueline, I said to her oh, I had to. I actually pulled myself from, pulled myself back from asking all about how tongue ties affect adults because I thought, you know, no, that's not the scope of this podcast. And I said that to her. I said, oh, I had to stop myself from asking you about how the tongue tie affects adults. You know when the babies grow up, and she has kindly offered to, she's given me a link to a podcast episode. So if you're interested in hearing how tongue ties can affect babies as they grow up, or yourself, if you're an adult and you know you've got a tongue tie, then click the link in the show notes and that podcast episode is there for you.

Katherine Baquie: 3:39

So in this podcast today we talk about. Jacqueline discusses what is a tongue tie and how it affects the ability to breastfeed. Jacqueline talks about the signs and symptoms of a tongue tie, how it can be diagnosed, and we talk about the treatment options too, and it's perhaps not as the all the treatment options available, or perhaps not quite as you would have thought. Well, they were a lot more varied than I had initially thought. So brilliant episode. I trust you're going to love it. Send Jacqueline and myself a DM on Instagram at fitnessmama and let us know if you've listened to this episode.

Katherine Baquie: 4:19

But before I do dive into this episode, I do just want to thank you all once again for supporting this podcast along the way. It is now over two and a half years old. We've released over 140 episodes and this podcast is now listened to in 99 countries, to be precise, nearly a hundred countries around the world. So thank you so much for your support, Sharing this with your pregnant friends and new mum friends too.

Katherine Baquie: 4:45

And thank you for all the ratings and reviews that this podcast has been receiving lately, because sharing, rating and reviewing this podcast is probably the most important way to help this podcast reach more people and, at the end of the day. That's what it's all about. It's helping you have a wonderful pregnancy, motherhood, pregnancy, birth and motherhood experience. So thank you all once again. Right, let's dive into this episode with Jacqueline. Jacqueline, thank you so much for joining me on the Fitness Mama podcast. We are chatting all things tongue ties and how that affects breastfeeding, so it's a really great discussion we're having. So thank you so much for taking the time out to chat today. Can you please quickly introduce yourself for those who haven't come across you before?

Jacqueline Kincer: 5:46

Yeah, absolutely I'm excited to be here and just I love shows like yours. So, yeah, for those who don't know me, I am an IBCLC, so that's an international board certified lactation consultant. I'm the owner of Holistic Lactation, so we do virtual appointments. In fact, we've had a ton of Australian clients, believe it or not. And then we have some herbal supplements which aren't available in Australia but in the US, and so those are for milk supply and things like that. And then I have a podcast, the breastfeeding talk podcast, and then we have some online courses for breastfeeding as part of our program called the Nurture Collective. We do all of those things online to support moms with breastfeeding.

Jacqueline Kincer: 6:29

And really, you know, I would say my area of passion is tongue ties and it's really I didn't know it at the time, but the reason why I got into this work and what I do, because I kept looking for answers as to why breastfeeding was not going so great with my first baby and so ultimately, I realized that it was a tongue tie and a lip tie. So yeah, it's just been an area of passion of mine. I've been in practice for seven years now and, gosh, I've seen. I've seen so many different families, so many different situations. And yeah, it's been incredible, yeah, brilliant.

Katherine Baquie: 7:05

So let's start off with just the basics, so everyone's on the same page. What is a tongue tie and how does it affect the ability to breastfeed?

Jacqueline Kincer: 7:15

Yeah, a tongue tie is. Well, start off by defining what a frenem or a frenulum is. So that is, the band of collagen tissue that is underneath the tongue connects the floor of the tongue to the floor of the mouth. So everyone has one, they're totally normal you also. There's other frenulums inside our bodies as well, but there's other notable ones in the mouth. So the center of the upper lip that connects to the upper gums, the center of the lower lip connects to the lower gums. There's what's called buccal frenems and those are on the sides of both the upper and lower jaw connecting the cheeks to the gums. And then your heart has a frenulum. Your genitalia typically has a frenulum, especially if you're a man. So they're in our bodies. They're there for a reason and they're to kind of hold things together so they don't move too far apart. But a tongue tie is a frenulum that is abnormal. So there's a few different types of collagen. So a tongue tie is a particular type of collagen that is not stretchy, it is not flexible. So there's restriction of movement already.

Jacqueline Kincer: 8:30

And a tongue tie is also something that happens when the baby is in utero. It's very early on in the embryo stage In fact. Tongue tie. It's all decided really before 16 weeks gestation. So a lot of parents will ask me you know, was there anything I could have done to prevent it? And I'm like not really. And even if there was, you may not even know you were pregnant. So like it's kind of said and done. So it's really an incomplete process of cell death. So there's really a full attachment between the tongue and the floor of the mouth and as that baby moves forward in each embryological stage up to 16 weeks, that tissue is kind of deleted in those cells die but not enough of those die and that creates a tongue tie or a lip tie. So yeah, it's really. You know, the difference between a frenulum and a tongue tie is that one is normal and allows a full range of motion and the other is abnormal and restricts motion.

Jacqueline Kincer: 9:29

So when it comes to breastfeeding, gosh tongue tie causes a number of problems, from a poor latch, inability to maintain a latch, sometimes it's the inability to even latch at all. It can cause swallowing of air during feeding, whether that's breastfeeding or bottle feeding. It can cause difficulty with bottle feeding. It can cause a lot of tension in the jaw, in the shoulders, in the entire body because it can affect posture and the way that the baby is positioning themselves to try to, you know, come to the breast to feed. It can cause an incorrect swallow oh my goodness.

Jacqueline Kincer: 10:07

There's so many things, but those are probably the main things I mean it can cause for the mother. It can cause pain during nursing, so cracked, bleeding nipples, that type of thing, misshapen nipples. It can cause clogged ducts, plugged ducts, mastitis, because the milk isn't being drained from the breast as effectively and in fact, if the tongue isn't moving properly, it can actually push milk back up into the pores and the ducts in the nipple and into the breast. We've actually witnessed that on ultrasound and so that can cause clogged ducts and inflammation and mastitis and things of that nature. It can cause low milk supply because milk is not being removed as efficiently or as effectively as it could be. So there's so many different issues that we would see in breastfeeding caused simply by a tongue tie.

Katherine Baquie: 10:53

Yeah, okay, that was a lot of information you provided, and I'd just like to go back to when you were saying how the baby's developing in the womb. Is this a genetic condition or does it just happen randomly through that development process?

Jacqueline Kincer: 11:13

That's a really good question. As much as we've been able to research and piece together, it is fair to say that it's a genetic condition. So I have yet to see a baby with a tongue tie that doesn't have one or both parents that also have a tongue tie. So a lot of times you know the symptoms and older children and adults will be different because they're not feeding in the same way that an infant does and they're speaking and there's other things going on. But they're there. You just have to know what to look for. So, yeah, it's very hereditary, passed down, and that's how a lot of parents figure out that they do have a tongue tie is when we find it in their babies.

Katherine Baquie: 11:50

Okay, so let's go into some of the signs and symptoms of a tongue tie. So if a mother is breastfeeding or you've got a parent, what are some signs that might alert them to the fact that perhaps there's an issue here?

Jacqueline Kincer: 12:06

Yeah I would say really you know it could go any which way right, and so you don't need all of these symptoms for your baby to have a tongue tie. You don't need all of the symptoms all of the time or at every stage of breastfeeding. So what I mean by that is I've absolutely seen babies with very visually obvious tongue ties that are nursing great right after birth and getting colostrum and big gulps of it and doing really well. But then over the course of the next two weeks there's other symptoms that begin to present themselves, and so I think it's important to remember certain principles about lactation. One is that you know immediately after the birth you don't have this abundance of milk and that's on purpose. You have colostrum. It's in smaller quantities than mature milk. So when that's the case, sometimes it's easier for babies to manage the flow because it's not as fast. Sometimes it's harder for babies because they can't get the milk very well. So those babies that find it easier when your milk sort of comes in and now you have this abundance of milk, they aren't doing so great, whereas the opposite might be true for another type of baby. So it really just depends. But I would say you know it's really it could be anything and there's other reasons why these things can happen besides a tongue tie. But you know they're not latching, they're struggling to latch, they're struggling to stay latch.

Jacqueline Kincer: 13:34

I would say that really an easy red flag is pain during nursing. If it's hurting, if it's not just tender and maybe feels uncomfortable, but there's actual pain involved. And especially, I mean I don't think that any mom who's breastfeeding and that's experiencing pain isn't trying to troubleshoot it Like they're. They're trying to work on the latch, they're trying to figure something out, the positioning, whatever right, like if you've done the work to try to get that going as well as possible but it still hurts, or you have scabbing or bruising or Bleeding of your nipples, it's very likely that it's something like a tongue tie. It's really rare that I've seen Nipple damage because simply by a latching technique or positioning I would say that's almost something I've never seen. So you can have pain and soreness, but I wouldn't go that far. So that's, that's an easy red flag.

Jacqueline Kincer: 14:26

Babies that just don't, you know, they prefer one breast over the other, babies that have a lot of reflux, babies that seem colicky those are some really big red flag symptoms that are often mistaken for food allergy or food intolerance. But colic and reflux are not allergy symptoms in and of themselves. So it's really important for moms to make that distinction and not blame themselves and eliminate all these foods from their diets when Realistically, it could just be a tongue tie. The baby is swallowing air. That air comes up, it brings milk with it or it's in their tummies and it's causing discomfort and that's why they're screaming their heads off and that's why they won't eat, and so that's a common issue as well. So there's other little ones I kind of mentioned. But really I would just say you know, poor latch, your low Milk supply dropping anytime between six and 12 weeks postpartum that's another big clue.

Jacqueline Kincer: 15:20

So your milk production is driven by hormones after birth, and then between six and 12 weeks is when it shifts to how well your baby is removing milk from the breast or if you're pumping, it would be decided by that. So if nursing's been going okay or fine, but all of a sudden your baby is frustrated and seems hungry. Every time they come to the breast and they latch and they cry, and they latch and they cry and you're going oh, my goodness, my milk is just drying up. No, it's not, that won't happen unless you know Something has biologically changed with you to a really great degree, typically like a medication that dries up milk or something like that. It's very often something like a tongue type, where the baby was just never very efficient and was just kind of coasting by on your Hormones driving milk production amazing.

Katherine Baquie: 16:10

So it's really, it's really good to be aware of this as a possibility, because what you're saying I now want to check out two of my children out of three. I'm like, oh, maybe that was the issue. So the next question is how is it diagnosed and are we able to see ourselves, or is this something we need to go and consult, like with the doctor?

Jacqueline Kincer: 16:32

That's a really good question. It's all of the above. So here's where you know, I think that I never want to disempower a family or a mom like, but at the same time I think that there has to be a respect and medical expertise being held in a somewhat high regard. Because if that's not your training and you don't know what to look for and you don't know how to properly assess and examine, looking under your child's tongue and determining whether or not they have a tie, that's not how it works, that's not what we do when we're assessing and diagnosing. So you know, it's kind of a there's, there's like a lot of pieces. That kind of fall into the answer, this question, which is that assessing and diagnosing a tongue tie is not done just by the appearance of the tie or the frenulum. That, like, you cannot send somebody a photo and say is this a tongue tie? Maybe, if it's attached to the tip and it's very clear, the tongue cannot elevate from the floor of the mouth at all. Yeah, I could definitively say that's a tongue tie, but at the same time, a photo is a still picture, it's not in motion. So how does it affect the tongue movement? Because, again, we all have a frenulum. Whether or not it's a tie is dependent on if it causes functional problems. So when we say functional problems, we mean you know the function of the tongue tie and you know the proper motion of the tongue. And so what's really important for the tongue, especially when it comes to breastfeeding but this also plays into things like speech and breathing and swallowing later on in life Is that the back of the tongue is able to elevate to the roof of the mouth. So the tip of the tongue doesn't. We don't really need that to move. When it comes to breastfeeding, we need the back of the tongue to move. The tie is always going to be attached at the back of the tongue. It may or may not be also attached at the front of the tongue. So there's this whole idea of an anterior tongue tie and a posterior tongue tie. Every tongue tie has a posterior component, not every tongue tie has an anterior component. So if we don't have that proper elevation, and that's really hard for a lot of parents to assess.

Jacqueline Kincer: 18:43

Even having a baby suck on a finger can tell us some information. But their lips are kind of closed, like their mouth is not as wide open as it would be if they were on the breast. When I assess, there's mechanical things I look for. I look for the ways that the musculature of the baby's face and jaw and even their neck move. There's certain muscles that should be activated and moving when a baby is breastfeeding Versus bottle feeding. When I work in person, I have a stethoscope that I use to listen to the tongue movements and the way that the swallow sound and that gives me the most information. It's as accurate as an ultrasound to do something like that if somebody is well trained.

Jacqueline Kincer: 19:23

But I would say it's important that you get a functional assessment if you're wondering whether or not your baby has a tongue tie, and that can only realistically be done by an iBCLC or somebody that has training in breastfeeding and understands infant oral mechanics. If you go to a pediatrician, the pediatrician understands babies. They rarely understand tongue ties and they certainly don't understand lactation and breastfeeding Like that's not their training. They're. They're there to, you know, examine and care for the infant. They're not there to examine and care for you, the breastfeeding mom.

Jacqueline Kincer: 19:58

So I think it's just really important distinction to make, right and and iBCLC is. It's an international Credential. So we're all over the world. There is, you know, some standardization of our education and training. However, there's, you know, kind of only a subset of us that I would say are really truly skilled on this assessment and treatment of ties.

Jacqueline Kincer: 20:17

Because Treating ties isn't just about doing a surgical procedure to cut that for an ULM, it's also about retraining that baby's mechanics so that they stop using their tongue in a way that they've Known since they were in the loom To a new way that they've never tried or practiced before. And how do we get that baby to do that? It's not simply a matter of fixing the latch or the positioning. It's not just having them suck on your finger and do suck training, like there's way more to it than that. And so a lot of parents will just go and get a surgical treatment, but they don't do all of the other sort of you know physical therapy Kind of stuff that they should be doing to get those breastfeeding mechanics up to par.

Katherine Baquie: 20:59

I didn't realize that diagnosing was so complicated. I thought just have a little look.

Jacqueline Kincer: 21:08

Okay, amazing. I wish I wish it was easier.

Katherine Baquie: 21:11

I do, because it would just be yeah, but yeah it's, it's not yeah, okay, I've got so many questions but one I'm putting you on the spot a little bit, but is there any Like? Do we know, apart from breastfeeding, are there any long-term potential complications with tongue tie Like? I know you mentioned speech there, but what are the known complications, potential complications, I should say.

Jacqueline Kincer: 21:37

Yeah, absolutely, there's quite a few, and actually there's some great books on this. Maybe it's okay if I just share the author's name, but Dr Sherene Lim. She's actually an Australian dentist and she wrote this book called Breathe, sleep Thrive, and she's great. I've actually met her at a conference. Her book answers that question super in depth. So, if you really want to know.

Jacqueline Kincer: 22:02

But realistically, speech is one Posture. Elevation of the tongue is what we use to create our sounds, at least in my version of the English language, but yours as well. So, depending on your dialect, right, there's variations so people can compensate for their shortcomings. So, meaning like, you could have a tongue tie and you could make an R sound that sounds as clear as the one that I'm making, but you have to put extra effort into it and you're straining to do it and it's unconscious for you at this point because you just learned this pattern right. So there's things like that. Speech is going to be something that we notice more in children, where they're often referred to speech therapy or something like that. But there's other things I'd say.

Jacqueline Kincer: 22:43

The most important thing to recognize with a tongue tie is the impact it has on the airway, and this is true no matter what the age, it just evolves over time. So the posterior part of the tongue, the back of the tongue, it's supposed to rise up to the roof of the mouth, the palate. When that happens, there's two parts of the palate the more forward part, the anterior part, is the hard palate. Behind that is the soft palate. The hard palate doesn't move, so that's the floor of your nasal cavity and actually the tongue is what shapes the jaw and the entire midface. So the tongue is not just one muscle, it's a set of muscles, and the way that it works when it's feeding, when it's talking, but more importantly when it's at rest, is so important. So at rest the tongue, the whole tongue, should be sectioned to the roof of the mouth. If that's not the case, either the muscles are weak or they're untrained, or they're trained improperly, or there's a tongue tie that's preventing them from doing that. When the tongue does not rest on the palate, it's like a scaffold. Then the palate doesn't grow wide and broad and flat, it grows upward like a church steeple and it's impacting then the nasal passages. So instead of those nasal passages having the space that they should, they're narrowed and they're squished because the palate is now coming up into that space. So if our nasal passages are more narrow, anytime you have any nasal obstruction whether it's some random boogers in there or you have allergies you're going to be more prone to mouth breathing.

Jacqueline Kincer: 24:24

Mouth breathing requires us to keep our tongues at the floor of our mouth. That weight resting on our lower jaw brings our whole face down. So if you're chronically mouth breathing, if you're mouth breathing during sleep, if your tongue is not in the right position, you're changing the entire growth of your face, but also your airway, and so what happens is if the tongue is on the floor of the mouth, it's further back in the throat, so it's including the airway. When you lay down to sleep, especially if you sleep on your back and your muscles are relaxed and you no longer have conscious control over them, your tongue can fall back and occlude your airway. This can cause snoring. It can also cause apnea episodes.

Jacqueline Kincer: 25:03

So sleep apnea is a really big issue that is terrible for your cardiac health, for your brain health, and it's often unrecognized because it's such a tricky like diagnostic criteria, like you have to stop breathing several times an hour to be considered to have sleep apnea. I don't know how many times an hour, you're okay with not breathing, but I feel like you know, zero is what we should be aiming for, not like 10 is okay. So when you go to a sleep study, they're like, oh, you're fine, you only have like an AHI of six, but like should you stop breathing once every 10 minutes? Like that doesn't make any sense. So, anyway, we have a long way to go with sleep medicine, but that's a huge impact. And truly, though, like if your airway is somewhat obstructed, you can breathe, but you're over breathing, you're working harder to breathe and you get tired more easily. We have absolutely seen in children, and I'm sure adults as well this just hasn't been well studied yet, but symptoms of ADHD, that your brain it's not getting the right oxygen, co2, nitric oxide concentration. You're having to work harder, you're almost, you know, kind of just over breathing to compensate for the struggle that your body is unconsciously going through to keep that airway open, and it's, it's stressful, it's a low baseline level of stress. So to me I would say that's the most important impact.

Jacqueline Kincer: 26:27

And then there's dental ones. So you know, if your jaw doesn't grow correctly, you get teeth crowding. Cavities are also very common because the tongue can't reach certain places to clean the food off of the teeth in between teeth brushing. So yeah, there's there's a lot posture. That's another one. When the face and the airway don't grow properly, we tend to there's a hunching over. That happens, there's a tension of the shoulders are pulled up and and there's just all of this extra like just pulling of all of the musculature. And so what's really interesting is I've worked with adults when they've gotten their tongue ties released and we've done what's called myofunctional therapy for their muscles and you can just like, as that is, that tongue tie is released, their whole body just relaxes, like it's incredible, and they're like whoa, all my, wow, my shoulders are so low, like it just it's all connected. There's fascia, there's muscles, it's all connected and so much is controlled by the tongue.

Katherine Baquie: 27:30

Oh, I feel like you're talking to me about one of my children, like everything is sort of adding up. So it's really interesting to hear, isn't it? Because it's not just a tongue tie, it can affect so many different facets of life. So, and that just demonstrates the importance of identifying this early and then seeking the treatment options and I'm sure they will vary depending on the severity, I guess, of the tongue tie. Is that correct?

Jacqueline Kincer: 28:00

It is actually and that's something I really like to talk about because anytime there's like a healthcare provider that gets educated on ties, there's a little bit of like excitement, you know, and just like, oh, let's treat all the ties. You know, yes, let's treat them, but treatment does not always mean a surgical release of the tie. So you know, when it comes to infants, right like you don't ever want to I don't want to say ever. There's no absolutes when it comes to healthcare but rarely do you want to just go and get that baby's tongue tie released by a dentist, a doctor, midwife, whoever like. That's generally not a good thing to do. The reason for that is because if you haven't begun trying to reeducate those muscles and in the latch and ensure that you know there's a mom here too, right, so she's dealing with low milk supply or clogged ducks, or you know she doesn't know how to achieve a good latch Like. We've got to do all that first because if she's, you get the baby's tongue tie released. It's like a reset button, it's like a chance for that baby to start fresh. And if you have that baby being brought to the breast with a poor latch technique, you know, while they're going through this healing process while they've had that tongue tie released there's, you're not providing the benefit that it should. Like we're just doing the same old thing and expecting different results. Just because you've changed the anatomy, it doesn't automatically create a better outcome, and I think that's what a lot of parents miss Now. There are times where, like the baby like just physically cannot eat enough, no matter if it's bottle or breast, and yet let's go get that released and then we can work on all the other stuff. So, but that's rare. So yeah, anyway, you would kind of know, right With your healthcare team there, that would be pretty obvious. But yeah, even with adults like you've had, you know, if you're in your 30s, you've had three decades of doing things incorrectly.

Jacqueline Kincer: 29:57

If you think that you're gonna go and get your tongue tie released, like I, you are in for a lot of pain and a lot of like you don't know what to do with your tongue. I cannot tell you how shaky your tongue will be, how swollen it will be, how much pain you will be in if you have not done the therapeutic work ahead of time. So a baby thankfully does not have. You know, they recover much quickly. They don't have all the years of you know improper muscle use and things of that nature. But yeah, it's.

Jacqueline Kincer: 30:27

Should you always treat the tongue tie? You know? Here's the thing If you work with, you know, a skilled IV CLC who will tell you whether or not you need other people to be involved in this treatment plan. Right, let's say you get enough improvement from that, that the latch technique, maybe there's oral exercises, there's, you know, some body exercises you're doing with your baby. What have you? Right, like you've learned to manage some of this stuff and you've gotten enough improvement.

Jacqueline Kincer: 30:54

That at that point it's like, well, if we can only get like 10% more improvement or 20% more improvement by going and getting the tongue tie surgically released, is that really worth it? It's painful for the baby. There's a recovery process that has to go really well. Like you are going to have to go in there several times a day and lift your baby's tongue and make sure that wound stays open and doesn't grow back and reattach to what it was before the procedure was done, cause we don't put babies under general anesthesia, we don't do stitches. It's way too risky. So there's this cost benefit analysis that happens.

Jacqueline Kincer: 31:32

It's like is there enough improvement? And if there is, okay, maybe we don't need to surgically treat. If not, then we know it's absolutely necessary. And then there's the other thing, which is parents get to decide right. And I think it's important. If you just kind of know, okay, we've gotten as much improvement as we can, I'm comfortable with that. But I should definitely keep an eye out as my child grows, to look out for these issues. If they're going to the dentist and they're seven years old and we're already looking at braces, okay, well, maybe we should be looking at treating the tongue tie at that age.

Katherine Baquie: 32:07

Mm. Okay, a lot. That's, yeah, amazing. A lot of stuff there, food for thought. So I don't know if there's I've got a follow up question. I feel like we have talked through everything, plus more of what I had planned. So, to wrap up, have you got any final like? Is there anything we haven't discussed that you do just want to let listeners know?

Jacqueline Kincer: 32:33

Yeah, to finish off with, I'll say that you know, tongue tie is what's really going to be responsible for most of the symptoms that stem from having oral ties. But there are lip ties, typically upper lip ties. There are buckle ties and those do also cause breastfeeding problems. They don't cause the same number or degree of breastfeeding problems but they're important. And so you know, a lip tie is more likely to cause breastfeeding pain, less likely to cause a lot of the other issues, because we're just talking about a lip that should generally be at rest and just create a seal around the breast or the bottle. It's not swallowing, it's not doing all the other.

Jacqueline Kincer: 33:16

You know way more advanced things, but it's important to make sure that you're treating all the ties if they exist and they're causing problems, treating only one of the tie and ties and deciding to leave the rest. I have never, ever seen that work out well and I have worked with a lot of tied people, like I've assisted in a dental office with doing the vernactomy procedure and being able to see the immediate pre-op and post-op outcomes. It's just. I would just say don't think it's only tongue tie or don't think it's only lip tie and then also lip ties and buckle ties, especially buckle ties really don't exist without a tongue tie. So if you're thinking, well, my baby only has a lip tie. I would say that you probably want to get a second opinion on that, because it's very, very likely they also have a tongue tie. So that would be my last piece.

Katherine Baquie: 34:08

Okay, and second opinion from IBCLC. I always get that wrong. I'm taking them for sure.

Jacqueline Kincer: 34:18

But yes, ibclc because and it's not like you don't have to, you know, work with me or everywhere, right, like whoever is, you know. But it's because an IBCLC is the only credential out there for lactation that makes somebody an actual clinician and a healthcare provider, where we have supervised clinical hours. We have a board exam that we pass. There are other lactation certifications that allow people to teach, to counsel you. They don't allow that person to do something more advanced.

Jacqueline Kincer: 34:52

And then kind of the issue with, like, obs and midwives. Midwives do no basic newborn care, of course, but OBs are focused on the mother and the woman and her health. Pediatricians are focused on the infant and that baby's health, and so there's like this you know, breastfeeding is two people. So I think you know I just haven't seen there are exceptions, of course, right, dentists are really typically a great option if you're wanting to get somebody that might know more about ties. But an IBCLC if you're breastfeeding, even if you're bottle feeding, we work with that as well. That's gonna be kind of the one stop shop where you go. This person is gonna know both the lactation and breastfeeding side of things plus the oral ties side of things, and then kind of help me navigate and communicate with all these other pieces if they need to be involved.

Katherine Baquie: 35:45

Amazing, jacqueline. Thank you, we will leave it there. That has been. Yeah. Trust that it has been really valuable to any mums or parents listening who are concerned about their baby's feeding and specifically any tongue ties. So thank you so much for joining me today. I really do appreciate you taking time out.

Jacqueline Kincer: 36:05

Yeah, thank you so much for having me. I'm excited to chat about this and, yeah, hopefully, this is helpful for your listeners and everyone's learned something new.