Understanding Tongue Tie from Birth Onwards – Post 6
Our blog series on assembling the ideal team to treat your tongue-tied infant continues today with amusing discussion of the role of a functional medicine pediatrician. Often, just having an IBLC and a bodyworker onboard to work with your baby before and after a frenectomy will be just fine. However, there are some babies who will have issues with healing and who will require further support. In this case, a functional medicine pediatrician can be an invaluable resource.
I am using the term “functional medicine pediatrician” to indicate that the average pediatrician will not have the training or knowledge required for this work. You will need a specialist who will likely be a pediatrician with training in understanding epigenetic and how it affects healing and inflammation. However, there can be other people who are qualified for this work and whose services can be more affordable and accessible than visiting a dedicated functional medicine pediatrician, such as a naturopath, functional medicine nutritionist, alternative physician, and some chiropractors. As with any medical professional, ensure that the person is reliable and qualified before entrusting them with the care of your child.
For simplicity sake, I will refer to the person in this role as a functional medicine pediatrician, but bear in mind but this role could be taken on a non-physician.
How healing occurs after a frenectomy
After frenectomy, a new frenum forms. The frenum is the muscle attachment that attaches the tongue to the lower jaw or mandible and which limits that range of motion, and in the case of a tongue tie it is too limited. Releasing the tongue tie should allow the tension to dissipate, but sometimes there can still be tension in this area. The connections of muscles and tissues throughout the body can create this which continues to pull the tongue down to the floor of the mouth, even when the tongue tie has been released. This tension means that the newly formed frenum can be short and tight like the tongue tie was before the surgery.
If this happens during healing, bodywork and intra-oral work is extremely helpful. But sometimes even this will not be enough to release the tension from the tongue, particularly when the baby’s body has systemic problems which give rise to inflammation. Inflammation can cause the body’s systems to attack the surgical wound too viciously, making the wound heal too tightly. In these cases, a functional medicine pediatrician can diagnose, recommend supplements to reduce overall systemic inflammation, recommend diet changes if they are contributing to the inflammation. When the inflammation is addressed, the new frenum will be able to remodel to have the right type of collagen, good elasticity, good length, and good function. I give an example here to my patients. I had a home birth planned for my daughter but ended up with an emergency c-section. I had some issues after her birth and formed a large, ugly keloid scar. This is abnormal wound healing. I know my genes, and I do not have the predisposition to heal this way. It wasn’t until my daughter was 16 months old that the inflammation in my body was under control (and at the same time all the extra weight and bloating was gone) that the keloid from the c-section completely remodeled and now looks like the skin around it. When a baby has a complete release and heals poorly, forming a new, short, tight frenum, it is imperative that you find out why they healed that way. If you find out and address that issue, they will remodel without any need for more surgery. If you don’t find out and just jump into a new surgery, almost without fail your baby will heal the same and then scarring can become a new issue.
What a functional medicine pediatrician does
A functional medicine pediatrician looks for indications of inflammation in the body. This can be done with some visual exam (things like baby acne, cradle cap, and eczema are obvious signs) or through the use of cheek swabs. There is also a developmental panel swab which can be analyzed for developmental, diet and genetic issues. These swabs could indicate an issue such as impaired methylation (a part of DNA production), impaired autophagy (the body’s ability to remove toxins), vaccine sensitivity, and inflammation and triggers in the diet.
The aim is to pinpoint the underlying causes of tightness or poor healing around the frenum and to handle any other issues which could be causing inflammation. The functional medicine pediatrician can also check whether the baby is suffering from food allergies (passed on from the mother’s diet via her milk) and advise on the safest vaccination schedule for babies facing specific challenges or sensitivities.
How a functional medicine pediatrician looks for genetic factors
If none of these issues are found, then the next step is to look at genetic factors, especially a variation in DNA called a single nucleotide polymorphism, or SNP, which can affect the body in all sorts of ways. For example, my nephew has an SNP which we know causes problems with healing, so if he were to have a frenectomy we would expect him to have healing problems that would have to be addressed.
It sounds scary, but you do not need to panic if an SNP is found. Genetics do not necessarily determine health outcomes so much as they determine how your body interacts with its environment. Again, in my nephew’s case, we know that he has SNP for celiac disease which means that if we didn’t know and fed him gluten he would eventually develop celiac. Knowing this, his parents have taken control of his diet to prevent this from happening and give him supplements when he does eat gluten at a friend’s house, for example. Knowing about the SNP allows them to take steps to prevent it from becoming a more serious problem.
How a functional medicine pediatrician helps treat a tongue tie
Once the tests have pinpointed a cause of inflammation, then work can begin in reducing it. If the problem is thought to be a food allergy then this can be investigated through an elimination diet, in which the mother cuts out certain food groups such as dairy or soy to see if that helps the baby to heal. This process will take some time so it won’t be the case that the inflammation disappears immediately. There are also supplements that can be given to reduce whole body systemic inflammation.
If there is an MTHFR SNP many just think they need to load up on folate. But, if a child has inflammation and you throw folate in their system it can have a negative effect. Dr. Paula Kruppstadt, a fantastic Functional Medicine Pediatrician, says it’s like “throwing gas on a fire.” She would tamp down the inflammation first, then add in the right methylation vitamins.
In the case of an SNP such as the tumor necrosis factor (TNS) SNP, for example, then the functional medicine pediatrician can prescribe supplements to aid in the healing process after a frenectomy. Just knowing a child has it would alter the way we approach the surgery for a more optimal outcome.
When you need a functional medicine pediatrician
With all the ways that a functional medicine pediatrician can help support a baby especially after surgery, you might expect that all babies would have swabs taken to check for these kinds of issues. Unfortunately, the access to this progressive, precise medicine is expensive and limited, therefore we usually only request these extra steps in the case of very tight healing…because it is vital to know which issues are causing problems with healing to avoid a second surgery.
Without the advice of a functional medicine pediatrician, surgeons can look at tight healing after surgery and assume that what the baby needs is another surgery, which as already mentioned would actually be detrimental to the baby’s well-being. Some kids can be subject to two or even three surgeries! Thoroughly investigating the underlying cause of any post-surgical tightness can enable fixing of the issue without further surgery, or at least can inform the methods of a second surgery for a better outcome.