Oral Ties and Infant Reflux. Can They Be Related?

When your infant is uncomfortable, everyone is uncomfortable.

Infant reflux, also known as gastroesophageal reflux (GER), is a common condition that occurs when stomach contents flow back into the esophagus. Although this typically resolves on its own as the infant’s digestive system matures, some infants may experience frequent or severe reflux, which can be a very challenging time for not only the infant but the caregivers of the infants as they work with medical professionals to figure out the appropriate treatments. Two conditions that can affect an infant’s ability to breastfeed or bottle-feed effectively, and may also be related to infant reflux, are tongue-tie and lip-tie.

Did you know that per the Journal of the American Dental Association, between 2 and 20% of infants will be diagnosed with a tongue-tie?

You may be wondering, what are a tongue-tie and a lip-tie? 

• Tongue-tie (or ankyloglossia): when the tissue that attaches the bottom of the tongue to the floor of the mouth is too short, tight, or thick and typically restricts the tongue's range of motion
• Lip-tie: when the tissue that attaches the upper lip to the upper gum is too short, tight, or overly large and often leads to decreased function of the upper lip 

Tongue and lip-ties often cause difficulty with breastfeeding due to an incorrect latch. The results of an incorrect latch may include the following: 

• Poor suck
• Poor seal around the breast
• Loud clicking noises due to tongue recoil
• Long feeding times
• Poor infant weight gain
• Infant fussiness and irritability during/after breastfeeding
• Maternal nipple pain
• Symptoms of reflux and colic 

When an infant has a poor latch and struggles with tongue or lip-ties, there may be an increase in the swallowing of air, also known as aerophagia. Oftentimes, this can lead to abdominal distention (swollen stomach) after feedings, colic, and possibly reflux. 

Reflux may be seen with aerophagia as the swallowing of air may increase stomach pressure and may overcome the lower esophageal sphincter pressure. This can lead to gastric contents refluxing into the upper airway. Therefore, evaluation for lip/tongue ties in infants with symptoms of reflux should be considered as part of the workup, diagnosis, and treatment. 

Symptoms of infant reflux may include the following: 

• Irritability and pain 
• The infant may be inconsolable especially when laid down flat 
• Difficulty sleeping when lying down 
• Arching their neck and back during or after feeding
• Problems swallowing
• Gagging, coughing, hiccupping, and drooling 
• Feeding refusal or constant feeding 

Is it too good to be true that a simple laser procedure correcting oral ties may help your child's reflux? Well, let’s take a look at a few articles that I found interesting. 

A retrospective analysis looked at 1000 breastfeeding mother-infant dyads over 5 years in a private oral and maxillofacial surgery practice. Of the 1000 infants, 525 (52.6%) had an improvement in symptoms of reflux within the first week after surgical release. The improvement in reflux was significant enough that either a reduction or a stop of their acid reflux medication happened. 

Lawrence Kutlow published a study which he completed at his private practice. He looked at 340 mothers who had been referred to him for breastfeeding difficulty - the infants ranged from 1 week to 8 months old. 194 mothers reported their baby had symptoms of reflux. Of the 194 babies with symptoms of reflux, 40% were being treated with acid-reducing medications with no improvement of reflux. He completed tongue/lip-tie releases and after a 48-hour follow-up, 93% of those infants indicated immediate improvement in clinical signs of reflux. 

1. _{Cruz, P. V., Souza-Oliveira, A. C., Notaro, S. Q., Occhi-Alexandre, I. G. P., Maia, R. M., De Luca Canto, G., Bendo, C. B., & Martins, C. C. (2022). Prevalence of ankyloglossia according to different assessment tools: A meta-analysis. Journal of the American Dental Association (1939), 153(11), 1026–1040.e31.}  
2. _{Mayo Foundation for Medical Education and Research. (2018, May 15). Tongue-tie (ankyloglossia). Mayo Clinic. Retrieved April 20, 2023.}
3. _{WebMD. (n.d.). Lip ties: Causes, symptoms, and more. WebMD. Retrieved April 22, 2023.}  
4. _{Kotlow, L. (2011). Infant Reflux and Aerophagia Associated with the Maxillary Lip-tie and Ankyloglossia (Tongue-tie). Clinical Lactation. 2. 25-29.}
5. _{Siegel, S. (2016). Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie). International Journal Of Clinical Pediatrics, 5(1), 6-8}
6. _{Kotlow, L. (n.d.). Infant Gastroesophageal Reflux (GER): Benign Infant Acid Reflux or just Plain Aerophagia? International Journal of Child Health and Nutrition. Retrieved April 20, 2023.}