What is infant reflux and how can it be affected by tongue and lip ties?
Infant reflux is a condition where the contents of the stomach are spit out, usually shortly after a feeding.
Often children are sent for invasive investigations or prescribed adult reflux medications to treat it without evaluation of the breastfeeding history. These medications, designed for adults often provide no resolution and have serious potential side effects.
Other times, parents are told to wait as their child outgrows it, which provides little comfort as their child cries inconsolably.
Lip-ties and tongue-ties can be a common source of reflux like symptoms. When they contribute to a poor latch, swallowing becomes uncoordinated, and clicking sounds may be heard. This allows the infant to swallow small amounts of air into their stomach. This is called aerophagia, or air-induced reflux and the symptoms are similar and often mistaken for acid-reflux.
The Symptoms Include:
Stomach distension or a hard belly
Unable to sleep lying down for long periods
Constant pain, crying or irritability
Unless held upright or comforted in their parents arms
Waking congested in the morning
Belching, vomiting or excessive gas
Aerophagia or Air-Induced Reflux must be ruled out to avoid the need for invasive investigations or acid-reflux medications that will not resolve the symptoms. These medications are designed for adults and, as mentioned above, can have serious potential side effects.
Evidence for the links with tethered tissues and aerophagia (air-induced reflux)
In 2016, a study published in the Journal of Clinical Paediatrics supported the importance of evaluating tongue and lip ties in infants with reflux to avoid unnecessary medications and reflux.
It analysed surveys of 1000 infants who were taking H2 blockers or proton pump inhibitor medications for acid reflux who also had laser release of tongue and lip ties due to painful or ineffective breastfeeding.
After the procedure
- 52% of infants showed improvement or complete reversal of symptoms to the point they could stop medication
- 28% had no change in reflux
- 19% showed improvement in post-feed irritability and fewer reflux symptoms but were not successful weaned off medications
Conclusions of this study
- there appears to be a relationship between tongue-ties and lip-ties and air-induced reflux
- a relatively simple procedure using laser may reduce or eliminate reflux
- many infants may be spared from invasive testing or medications that have potentially significant side effects
In another study by Dr. Larry Kotlow, published in 2016, 40% of patients referred to his private practice for the release of tethered tissues were being treated with anti-reflux medications with no apparent resolution.
“The releases of these tissues (the tongue and upper lip) were surgically completed in the dental office. The post-surgical follow-up at 48 hours indicated that 93% of the infants the release of the upper lip and tongue-ties showed immediate improvement in clinical signs of gastrointestinal reflux such as; regurgitation or vomiting after nursing, pain, arching of back, sleep and morning nasal congestion. A post-surgery survey returned at two weeks indicated that there were no relapses and the infants remained symptom-free.”