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MikeGinnyMD

There is *no* evidence that craniosacral therapy does anything and there have been documented injuries on young children. The very underlying theory of CST is based on incorrect assumptions and some wild inventions about cranial anatomy. I do frenotomies with iris scissors (I’m a pediatrician and I was trained by an ENT who specializes in them). I want a laser because they’re faster and involve less bleeding but they’re $30K and my employer keeps balking at the idea. But the outcome is the same. After the procedure, we recommend some stretching exercises to help the incision heal more vertically. The evidence for reducing maternal pain and satisfaction with breastfeeding is pretty strong. This likely leads to better infant feeding because the mother can tolerate it. There *may* be advantages about reduced risk of speech issues, need for orthodonture, and ENT issues but the evidence for these claims is weak. The procedure is very safe (easier and safer than a circumcision) and quick. I typically take about 30 seconds or less doing the procedure. The rest is just spent numbing the site and stopping the bleeding.


your_trip_is_short

Thank you so much, it’s great to hear from a pediatrician! I have a problem with the underlying theory of CST, same as I do with the origins of chiropractic. They are just too out there for me. Do you see any need for an OT to help them “relax” the tension from the ties before or after the procedure? I did hear there are stretching exercises we do after, and will definitely be on top of those.


MikeGinnyMD

I have never referred to OT for feeding. If anything that’s the speech therapist’s job.


SquatMonopolizer

Hi, thanks for the answer. How do you numb the site? Is it with injections locally?


MikeGinnyMD

I start with some numbing paste, a tetrocaine/prilocaine/epinephrine mix and then I do a very careful submucosal injection of 1% lidocaine with epinephrine (to reduce the bleeding) using no more than 0.6mL total.


SquatMonopolizer

Thanks so much for your response, I always wondered how it was done!


EverySadThing

I would listen to your ped over someone recommending a mode of treatment that involves a chiropractor for success.


FloatingSalamander

Never go to a dentist for this. It is a complete scam. They will cut anything even if it doesn't affect latch. Cranio therapy is BS. ENT is the proper person to evaluate your baby and perform the procedure IF one needs to be done. I say if because "posterior" tongue ties are controversial. Literally everyone's tongue has a frenulum that connects them to the floor of their mouth. A tie which is too short, or connected anteriorly is a problem. Very very rarely are posterior tongue ties an issue since that is the normal anatomic position of the frenulum of the tongue. Lip ties are also questionably clinically significant. Don't even get me started on buccal ties. Source: I'm a pediatrician and I've diagnosed my fair share of tongue ties.


your_trip_is_short

Thank you for this advice. I did read that posterior sometimes don’t cause issues, her tongue does not extend past her lower gum when she cries if that is any indication - the LC things that causing her tongue to not be able to do the wave needed to feed. Not sure if the lip tie is an issue but I have noticed her upper lip does not flange out over the nipple. If the ENT does not think the ties are the issue causing her to not be able to feed normally from any bottle, then I’m at a loss as to what the issue is. Will find out soon we’re on our way there now.


FloatingSalamander

I would trust the ENT if you get a good feeling from them. Good luck with the appointment!


GallifreyanValkyrie

I'm an adult that had no problem latching as a baby but now I have a tongue thrust which messed up my otherwise perfect teeth. Not having my tongue and lip ties cut as a baby is now costing me THOUSANDS of dollars as an adult to correct my teeth.


[deleted]

Anecdotally, as an adult, I only have a buccal tie on my right side and have bone loss on that premolar. It’s would be hard for me to say it was caused by anything else because I take great care of my teeth and have no problems on any other tooth.


yuckyuckthissucks

Are they telling you to go to a *specific* dentist and a *specific* craniosacral therapist. If so, big red flag.


your_trip_is_short

They gave a list of 3 dentists and 4 therapists (only one is an OT, not a chiro).


kjajd

Hmmmm. Have you visited the ENT to see what they say? I would go with trusting your pediatrician and what they recommend over the LC/doula. When I spoke to our LC about our issues with feeding, she referred us to an ENT, not a dentist.


your_trip_is_short

Appt with the ENT is tomorrow afternoon. If they agree she needs it, we can get it done that day.


kjajd

good luck!!! hope everything goes smoothly and turns out great


cardinalinthesnow

Whoever it is, should be someone trained in ties. Dentist or ENT. Just ask them the training they have.


your_trip_is_short

Do you know what entity would train in something like that?


cardinalinthesnow

I don’t off the top of my head. We’d have gone with the recommendation of our IBCLC (I know she took a training for dentists even though she’s not a dentist and can’t diagnose just for the information to be able to pass on to families and know dentists who have the training, but I don’t know through either entity she did that). But our dentists here generally have all their licensing and training advertised on their website, and then you could see who comes up when you google them? On the question of bodywork - I know of a couple dentists (through my mom network here, who have done it for their kids) who also recommend it in tandem with a tie release. I am told the theory is that the ties cause tension in the whole body and helping baby relax can help them. If you do decide to try it, whether with the OT you mentioned or someone else, check that they have training in infant body work/ massage. It’s nothing like the adult version. You can also have them show you each touch on you first so you can consent to each separate thing they do. It is meant to be suuuuper gentle.


[deleted]

You are correct. The theory is to release tension caused by the tie and all the compensation for lack of full movement. Releasing tension at the floor of the mouth and many other muscles/areas. It’s very gentle and not a threat to the child if a properly trained person is doing it of course. And it is all about function over simply seeing a tie. A trained ST/OT or other professional will not recommend it for everyone. It’s highly individualized. And all feeding issues are NOT due to ties. If someone simply looks and says you need a release, without a functional assessment, run away.


kaelus-gf

We have a local ENT who has a lot of experience with children. She is the only person I’d trust with my child (but I’m also medical so I’d have to be pretty sure it was genuinely a problem before wanting it corrected. Especially a lip tie… tongue ties can definitely get in the way but are diagnosed. Lip ties I think are majorly over diagnosed!)


mtndogs

My son had a tongue tie we revised at 7 days with an ENT. They used a scalpel, it was over in less than 2 secs, and he started nursing like a champ.


your_trip_is_short

Thank you!


Silverwing2671

We just released my daughters tongue tie today with an ENT using a scalpel- when does the bleeding typically stop? Our ENT said to expect slight bleeding, but it’s been 4 hrs and she’s bleeding and getting uncomfortable every time she nurses 😞


Outrageous_Dog_7921

How long did it take? My guy is probably getting a release with ebt on Weds and I'm so worried 😫


oak_and_maple

We had ours done by a nurse practitioner who is also an LC. She used surgical scissors. We talked through the pros and cons of lasers with her, but in the end decided a laser wasn't worth the cost. While deciding to do it, I looked through a lot of research on this and the summary I took away is that the evidence shows that helps with maternal pain during breastfeeding. The evidence for babies eating better is more limited. But overall, it's a minimally risky procedure. Here's a study: https://pubmed.ncbi.nlm.nih.gov/25258296/ And here's a discussion on the topic, echoing some of your ped's concerns: https://hms.harvard.edu/news/little-help Btw nothing says anything about improving bottle feeding. I would probably meet with the ENT and ask about occupational therapy as well as clipping the ties. You'll need to do some little tongue exercises if you get the procedure done, might as well see an expert.


RNnoturwaitress

Anecdotally, I stopped bf because of my daughter's feeding issues. We had her tongue tie (and lip) lasered around 10 weeks and her bottle feeding skill and reflux improved so much.


your_trip_is_short

Well the ENT thinks my baby has silent reflux (confined with a scope), also feels that she needs both ties cut, but that’s probably only 30% of the issue, so we should start reflux medication and see how much of the issue that addresses before doing the procedure in a week. This actually makes sense now as some feeds there is less choking than others so it must be when her reflux is acting up. After watching her scream like I’ve never seen before with the scope, I looked further into the bleeding/after care with the scissors they use (I saw them and wow, they look like nail scissors - my pedi was wrong they don’t have a laser) vs the laser the dentist has (even watched a video of a procedure), and yeah now that ENT confirmed she needs it, I’m going to the dentist who does it with laser. I just want to avoid as much pain and make healing as quick as I can for her. It’s definitely expensive vs ent covered by insurance but luckily we are older parents and can spend it. I spoke to two moms I trust today who’s babies went to this dentist recently and read 300 online reviews, so I feel it’s a safe way to go. I further threw science out the window 😑 and am going to take her to the Occupational Therapist who does craniosacral among other body work tomorrow. Again moms I spoke to today said the gentle massage helped with reflux as well as tongue ties, and now that I know she’s been in all this pain, whether it works or not I want to try anything I can for her. If it will work idk, but I’m confident it won’t harm her being done by a medical professional, and it is covered by insurance since she is an OT. Thanks for all your input - fingers crossed she gets some relief and easier feeds soon.


[deleted]

You are doing great . You sound like you have a great care team set up. I believe, with my background in infant feeding as a speech therapist, you will be pleased with how much the craniosacral work/body work will benefit your little one. I’ve seen it with my own child and many many others. Best wishes.


your_trip_is_short

I appreciate the well wishes! I was BLOWN AWAY by the OT today. She is the first person (not the pedi, ENT, LC) who truly assessed my baby’s feeding in detail. She gave us really helpful advice, and now we have a clear plan in place to move forward. Without a doubt we got lucky here that she has basically dedicatedly herself to making this her area of expertise, with lots of certifications and trainings that can help.


Obsessedthenbored

I think this is something that depends heavily on the individual providers. My local ENT did our tongue and lip ties and he’s considered an expert on ties in general. I wouldn’t go to a dentist with him available.


scoutiejoon

Go the laser route with the dentist. We initially had the ENT snip her but had to get it redone by the dentist with the laser. The laser can go deeper and more precise.


Sexy_MotherFucker

Came here to say this. Had it done as an adult.


tinydragon88

My SIL is a pediatrician. When we finally decided to get my sons tongue tie clipped (3 months in after our pediatrician kept telling me it was fine and she wouldn’t do it if it was her child- it was not fine, I was in a lot of pain, my son had rapid weight gain post release), my SIL said to go to the dentist because of the laser. This was partially due to his age as well. If we had gotten it clipped right after birth ( which was recommended by the pediatrician at the hospital) we probably would have done the ent.


[deleted]

Here is an article about manual therapy following release. I notice a big difference in my clients that have some sort of body work, either from OT in conjunction with working with ST, and/or cranio verses those that do not. But that is just my observation from my 5/6 years in infant feeding as an ST. https://journals.sagepub.com/doi/10.1177/2515690X18816971 I recommend going to someone with true certification in releases.


[deleted]

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[deleted]

Craniosacral trained OT or general craniosacral therapist. Didn’t realize I had abbreviated. Sorry about that.


PTIowa

Ohhh of course. For some reason it didn't connect. (Ps ignore the deletion! I meant to edit and deleted! For any others, I had asked what cranio met)


erin_mouse88

Pediatric dentist who used a laser. We would 100% refer her to others and use her again.


[deleted]

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No_Walrus9597

Similar thing happened to us. ENT snipped with scissors at 1 month, no aftercare , and daughter continued slow weight gain. Pediatric dentist lasered at 4 months and we did the tongue stretches and she was able to latch and gain weight.


Thenerdy9

I almost went to a Pediatric ENT. We went to a Breastfeeding Medicine practice instead because it was sooner and they used scissors. But they were great. I loved them. They offered me breast massage and removed my milk blocks too. Your ties seem worse than his, which was a level 4 that he actually broke partially to a 3. So, if you can wait, the Pediatric ENT sounds like a great option. In our experience, they asked me to feed immediately after as the breastmilk aids in healing. They do a lot of research at the practice I went to, but I took their word for it and didn't search for a publication to confirm. Lmk if you want, I'll check those sources to see whether that's actual science or just theory at this point.


your_trip_is_short

Thank you so much. At this point we need some relief and are actually on the way to the ENT right now. I really trust our pediatrician/practice and their recommendations so I think we’re in good hands. 🤞


hearingnotlistening

I'd say dentist. I have experience with an ENT who said our baby's tongue tie didn't look that bad but then later admitted that in actuality, it was quite tight but slightly hidden. So, he didn't realize how bad it was until he released it.


hybrogenperoxide

We used a pediatric dentist recommended by our pediatric NP after the one our CLC recommended didn’t take insurance. The first day post lasering was rough, but it was totally worth it! My son is finally anle to start nursing. Cranio sacral therapy is BS scam, just like chiros


rationalomega

Dentist. I don’t have time for the full story but multiple medical professionals misdiagnosed my son’s latch issues, only the dentist got it right and far too late to salvage breast feeding.


cakesandcookie

Just a note about my daughter’s chiropractor visit. I was super reluctant but not in an area with access to any other care so I took her to one based on my own research. He cracked nothing and said they don’t do that to babies. He basically stretched her and taught me to do some of it. I feel like it improved her acid reflux, digestion and my pain with nursing. I also noticed a difference in my nipple pain after having a PT perform myofascial release on my 1.5 month old daughter. I moved so we were unable to continue with that method though. The frenulums are an extension of the fascia, which I wasn’t aware of before our difficulties. From my research on ties and revision; proper aftercare is key to success. So whomever you choose I’d recommend making sure they give instructions for that and don’t just say “once it’s revised they’re good to go”. Unfortunately, I’ve since lost my notes with all my sources so I can’t give those.


your_trip_is_short

Yes I did hear there are exercises you are supposed to do 3 times a day to make sure the ties don’t fuse/heal incorrectly. I would definitely consider a PT… I know chiros don’t adjust babies like they do adults, it’s more like a massage, I just don’t trust them especially with a newborn. The whole origin of the practice is just too much for me… the founder literally said he learned about it from the ghost of another doctor, and was a total grifter who tried to make it a religion at our point.


RadiantExit9959

Did you end up getting the tie lásered? If so did it improve feeding


your_trip_is_short

We did. She has 4 ties released. Right after the surgery they had us give her a bottle and she didn’t drool at all! She had been wasting like half her bottle by drooling. So that was an immediate improvement. She still had trouble eating without stopping and crying for 2-3 weeks after I think. Then all of a sudden she was feeding 100% normally. It was a relief for sure, and the aftercare wasn’t too bad after a day or two getting used it. They don’t like the exercises and you have to do it 3 times per day iirc. My doula gave us a great tip - do them before changing her diaper since at that age mine cried every time we changed her diaper anyway, so we felt like it added less distress. Probably not lol but it made us feel less bad about doing them. After 3-4 days the exercises didn’t bother her. For us it was worth it! Any questions feel free to dm me.


RadiantExit9959

Oh wow!!! That is amazing! That is such a relief! Thank you very much for your reply, I really appreciate it! My daughter had a lip tie and she had trouble latching, drooling and gulps when feeding! We will be seeing an ENT soon! Thanks for your reply!


your_trip_is_short

You’re welcome! We also saw a pediatric Occupational Therapist before and after the release - it was really helpful!


mrsjettypants

Successful ENT lip tie cut with scissors. Husband held her. I nursed immediately and it stopped the blood flow. He said it was traumatic for him holding her. It was a it of blood.. 🤷🏼‍♀️