Reflux and Tongue Tie

Aerophagia (air swallowing) induced reflux is a fairly common finding with oral function challenges like tongue tie.  

Tongue tie can impair baby's ability to extend (stick out) their tongue, and this often results in nipple pain or bottle nipple pinching.  The tie can also prevent the tongue in the back of the mouth from lifting and sealing with the soft palate (the part of the throat which starts at the back of the mouth).  

When this seal is interrupted baby can choke or sputter during feeding and they can accidentally swallow air.  This can lead to fussiness, gas, and reflux (when milk comes up the esophagus and out of the stomach).

When baby is born the ring of muscles at the top of the stomach (LES) which holds in food is not very strong or well developed until about 6 months.  This ring of muscles acts like a pressure valve which is why you might notice your baby spitting up more if they have any pressure on their tummy right after eating.

Most babies spit up a little bit with a peak at 3-4 months!  However, when baby is swallowing air along with their milk the “pressure valve” is overwhelmed and we can notice a lot more spitting up and babies who are pretty uncomfortable and fussy. Hill 2023 interviewed 84 parents of infants prior to and 2 weeks post frenotomy using the GIGER scale (screening tool used for child reflux symptoms). Younger infants and those with more severe presentations showed the most improvement with GI and GER symptoms

The process for why aerophagia may occur was highlighted in this study:

"during swallowing the vocal cords and epiglottis close to protect the airway and the base of the tongue contracts the posterior pharyngeal wall to create pressure to move the bolus downward. If the movement of the tongue is restricted, it may prevent the tongue from making appropriate contact with the posterior pharyngeal wall, resulting in nasopharyngeal reflux and may interfere with the closure of the structures protecting the airway placing the infant at risk for aspiration. With impaired tongue movement, the infant may cough, make loud gulping sounds, or develop aerophagia"

Several studies have found that when tongue ties are corrected, babies will have significant improvement in spitting up and discomfort by 2 weeks post-release.

Kotlow, 2016, 2011. Fishbein, 2012. Siegel, 2016. Hill, 2023. Ghaheri, 2018. Ghaheri & Lincoln, 2022.