February 25, 2021 • 33 mins
One of the most common misconceptions we hear at Nest Collaborative is how natural and effortless the feeding bond between mama and baby is supposed to be. But more often than not, it simply isn’t the case. Here we are at the beginning stages of breastfeeding - awkwardly fumbling through, trying to figure it all out. But after a few days and weeks, it should get better right? In theory, yes. But what if it doesn’t?
You may have heard the term “tongue-tie”, which seems to be the phrase du jour for breastfed babies who can’t quite get a grasp on the latch. Believe it or not, up to 37% of babies are diagnosed with tongue-tie, so the problem is more common than many of us realize.
So what exactly is tongue-tie, how do you know if your baby has it, and what can you do about it? On the show today is the amazing Dr. Scott Siegel, President of the Northeast Oral & Maxillofacial Surgery Center for Tethered Oral Tissues in Manhattan and Long Island. Dr. Siegel has over 25 years of experience and has devoted the past 18 years to the treatment of issues related to tethered oral tissues, and to date, he has performed over 30,000 tethered oral tissue surgical procedures. To say he is an expert is quite the understatement!
We look forward to having you join us for our chat today on Breastfeeding Unplugged.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Amanda Gorman (00:00):
[Intro] Breastfeeding Unplugged.
Welcome. Welcome. Welcome mamasand mamas-to-be. A podcast
dedicated to helping momsnavigate their way through the
tricky world of breastfeeding.
Breastfeeding Unplugged.
(00:22):
Breastfeeding Unplugged.
Welcome to the podcast mamas andmamas-to-be. I'm your host
Amanda Gorman of NestCollaborative. And this week's
episode is one that I know willresonate with so many of you. As
you know by now at Nest, we helpmoms all over the country
through their breastfeedingjourney. And more often than
(00:44):
not, that first call can be fullof confusion, and sometimes
fear. After all, breastfeedingis supposed to be easy, right?
Not all the time. So one of themost common misconceptions we
hear is how natural andeffortless the feeding bond
between mama and baby issupposed to be. But more often
(01:05):
than not, it's simply not thecase. For most moms, the first
few days and weeks ofbreastfeeding is hard, harder
than we ever thought it mightbe. Sure, there are a few cases
where the baby latches andeverything is A-okay. But for
many of us, it isn't smoothsailing from the start. And
that's if mama and baby are bothwilling and able to start this
(01:28):
journey together.
So here we are at the beginningstages of breastfeeding,
awkwardly fumbling through,trying to figure it all out. But
after a few days and weeks, itshould get better, right? In
theory, yes, but what if itdoesn't? You may have heard the
term tongue tie, which seems tobe the term de jour for
(01:50):
breastfed babies who can't quiteget a grasp on the latch.
Believe it or not, up to 37% ofbabies are diagnosed with some
sort of tongue or lip tie. Sothe problem is more common than
many of us realize. So whatexactly is tongue tie? How do
you know if your baby has it?
And what can you do about it?
(02:13):
With me today is the amazing Dr.
Scott Siegel, president of theNortheast Oral and Maxillofacial
Surgery Center for Tethered OralTissues in Manhattan and Long
Island. Dr. Siegel is a doubleboard certified, dual degree MD
DDS, oral and maxillofacialsurgeon who has over 25 years of
experience and has devoted thepast 18 years to the treatment
(02:36):
of issues related to tetheredoral tissues. To date, he has
performed over 30,000 tetheredoral tissue surgical procedures.
So to say he is an expert, is anunderstatement. Dr. Siegel.
Welcome. We're absolutelythrilled to have you with us
today.
Dr. Scott Siegel (02:56):
Oh, thank you so much, Amanda. It's it's an
honor and privilege to be herewith you today, and I give you
so much praise for what you'redoing and help- helping with
education and moving thingsforward.
Amanda Gorman (03:11):
Yep, we love it.
We love working with you. So letme jump right in. Can we start
off with a quick definition oftongue tie?
Dr. Scott Siegel (03:21):
Sure. You know, and and it's, you know,
the first thing is that there'sso much confusion out there,
we're still trying to clarifythis for, for the general masses
and moms and pediatricians ofthe like. So, you know, in
simple terms, a tongue tie is,you know, when you look under
the tongue, the little stringthat we often see under the
(03:42):
tongue, and it's normal to havea little string under there. But
we define it as a tie or arestriction when when that
little string is too tight forfunction. And, you know,
basically, in simple terms,that's what it is. And it's not
the inability to stick thetongue out, but it's to elevate
(04:02):
and lift the tongue up to theroof of the mouth, it's often
restricted. And that can impactfeeding, it can impact
breastfeeding, it can impactbottle feeding. So I kind of
keep it simple. And you know,that's the quick, quickest
definition I can give you.
Amanda Gorman (04:18):
No, that's, that's helpful. So for parents
of newborns, what should they belooking for? Or are there any
real telltale signs if theirbaby has a tongue tie?
Dr. Scott Siegel (04:31):
Right, I'd say that, you know, what we have
found in the United Statesanyway, but sometimes even
worldwide, is that there's not auniform way of screening babies
in the hospitals for thesethings. So and there's different
types of tongue ties. Some arereally easy to see like this
little web at the tip of thetongue, and some are a little
(04:52):
further back. But I'd say one ofthe quickest things that happens
if especially you know, asbreastfeeding rates are climbing
up worldwide, is sometimes thealmost immediate inability to
latch or painful latching onbreastfeeding is one of the
earliest signs that we'll see.
But trying to assess under thetongue is not such an easy thing
(05:13):
to do. And unfortunately, mostpediatricians aren't really
trained in this area. We do findthat majority of lactation
consultants are, so one of thefirst things we will recommend
is seeing a lactationconsultant, you know, like
yourself for an earlyassessment.
Amanda Gorman (05:34):
Yes, absolutely.
And then, the women we do see,often will bring the information
back to their pediatrician. Butwe do find sometimes
pediatricians and otherpediatric providers can tend to
dismiss tongue tie when they dobring it up. Why is there such a
disconnect on the issue?
Dr. Scott Siegel (05:54):
We find there's a big disconnect and the
majority of the issues reallyhave to do with education and
experience in this area. One ofthe biggest I guess voids in
medical education is about whatwe consider normal eating,
normal breastfeeding, oralinfant anatomy, or infant
oriental anatomy inside themouth and what's in- what we
(06:17):
consider normal and not normal.
And there's really a lack ofeducation or consensus among
pediatricians. And that comesdown to the education in not
only medical school, but also inthe residency program. The
American Academy of Pediatricsreally doesn't give many
guidelines to pediatriciansabout what they're looking for
inside the mouth, or what reallyconstitutes normal
(06:40):
breastfeeding, or normal feedingthat should be occurring on a 24
hour cycle. So mostpediatricians will look at
something and call it mild intheir eyes, when it's actually
not and a baby's reallystruggling with feeding or
painful breastfeeding. And wefind that a lot of it gets
dismissed, because thepediatrician's primary goal is
(07:01):
to look at weight gain on theirhealthy visits. And we see that
or hear that a lot that thepediatrician says my baby's
gaining weight, so they're okay.
But they're not asking the mom,well, how is feeding going on a
24 hour basis, mom's dying,they're in so much pain, the
baby is constantly popping offthe breast or falling asleep at
(07:24):
the breast commonly or you know,non stop. And feeding is a big
struggle. And they might begaining weight because of the
increase in frequency of thefeed. Or mom has the pump and
you know, give the baby moremilk through a bottle or double
or triple feed in her baby. So apediatrician may often say, oh,
(07:46):
that's great, you know, orswitch them to formula, we hear
all these different things. Sothere's really inconsistency
with education. And that'sreally where it stems from.
Amanda Gorman (07:55):
One question we get additionally from from
parents is whether tongue tie ishereditary? Do we think that's
the case?
Dr. Scott Siegel (08:03):
So in some cases, yes. And there are genes
that have been isolated for along time. And some of them
actually run, you know, more onthe male side. So there's like a
little bit more of apredominance on in the, in the
males of the boys. But so youknow, when you start to talk
about it, you will see some thatcome into my office anyway and
(08:24):
say yes, you know, dad has it ormom had it, or in the family,
we, you know, it's agenerational thing. And then
there are some that just seem tocome out of the blue. You know,
and there's other reasons thatwe may be developing the ties
and we're not exactly sure.
There's the research and someexperience looking at even the
amount of folic acid or folatethat's being put into prenatal
(08:45):
vitamins may have there may be alinkage to that. Not been
proven, but we may be protectingagainst, you know, bigger, bad
things like neural tube defects.
But having a trade off of atongue tie or lip tie or ties in
the mouth may be secondary tothat. Kind of the short answer
is like yeah, there are geneticpredisposition, but not in all
(09:09):
cases.
Amanda Gorman (09:10):
So there can be more than one type of tie in the
mouth. Is that true?
Dr. Scott Siegel (09:14):
That is true.
Now, most everybody talks about,you know, ties or tongue ties as
as you know, the be all and endall but I'd say the most
prevalent or the one that seemsto impact the breastfeeding the
most or feeding seems to be thetongue tie. But there's
basically up to seven spots thatwe check for the ties or we
commonly also call as tethers ortether oral tissues, or T.O.T a
(09:36):
lot of people will call it. Sokind of lifting them in in order
prevalence we see the tongue tienumber one as probably the more
common one, but lip ties areeither the upper lip or the
lower lip are very common. Andyou can also have them in the
cheek, which are also calledbuccal or "buccal" buccal ties.
(09:56):
And you can have those on theupper, or the lower cheeks on
the right and left side. Sobasically, there's seven spots
that we generally will screenfor. And the majority of the
babies will have, you know,either the tongue, tongue and
lip, or maybe upper buccals. Soit's but on a on occasion we'll
(10:18):
see all seven spots that aretied.
Amanda Gorman (10:25):
I had no idea. A lot of potential issues other
than tongue tie can affect ababy's ability to breastfeed,
no?
Dr. Scott Siegel (10:36):
When we look at these things, and you know,
unfortunately, sometimes peoplewill really kind of say, won't
you get the tongue tie fixed,and everything's gonna be fine.
We look at these as a piece of apuzzle. And there could be
definitely other issues that aregoing on with feeding. And you
know, from my perspective, as asurgeon, it's really important
to have these babies assess, youknow, from a functional standp-,
(10:59):
standpoint by an InternationalBoard Certified Lactation
Consultant, IBCLC, because they,you guys really understand
what's going on from afunctional standpoint. And there
could be other issues going on.
So we always look at, you know,what's going on with mom, mom's
anatomy, mom's supply, and otherissues going on, on that end. We
look at the baby, we look atbaby's function, we look at
(11:22):
baby's anatomy, you know, sowe're looking at structure,
structure and function. Andputting those pieces of the
puzzle together. Then we look atthe baby as a whole.
Some babies will have otherissues going on, whether it's
neurologic, whether it's like astructural issue with where a
baby is requiring some sort ofp.t, maybe they have some neck
(11:45):
issues, torticollis or otherbody issues, though, you know,
the the broad picture that wherewe say there's little pieces of
a puzzle, and we're trying totrying to take all of these and
look at the big picture. I don'tknow if that kind of answers
that.
Amanda Gorman (12:01):
Yeah, no, absolutely. It's good to kind of
take a look at all all potentialvariables.
Dr. Scott Siegel (12:08):
Right. Kind of look at what's going on. And
then you say, well, if the babydoes have a tie, and it goes in,
you know, with that picture,then we just go back to kind of,
you know, risk versus benefit oftreatment of the tie.
Amanda Gorman (12:22):
So a lot of moms want to know if their baby feels
pain, if they have a tongue tieor any other related issue.
Dr. Scott Siegel (12:30):
So you know, if, you know, if they're for the
procedure itself, is that thequestion or-?
Amanda Gorman (12:34):
No, just when they-
Dr. Scott Siegel (12:35):
Just in general just having a tie?
Amanda Gorman (12:37):
Yeah.
Dr. Scott Siegel (12:37):
Yeah, I mean, you know, when we see, I can't
tell what a baby's feeling, butwe see it when we have older
kids come in, that can tell uswhat it feels like. And a lot of
kids will actually come incomplaining that things feel
tight. Sometimes we'll have youknow, kids that are very
restricted, when they're tryingto function it is uncomfortable.
We would just kind of assumethat a baby would, you know,
(12:59):
maybe tire out quickly, whenthey're trying to feed with
these things, because they'rereally kind of using up so much
energy, we call it beatingefficiency. So many times,
they'll fatigue faster, they mayget a little more sore in
certain spots, because of excesspull, you know, of the soft
tissues when they're trying tofeed. So we can kind of say
(13:22):
they're probably not maybe notin severe pain, but they're
probably uncomfortable, they'reprobably tiring out quickly. You
know, so that's kind of what Iwould assume, you know, from the
baby's standpoint.
Amanda Gorman (13:38):
And perhaps, maybe you can take us through
what a procedure looks like fora tie revision.
Dr. Scott Siegel (13:44):
So when we talk about, you know, procedures
and surgery and risk versusbenefit, it's very overwhelming
for, you know, parents, for mom,for the whole family. And we
always say we're treating thewhole family, we're not just
treating a baby here. So we'retreating the whole family. And
when we- when I consult with myfamilies, when they come in, and
(14:05):
I really kind of sit there andtalk with them, I talk about
risk versus benefit. And I talkabout you know, an actual
procedure as far as theprocedure itself is such a very
quick, easy surgical procedurein my office. That and the, the
amount of pain that is actuallyfelt is, seems to be minimal.
And I can say that only becausewhen I do older kids who can
(14:27):
tell me what it feels like, theywill not complain much of pain.
It's more scary than anythingelse.
The actual procedure to releasethe tongue or lip tie or
multiple ties and in my office,I use a laser for it. So we just
wind up using a topicalanesthetic. So the risk of the
procedure from an anesthesiastandpoint is minimal. There are
(14:50):
some doctors that will put youknow, babies under general
anesthesia and that is in mymind, the risk of the anesthetic
outweighs the risk of theprocedure. So when we look at
these procedures, we want tokeep things as minimal risk as
possible, as easy as possiblefor the baby and for the mom and
for the whole family.
(15:12):
And the actual procedure itself,I do allow families to stay in
the room so they can witnesswhat's going on with their child
and their baby. So that baby'snot taken from them, they
actually will be able to touchtheir baby, while it's going
through any sort of procedure.
And, you know, we feel that'simportant. Because we do, we do
expect, you know, there is adegree I don't like to say pain,
(15:35):
but it hurts a little bit, youknow, so we do numb the area up.
There are some doctors out therewho won't use any form of either
topical anesthetic because theyfeel it's so quick that it won't
hurt them. But we say any, anybaby or any person can still
feel pain. So we want to try tomake it as easy and pleasant as
possible for everybody.
Amanda Gorman (15:59):
I'm sure that's relieving for the moms to be
able to be in there and justmore informed.
Dr. Scott Siegel (16:04):
Yeah, and it's, you know, I always tell
them, the moms, you know, yourbaby's gonna cry, and you're
gonna cry more and, and thenit's gonna be done. And as soon
as we are done, they pick themright up, we go into a private
room so they can get right onskin to skin, and get them on
the breast. And we do have alactation, or TLC with us, that
(16:24):
just helps them moms withlatching and whatnot, right
afterwards. Just to kind ofhelp, you know, get things
moving along faster, because thebiggest thing, it's not so much
the procedure, but it's justhelping holding hands. And I
think that's the biggest thingis, you know, trying to get- it,
we always talk about taking avillage it take it does take a
(16:47):
village to help these babiesfeed, you know, we talked about,
many moms will come in with apreconceived thing, you know I
thought it was gonna be so mucheasier than it is, like you said
in your intro. And it's not andthey, and it's even when we do
these procedures, it's not, youknow, something that you do the
procedure and everything's fixedimmediately. There is a process
(17:08):
to it.
Amanda Gorman (17:09):
That's great. You know, so when mom and the family
is in the room for theprocedure, how do you keep baby
still, when you're-
Dr. Scott Siegel (17:17):
So the babies are kept still by swaddling 'em.
So we swaddle them and prettytightening in a receiving
blanket. And actually, you know,we have either one or two
surgical assistants in with meholding the baby. I'm back
basically controlling, you know,the mouth and the head. There is
a little retractor that comesunderneath the tongue to hold
(17:40):
the tongue up and keep it still.
And I usually will hold the lipmyself with the-, you know, with
my, my fingers. And then youknow, the procedure itself is
very quick. I get a lot ofquestions, well, what happens if
the baby moves or you slip. AndI will jokingly tell them that
it's not like I'm using alightsaber that's just kind of
slices right through everythingit's touching. The actual laser
is a very delicate instrument.
(18:04):
And it's only basically takingcell layers off at a time. And
you kind of have to, you know,with the years of experience and
knowing how to do it, that's howyou become very quick and adept
at it. But it's a very safe andmeticulous and precise, you
know, way of doing theprocedure. So it's not like I'm,
you know, working on a movingtarget the whole time. The other
(18:25):
thing from a surgical standpointis that I use magnifying loops.
So I'm actually looking atthings, either three to five
times magnification. So it'slike, you know, very large in my
eyes, that I see.
Amanda Gorman (18:38):
So you mentioned laser but some procedures use
more of a cut or a clipper. Sowhat is the difference between
those two?
Dr. Scott Siegel (18:47):
So the difference between what you call
quote unquote clipping orcutting and laser is that the
clipping or cutting is usingeither a scissor or a scalpel.
And if you kind of lookworldwide at the doctors that
are, you know, providers thatare- been doing this for a long
time or see the most [unknown]of baby or babies or really
doing the researches, majorityof us are using lasers. And
(19:10):
reason we like laser is that it,it helps stop bleeding or
coagulates or cauterizes as wecut. So we find that we get a
lot less bleeding, we getbitter- better visualization of
the surgical site. And what weconsider more of a complete
relief, you know, less bleeding,so in theory you have less
reattachment and other issuesafterwards.
(19:33):
So for me, my instrument ofchoice has been laser for 20
years. And it's been 20 years, Iknow in the intro that 18 years,
but I'm doing it 20 years atthis point. And there's many
doctors out there who clip orsnip with scissors and they
sometimes can get very goodresults. But we find when we
look at these side by side, andwe're trying to get the research
(19:56):
out there we do find thatthere's better wound healing,
less bleeding for sure, maybesome less pain. So that's the
biggest differences that we seebetween the two.
Amanda Gorman (20:06):
Okay. And you mentioned, you know, looking at
the big picture and the puzzlepieces. So I assume then there
are some cases of tongue tiethat might not need revision, or
are there other options, than arevision?
Dr. Scott Siegel (20:21):
Right, so when we, when we talk about tongue
ties, the biggest thing we'relooking at is what's going on
from what we call symptoms orfunction. And I have some babies
that will come in, and they'reactually feeding pretty well,
they're gaining weight prettywell. You know, it's not painful
on mom, and we kind of just willkind of, almost take a wait and
see approach. Like, "Well, mybaby's doing pretty well. But
(20:44):
you know, I just want to get itscreened." And we'll say, on
exam, I feel a bit ofrestriction, maybe there's some
issues going on. And in somecases, we'll actually, you know,
do some other forms of therapyfirst. We'll either do some oral
suck training therapy with alactation consultant, or in
combination, we will work withwhat we call a body worker,
(21:05):
which is either physicaltherapist, occupational
therapist, chiropractor. Thingsthat would kind of work on what
we call your body tension andtightness, because there's a lot
of connections between theseareas. And sometimes we'll give
we'll go that route before evenconsidering a surgery.
Amanda Gorman (21:24):
That makes sense.
Least invasive first. So if amom elects not to do a
procedure, are there anypotential longer term effects
for baby?
Dr. Scott Siegel (21:38):
Yeah, so when we look at these things, many of
us, you know, especially if ababy is coming in with a
functional issue. And we wetalked to the parent, we
identify that there are obviousties, and we'll we'll review
them with the family, like, wego back to the risk versus
benefit. And we're really- iskind of emerging research in
(21:59):
this area coming out, even inthe past few years looking at
untreated ties, and making kidsmore predisposed for developing
other issues as they get older.
And we have found that, althoughthis is not a lot of hard
science and research, althoughthose come kind of coming down
the pike, there are risks ofuntreated ties. Now, when we go
(22:21):
back to, you know, what we seein our experience, in my 20
years of experience, is a lot ofthese kids follow patterns. And
we see a lot of these kids, whenI see a lot of these kids coming
in with speech issues or solidfood feeding issues or longer
down the road with either sleepdisordered breathing,
orthodontic issues. You go backin their history, many of them
(22:44):
started off with a breast orbottle feeding issue, and then
they kind of just progresseddown the line.
So when I actually do myconsult, you know, we talk about
the long term impact andprevention. So, you know, when I
kind of talk as a as acomplication, and I know it's
(23:05):
one of the questions in thiskind of ties in pardon the pun,
it kind of ties in, when a momelects not to do a procedure, I
will kind of tell them, what weusually will see long term. And
usually we'll start to see whena tongue is restricted in its
elevation, one of the thingsthat happens, it's not allowing
the roof of the mouth to kind offlatten out and spread out. So
(23:28):
what we have found, and a lot ofthat research has come out from
the oral myofunctional communityspeech therapy community is
normal resting posture for atongue should be resting on the
roof of the mouth, and we startto see that in the babies. So in
my consultation, I'll say,"Well, you know, if the baby
can't elevate its tongue andrest on the roof of the mouth,
that's going to start to affecthow they grow and develop long
(23:51):
term." And what will happenduring during the growth and
development of the babiesinstead of the roof of the mouth
flattening out and spreadingout. It starts to get narrowed,
it arches up higher. That does acouple of things, it makes it
more difficult for the tongue toget up to the roof of the mouth
for feeding.
But it also makes it moredifficult for the baby to
breathe, and they start tobecome more mouth breathers. As
(24:15):
the kids continue to grow anddevelop, oftentimes, that'll
start to lead into difficultieswith eating solid foods because
they can't get the tongueelevated. They can't get this
good wave like motion of thetongue going on. And we just see
them coming back in. I can seethem coming back in at the next
stage with solid food feedingissues. After that is usually a
(24:35):
speech and articulation issue.
And then longer term after thatthey can cause issues with the
growth and development of thejaws, teeth, airway. So that's
kind of you know, what we seewith untreated ties and that's
what I talk about myconsultation with the families.
Not to overwhelm them, but kindof give them you know, all of
the information so that they canmake an informed decision.
Amanda Gorman (24:58):
I agree 100%. You know, talking about your
consultations, what is theprocess kind of from when mom
and baby first come in toconsult with you through the
actual procedure?
Dr. Scott Siegel (25:12):
Right. So it, you know it all starts from the
first phone call. And themajority of moms and families
are, you know, extremelyanxious. And so my staff deals
with this all day long. And wejust number one want to tell
them that, you know, you comein, as soon as you know,
they're, they get that firstphone call, we try to be warm
(25:33):
and inviting, and make them feelsafe and secure. So that, you
know, starts when the firstphone call. When they come in
the actual consultation, themajority of it is listening. I
really need to sit there andlisten, because even when I'm
training pediatricians andpediatric dentists and others,
like the parents, and the momwill tell you the diagnosis, as
(25:56):
soon as you're sitting there andlistening to the full story of,
you know, tell me what's goingon. What's bringing you here,
tell me about your feeding andyour feeding experience. And you
know, what, what is it like on a24 hour cycle. And that's
really, the majority of my timeis spent listening. A small
majority of my time is then youknow, taking a look at the baby
(26:19):
and doing my exam.
I typically don't need to reallysit there and look at the baby
feeding because the majority ofwhat's told to me kind of make
that assessment. And when I say,you know, a vast majority of
these babies already have beenassessed by a lactation
consultant as well. So I look atthe baby, we swaddle them up,
(26:40):
and I look at them. And Iexamine them from behind,
because it's really the best wayto kind of get in there and look
at you know, lift up the lip,get underneath the tongue, do a
full oral exam. And I will kindof, you know, if I see something
in the mouth, and if I see ties,I bring the parents right over
and show them what they- what Isee, that this is what I see,
(27:00):
this is what I don't see. Andthen I talk about each area and
how it's impacting theirfeeding. And as, as I said
earlier, pieces of a puzzle. Andthen I talk about the actual
procedure, which I kind ofdescribed before, and I go over
the risk and benefit. And in myexperience with these
procedures, the actual risk isvery low.
(27:22):
The biggest issues I find and Idon't really like the word- to
use the word risk, is that theycan heal back together. And many
people call it quote unquotereattachment, or you know,
meaning those areas healing backtogether a little scar tissue.
And that's really, you know,from a surgical standpoint, what
I see. In my own practice inthose 30,000 cases or whatnot, I
(27:43):
have not even seen an infectionfrom this. And that's what I
tell the parents. We're not nearany major anatomy for the
procedures, as long as you'redoing it with somebody who's
experienced. So we're not seeingany issues with nerve injuries.
We're not seeing any issues withyou know, salivary gland,
injuries. There are reports inthe literature of certain
things. So if you look at thoserisks, and those get listed on a
(28:06):
consent form, so it cansometimes be scary for a family
to see that. But then we say no,this is not what we see.
In my experience, thereattachment is the thing that
we battle. So to prevent that,we have to do some stretching
exercises at home, which arepretty easy to do. And we show
you how to do that. And youknow, where I will have my
(28:27):
families check in with me weeklywith pictures and in between any
texting to know if there's anyquestions or concerns. So that's
the consultation. That's what Iam basically telling you exactly
what I tell the family and myconsultation.
Amanda Gorman (28:40):
Okay, and then would mom and baby expect to
have the procedure done on thesame day?
Dr. Scott Siegel (28:45):
They are, you know, when we always build the
time in, so when I presenteverything to them, and go over
that- what I said to you- andwe're at the end of the
consultation, I'll say, "And itreally it's up to you that those
are indications we wouldrecommend the procedure and it
could be done today if youwanted to. If you don't, there's
absolutely no pressure, you canthink about it, you can come
(29:06):
back." I would say probablyabout 99% of the families have
already made up their mind evenbefore coming into the office
and say, you know, if you seesomething, and it's there that
we want to go ahead and get itdone. So it can be done. And I'm
right then and there. And theparents are welcome to stay
right in the room. As I statedbefore, I welcome that. I prefer
(29:28):
it so that they can actuallystill maintain contact with
their baby and touch them andthen scoop them up as soon as
we're done.
Amanda Gorman (29:37):
Great. And so you mentioned the aftercare
exercises and that you check inwith photographs. Is there any-
anything specific that you wantparents to be looking out for or
to know about post-op other thanthe exercise?
Dr. Scott Siegel (29:53):
The biggest thing is post-op while again we
go over big in a lot of post opinstructions. We're always
talking about pain management,you know, right off the get go
and trying to keep things asminimal and I find the majority
of babies don't have much pain.
But the newborns, I do find thatthey're pretty fussy the first
day, the first six to eighthours or so. So we do a lot of
hand holding, we recommend mom'sa warm bath, skin to skin, you
(30:16):
know tons of skin to skin, andgetting, you know, back in touch
with, with you guys as soon aspossible, you know, make making
sure that they have thelactation support.
From a, from a wound carestandpoint, aftercare is what we
call it, or active woundmanagement. There's a series of
stretching exercises that wehave families do, they're easy.
(30:38):
And basically, the goal is tojust open up the wounds, by
little gentle stretches, justespecially over the first two
weeks, we do it on like a fivetimes a day basis. So it's
usually like at a diaper changeor, or around a feeding time.
And that is, you know, really,we kind of really show them the
(30:58):
families what to do. As far asthe stretches, we have them
videotape how to stretch, weactually have them practice how
to stretch before they leave sothat they feel comfortable with
understanding, you know whatthey need to do.
As far as what to look for,there's really not much. The
wounds will will turn color asit's healing. It's kind of like
a scab inside their mouth, itwill kind of turn yellow, maybe
(31:21):
a little gray looking. And ittakes about two weeks for the
wound to kind of look pink andnormal, or what we call normal
coloring of the mouth at thatpoint. The biggest things we
kind of say what to expect. Andagain, when when I see my
families if they if there's anyquestions or concerns or you're
not sure what it's supposed tolook like, you can text me, you
(31:42):
can take pictures and text it tome in the meantime. So we the
biggest goal is to make surethat they're not feeling all
alone. You know, they have thatsupport system in place.
Amanda Gorman (31:53):
Absolutely. Well, I really can't tell you how
informative this has been. Youknow, we at Nest Collaborative
are firm believers that aneducated mom is the best kind.
And it sounds like that is yoursupport and your mission as
well. So Dr. Siegel, we'rereally grateful that you took
the time to speak with us today.
And how can listeners get intouch with you if they have
(32:15):
questions or want to book aconsult?
Dr. Scott Siegel (32:19):
Right, the the easiest thing to do is either,
you know, you can go onto mywebsite, which is
www.drscottsiegel.com. "drscott, scott siegel,
siegel.com". My email is onthere. That's an easy way to
contact us. My phone number ison there too. That's probably
(32:42):
the best way just even forgeneral questions. Contact me
directly.
Amanda Gorman (32:48):
Excellent. Well, thank you so much again, we
can't wait until you visit usnext time. And we certainly
would love to have you back.
Dr. Scott Siegel (32:56):
It's my pleasure. And you guys are doing
an amazing job. And again, youknow, you're educating, we're
educating, and you know, one onebaby at a time, one mom at a
time, and it's helping everybodymove forward.
Amanda Gorman (33:11):
Yeah. Well, mamas and mamas-to-be that is all that
we have time for today. Don'tforget to check us out on
Facebook and Instagram where wewill provide you with links to a
full transcription of today'spodcast so you don't miss a
beat. As always, we do want tohear from you. So if there's a
topic you'd like to explore, weare all ears. Until next week,
it's me Amanda wishing you wellon your breastfeeding journey.
(33:34):
Boo bye. [Outro] BreastfeedingUnplugged. Breastfeeding
Unplugged.
[Intro] Breastfeeding Unplugged.
Welcome. Welcome. Welcome mamasand mamas-to-be. A podcast
dedicated to helping momsnavigate their way through the
tricky world of breastfeeding.
Breastfeeding Unplugged.
(00:22):
Breastfeeding Unplugged.
Welcome to the podcast mamas andmamas-to-be. I'm your host
Amanda Gorman of NestCollaborative. And this week's
episode is one that I know willresonate with so many of you. As
you know by now at Nest, we helpmoms all over the country
through their breastfeedingjourney. And more often than
(00:44):
not, that first call can be fullof confusion, and sometimes
fear. After all, breastfeedingis supposed to be easy, right?
Not all the time. So one of themost common misconceptions we
hear is how natural andeffortless the feeding bond
between mama and baby issupposed to be. But more often
(01:05):
than not, it's simply not thecase. For most moms, the first
few days and weeks ofbreastfeeding is hard, harder
than we ever thought it mightbe. Sure, there are a few cases
where the baby latches andeverything is A-okay. But for
many of us, it isn't smoothsailing from the start. And
that's if mama and baby are bothwilling and able to start this
(01:28):
journey together.
So here we are at the beginningstages of breastfeeding,
awkwardly fumbling through,trying to figure it all out. But
after a few days and weeks, itshould get better, right? In
theory, yes, but what if itdoesn't? You may have heard the
term tongue tie, which seems tobe the term de jour for
(01:50):
breastfed babies who can't quiteget a grasp on the latch.
Believe it or not, up to 37% ofbabies are diagnosed with some
sort of tongue or lip tie. Sothe problem is more common than
many of us realize. So whatexactly is tongue tie? How do
you know if your baby has it?
And what can you do about it?
(02:13):
With me today is the amazing Dr.
Scott Siegel, president of theNortheast Oral and Maxillofacial
Surgery Center for Tethered OralTissues in Manhattan and Long
Island. Dr. Siegel is a doubleboard certified, dual degree MD
DDS, oral and maxillofacialsurgeon who has over 25 years of
experience and has devoted thepast 18 years to the treatment
(02:36):
of issues related to tetheredoral tissues. To date, he has
performed over 30,000 tetheredoral tissue surgical procedures.
So to say he is an expert, is anunderstatement. Dr. Siegel.
Welcome. We're absolutelythrilled to have you with us
today.
Dr. Scott Siegel (02:56):
Oh, thank you so much, Amanda. It's it's an
honor and privilege to be herewith you today, and I give you
so much praise for what you'redoing and help- helping with
education and moving thingsforward.
Amanda Gorman (03:11):
Yep, we love it.
We love working with you. So letme jump right in. Can we start
off with a quick definition oftongue tie?
Dr. Scott Siegel (03:21):
Sure. You know, and and it's, you know,
the first thing is that there'sso much confusion out there,
we're still trying to clarifythis for, for the general masses
and moms and pediatricians ofthe like. So, you know, in
simple terms, a tongue tie is,you know, when you look under
the tongue, the little stringthat we often see under the
(03:42):
tongue, and it's normal to havea little string under there. But
we define it as a tie or arestriction when when that
little string is too tight forfunction. And, you know,
basically, in simple terms,that's what it is. And it's not
the inability to stick thetongue out, but it's to elevate
(04:02):
and lift the tongue up to theroof of the mouth, it's often
restricted. And that can impactfeeding, it can impact
breastfeeding, it can impactbottle feeding. So I kind of
keep it simple. And you know,that's the quick, quickest
definition I can give you.
Amanda Gorman (04:18):
No, that's, that's helpful. So for parents
of newborns, what should they belooking for? Or are there any
real telltale signs if theirbaby has a tongue tie?
Dr. Scott Siegel (04:31):
Right, I'd say that, you know, what we have
found in the United Statesanyway, but sometimes even
worldwide, is that there's not auniform way of screening babies
in the hospitals for thesethings. So and there's different
types of tongue ties. Some arereally easy to see like this
little web at the tip of thetongue, and some are a little
(04:52):
further back. But I'd say one ofthe quickest things that happens
if especially you know, asbreastfeeding rates are climbing
up worldwide, is sometimes thealmost immediate inability to
latch or painful latching onbreastfeeding is one of the
earliest signs that we'll see.
But trying to assess under thetongue is not such an easy thing
(05:13):
to do. And unfortunately, mostpediatricians aren't really
trained in this area. We do findthat majority of lactation
consultants are, so one of thefirst things we will recommend
is seeing a lactationconsultant, you know, like
yourself for an earlyassessment.
Amanda Gorman (05:34):
Yes, absolutely.
And then, the women we do see,often will bring the information
back to their pediatrician. Butwe do find sometimes
pediatricians and otherpediatric providers can tend to
dismiss tongue tie when they dobring it up. Why is there such a
disconnect on the issue?
Dr. Scott Siegel (05:54):
We find there's a big disconnect and the
majority of the issues reallyhave to do with education and
experience in this area. One ofthe biggest I guess voids in
medical education is about whatwe consider normal eating,
normal breastfeeding, oralinfant anatomy, or infant
oriental anatomy inside themouth and what's in- what we
(06:17):
consider normal and not normal.
And there's really a lack ofeducation or consensus among
pediatricians. And that comesdown to the education in not
only medical school, but also inthe residency program. The
American Academy of Pediatricsreally doesn't give many
guidelines to pediatriciansabout what they're looking for
inside the mouth, or what reallyconstitutes normal
(06:40):
breastfeeding, or normal feedingthat should be occurring on a 24
hour cycle. So mostpediatricians will look at
something and call it mild intheir eyes, when it's actually
not and a baby's reallystruggling with feeding or
painful breastfeeding. And wefind that a lot of it gets
dismissed, because thepediatrician's primary goal is
(07:01):
to look at weight gain on theirhealthy visits. And we see that
or hear that a lot that thepediatrician says my baby's
gaining weight, so they're okay.
But they're not asking the mom,well, how is feeding going on a
24 hour basis, mom's dying,they're in so much pain, the
baby is constantly popping offthe breast or falling asleep at
(07:24):
the breast commonly or you know,non stop. And feeding is a big
struggle. And they might begaining weight because of the
increase in frequency of thefeed. Or mom has the pump and
you know, give the baby moremilk through a bottle or double
or triple feed in her baby. So apediatrician may often say, oh,
(07:46):
that's great, you know, orswitch them to formula, we hear
all these different things. Sothere's really inconsistency
with education. And that'sreally where it stems from.
Amanda Gorman (07:55):
One question we get additionally from from
parents is whether tongue tie ishereditary? Do we think that's
the case?
Dr. Scott Siegel (08:03):
So in some cases, yes. And there are genes
that have been isolated for along time. And some of them
actually run, you know, more onthe male side. So there's like a
little bit more of apredominance on in the, in the
males of the boys. But so youknow, when you start to talk
about it, you will see some thatcome into my office anyway and
(08:24):
say yes, you know, dad has it ormom had it, or in the family,
we, you know, it's agenerational thing. And then
there are some that just seem tocome out of the blue. You know,
and there's other reasons thatwe may be developing the ties
and we're not exactly sure.
There's the research and someexperience looking at even the
amount of folic acid or folatethat's being put into prenatal
(08:45):
vitamins may have there may be alinkage to that. Not been
proven, but we may be protectingagainst, you know, bigger, bad
things like neural tube defects.
But having a trade off of atongue tie or lip tie or ties in
the mouth may be secondary tothat. Kind of the short answer
is like yeah, there are geneticpredisposition, but not in all
(09:09):
cases.
Amanda Gorman (09:10):
So there can be more than one type of tie in the
mouth. Is that true?
Dr. Scott Siegel (09:14):
That is true.
Now, most everybody talks about,you know, ties or tongue ties as
as you know, the be all and endall but I'd say the most
prevalent or the one that seemsto impact the breastfeeding the
most or feeding seems to be thetongue tie. But there's
basically up to seven spots thatwe check for the ties or we
commonly also call as tethers ortether oral tissues, or T.O.T a
(09:36):
lot of people will call it. Sokind of lifting them in in order
prevalence we see the tongue tienumber one as probably the more
common one, but lip ties areeither the upper lip or the
lower lip are very common. Andyou can also have them in the
cheek, which are also calledbuccal or "buccal" buccal ties.
(09:56):
And you can have those on theupper, or the lower cheeks on
the right and left side. Sobasically, there's seven spots
that we generally will screenfor. And the majority of the
babies will have, you know,either the tongue, tongue and
lip, or maybe upper buccals. Soit's but on a on occasion we'll
(10:18):
see all seven spots that aretied.
Amanda Gorman (10:25):
I had no idea. A lot of potential issues other
than tongue tie can affect ababy's ability to breastfeed,
no?
Dr. Scott Siegel (10:36):
When we look at these things, and you know,
unfortunately, sometimes peoplewill really kind of say, won't
you get the tongue tie fixed,and everything's gonna be fine.
We look at these as a piece of apuzzle. And there could be
definitely other issues that aregoing on with feeding. And you
know, from my perspective, as asurgeon, it's really important
to have these babies assess, youknow, from a functional standp-,
(10:59):
standpoint by an InternationalBoard Certified Lactation
Consultant, IBCLC, because they,you guys really understand
what's going on from afunctional standpoint. And there
could be other issues going on.
So we always look at, you know,what's going on with mom, mom's
anatomy, mom's supply, and otherissues going on, on that end. We
look at the baby, we look atbaby's function, we look at
(11:22):
baby's anatomy, you know, sowe're looking at structure,
structure and function. Andputting those pieces of the
puzzle together. Then we look atthe baby as a whole.
Some babies will have otherissues going on, whether it's
neurologic, whether it's like astructural issue with where a
baby is requiring some sort ofp.t, maybe they have some neck
(11:45):
issues, torticollis or otherbody issues, though, you know,
the the broad picture that wherewe say there's little pieces of
a puzzle, and we're trying totrying to take all of these and
look at the big picture. I don'tknow if that kind of answers
that.
Amanda Gorman (12:01):
Yeah, no, absolutely. It's good to kind of
take a look at all all potentialvariables.
Dr. Scott Siegel (12:08):
Right. Kind of look at what's going on. And
then you say, well, if the babydoes have a tie, and it goes in,
you know, with that picture,then we just go back to kind of,
you know, risk versus benefit oftreatment of the tie.
Amanda Gorman (12:22):
So a lot of moms want to know if their baby feels
pain, if they have a tongue tieor any other related issue.
Dr. Scott Siegel (12:30):
So you know, if, you know, if they're for the
procedure itself, is that thequestion or-?
Amanda Gorman (12:34):
No, just when they-
Dr. Scott Siegel (12:35):
Just in general just having a tie?
Amanda Gorman (12:37):
Yeah.
Dr. Scott Siegel (12:37):
Yeah, I mean, you know, when we see, I can't
tell what a baby's feeling, butwe see it when we have older
kids come in, that can tell uswhat it feels like. And a lot of
kids will actually come incomplaining that things feel
tight. Sometimes we'll have youknow, kids that are very
restricted, when they're tryingto function it is uncomfortable.
We would just kind of assumethat a baby would, you know,
(12:59):
maybe tire out quickly, whenthey're trying to feed with
these things, because they'rereally kind of using up so much
energy, we call it beatingefficiency. So many times,
they'll fatigue faster, they mayget a little more sore in
certain spots, because of excesspull, you know, of the soft
tissues when they're trying tofeed. So we can kind of say
(13:22):
they're probably not maybe notin severe pain, but they're
probably uncomfortable, they'reprobably tiring out quickly. You
know, so that's kind of what Iwould assume, you know, from the
baby's standpoint.
Amanda Gorman (13:38):
And perhaps, maybe you can take us through
what a procedure looks like fora tie revision.
Dr. Scott Siegel (13:44):
So when we talk about, you know, procedures
and surgery and risk versusbenefit, it's very overwhelming
for, you know, parents, for mom,for the whole family. And we
always say we're treating thewhole family, we're not just
treating a baby here. So we'retreating the whole family. And
when we- when I consult with myfamilies, when they come in, and
(14:05):
I really kind of sit there andtalk with them, I talk about
risk versus benefit. And I talkabout you know, an actual
procedure as far as theprocedure itself is such a very
quick, easy surgical procedurein my office. That and the, the
amount of pain that is actuallyfelt is, seems to be minimal.
And I can say that only becausewhen I do older kids who can
(14:27):
tell me what it feels like, theywill not complain much of pain.
It's more scary than anythingelse.
The actual procedure to releasethe tongue or lip tie or
multiple ties and in my office,I use a laser for it. So we just
wind up using a topicalanesthetic. So the risk of the
procedure from an anesthesiastandpoint is minimal. There are
(14:50):
some doctors that will put youknow, babies under general
anesthesia and that is in mymind, the risk of the anesthetic
outweighs the risk of theprocedure. So when we look at
these procedures, we want tokeep things as minimal risk as
possible, as easy as possiblefor the baby and for the mom and
for the whole family.
(15:12):
And the actual procedure itself,I do allow families to stay in
the room so they can witnesswhat's going on with their child
and their baby. So that baby'snot taken from them, they
actually will be able to touchtheir baby, while it's going
through any sort of procedure.
And, you know, we feel that'simportant. Because we do, we do
expect, you know, there is adegree I don't like to say pain,
(15:35):
but it hurts a little bit, youknow, so we do numb the area up.
There are some doctors out therewho won't use any form of either
topical anesthetic because theyfeel it's so quick that it won't
hurt them. But we say any, anybaby or any person can still
feel pain. So we want to try tomake it as easy and pleasant as
possible for everybody.
Amanda Gorman (15:59):
I'm sure that's relieving for the moms to be
able to be in there and justmore informed.
Dr. Scott Siegel (16:04):
Yeah, and it's, you know, I always tell
them, the moms, you know, yourbaby's gonna cry, and you're
gonna cry more and, and thenit's gonna be done. And as soon
as we are done, they pick themright up, we go into a private
room so they can get right onskin to skin, and get them on
the breast. And we do have alactation, or TLC with us, that
(16:24):
just helps them moms withlatching and whatnot, right
afterwards. Just to kind ofhelp, you know, get things
moving along faster, because thebiggest thing, it's not so much
the procedure, but it's justhelping holding hands. And I
think that's the biggest thingis, you know, trying to get- it,
we always talk about taking avillage it take it does take a
(16:47):
village to help these babiesfeed, you know, we talked about,
many moms will come in with apreconceived thing, you know I
thought it was gonna be so mucheasier than it is, like you said
in your intro. And it's not andthey, and it's even when we do
these procedures, it's not, youknow, something that you do the
procedure and everything's fixedimmediately. There is a process
(17:08):
to it.
Amanda Gorman (17:09):
That's great. You know, so when mom and the family
is in the room for theprocedure, how do you keep baby
still, when you're-
Dr. Scott Siegel (17:17):
So the babies are kept still by swaddling 'em.
So we swaddle them and prettytightening in a receiving
blanket. And actually, you know,we have either one or two
surgical assistants in with meholding the baby. I'm back
basically controlling, you know,the mouth and the head. There is
a little retractor that comesunderneath the tongue to hold
(17:40):
the tongue up and keep it still.
And I usually will hold the lipmyself with the-, you know, with
my, my fingers. And then youknow, the procedure itself is
very quick. I get a lot ofquestions, well, what happens if
the baby moves or you slip. AndI will jokingly tell them that
it's not like I'm using alightsaber that's just kind of
slices right through everythingit's touching. The actual laser
is a very delicate instrument.
(18:04):
And it's only basically takingcell layers off at a time. And
you kind of have to, you know,with the years of experience and
knowing how to do it, that's howyou become very quick and adept
at it. But it's a very safe andmeticulous and precise, you
know, way of doing theprocedure. So it's not like I'm,
you know, working on a movingtarget the whole time. The other
(18:25):
thing from a surgical standpointis that I use magnifying loops.
So I'm actually looking atthings, either three to five
times magnification. So it'slike, you know, very large in my
eyes, that I see.
Amanda Gorman (18:38):
So you mentioned laser but some procedures use
more of a cut or a clipper. Sowhat is the difference between
those two?
Dr. Scott Siegel (18:47):
So the difference between what you call
quote unquote clipping orcutting and laser is that the
clipping or cutting is usingeither a scissor or a scalpel.
And if you kind of lookworldwide at the doctors that
are, you know, providers thatare- been doing this for a long
time or see the most [unknown]of baby or babies or really
doing the researches, majorityof us are using lasers. And
(19:10):
reason we like laser is that it,it helps stop bleeding or
coagulates or cauterizes as wecut. So we find that we get a
lot less bleeding, we getbitter- better visualization of
the surgical site. And what weconsider more of a complete
relief, you know, less bleeding,so in theory you have less
reattachment and other issuesafterwards.
(19:33):
So for me, my instrument ofchoice has been laser for 20
years. And it's been 20 years, Iknow in the intro that 18 years,
but I'm doing it 20 years atthis point. And there's many
doctors out there who clip orsnip with scissors and they
sometimes can get very goodresults. But we find when we
look at these side by side, andwe're trying to get the research
(19:56):
out there we do find thatthere's better wound healing,
less bleeding for sure, maybesome less pain. So that's the
biggest differences that we seebetween the two.
Amanda Gorman (20:06):
Okay. And you mentioned, you know, looking at
the big picture and the puzzlepieces. So I assume then there
are some cases of tongue tiethat might not need revision, or
are there other options, than arevision?
Dr. Scott Siegel (20:21):
Right, so when we, when we talk about tongue
ties, the biggest thing we'relooking at is what's going on
from what we call symptoms orfunction. And I have some babies
that will come in, and they'reactually feeding pretty well,
they're gaining weight prettywell. You know, it's not painful
on mom, and we kind of just willkind of, almost take a wait and
see approach. Like, "Well, mybaby's doing pretty well. But
(20:44):
you know, I just want to get itscreened." And we'll say, on
exam, I feel a bit ofrestriction, maybe there's some
issues going on. And in somecases, we'll actually, you know,
do some other forms of therapyfirst. We'll either do some oral
suck training therapy with alactation consultant, or in
combination, we will work withwhat we call a body worker,
(21:05):
which is either physicaltherapist, occupational
therapist, chiropractor. Thingsthat would kind of work on what
we call your body tension andtightness, because there's a lot
of connections between theseareas. And sometimes we'll give
we'll go that route before evenconsidering a surgery.
Amanda Gorman (21:24):
That makes sense.
Least invasive first. So if amom elects not to do a
procedure, are there anypotential longer term effects
for baby?
Dr. Scott Siegel (21:38):
Yeah, so when we look at these things, many of
us, you know, especially if ababy is coming in with a
functional issue. And we wetalked to the parent, we
identify that there are obviousties, and we'll we'll review
them with the family, like, wego back to the risk versus
benefit. And we're really- iskind of emerging research in
(21:59):
this area coming out, even inthe past few years looking at
untreated ties, and making kidsmore predisposed for developing
other issues as they get older.
And we have found that, althoughthis is not a lot of hard
science and research, althoughthose come kind of coming down
the pike, there are risks ofuntreated ties. Now, when we go
(22:21):
back to, you know, what we seein our experience, in my 20
years of experience, is a lot ofthese kids follow patterns. And
we see a lot of these kids, whenI see a lot of these kids coming
in with speech issues or solidfood feeding issues or longer
down the road with either sleepdisordered breathing,
orthodontic issues. You go backin their history, many of them
(22:44):
started off with a breast orbottle feeding issue, and then
they kind of just progresseddown the line.
So when I actually do myconsult, you know, we talk about
the long term impact andprevention. So, you know, when I
kind of talk as a as acomplication, and I know it's
(23:05):
one of the questions in thiskind of ties in pardon the pun,
it kind of ties in, when a momelects not to do a procedure, I
will kind of tell them, what weusually will see long term. And
usually we'll start to see whena tongue is restricted in its
elevation, one of the thingsthat happens, it's not allowing
the roof of the mouth to kind offlatten out and spread out. So
(23:28):
what we have found, and a lot ofthat research has come out from
the oral myofunctional communityspeech therapy community is
normal resting posture for atongue should be resting on the
roof of the mouth, and we startto see that in the babies. So in
my consultation, I'll say,"Well, you know, if the baby
can't elevate its tongue andrest on the roof of the mouth,
that's going to start to affecthow they grow and develop long
(23:51):
term." And what will happenduring during the growth and
development of the babiesinstead of the roof of the mouth
flattening out and spreadingout. It starts to get narrowed,
it arches up higher. That does acouple of things, it makes it
more difficult for the tongue toget up to the roof of the mouth
for feeding.
But it also makes it moredifficult for the baby to
breathe, and they start tobecome more mouth breathers. As
(24:15):
the kids continue to grow anddevelop, oftentimes, that'll
start to lead into difficultieswith eating solid foods because
they can't get the tongueelevated. They can't get this
good wave like motion of thetongue going on. And we just see
them coming back in. I can seethem coming back in at the next
stage with solid food feedingissues. After that is usually a
(24:35):
speech and articulation issue.
And then longer term after thatthey can cause issues with the
growth and development of thejaws, teeth, airway. So that's
kind of you know, what we seewith untreated ties and that's
what I talk about myconsultation with the families.
Not to overwhelm them, but kindof give them you know, all of
the information so that they canmake an informed decision.
Amanda Gorman (24:58):
I agree 100%. You know, talking about your
consultations, what is theprocess kind of from when mom
and baby first come in toconsult with you through the
actual procedure?
Dr. Scott Siegel (25:12):
Right. So it, you know it all starts from the
first phone call. And themajority of moms and families
are, you know, extremelyanxious. And so my staff deals
with this all day long. And wejust number one want to tell
them that, you know, you comein, as soon as you know,
they're, they get that firstphone call, we try to be warm
(25:33):
and inviting, and make them feelsafe and secure. So that, you
know, starts when the firstphone call. When they come in
the actual consultation, themajority of it is listening. I
really need to sit there andlisten, because even when I'm
training pediatricians andpediatric dentists and others,
like the parents, and the momwill tell you the diagnosis, as
(25:56):
soon as you're sitting there andlistening to the full story of,
you know, tell me what's goingon. What's bringing you here,
tell me about your feeding andyour feeding experience. And you
know, what, what is it like on a24 hour cycle. And that's
really, the majority of my timeis spent listening. A small
majority of my time is then youknow, taking a look at the baby
(26:19):
and doing my exam.
I typically don't need to reallysit there and look at the baby
feeding because the majority ofwhat's told to me kind of make
that assessment. And when I say,you know, a vast majority of
these babies already have beenassessed by a lactation
consultant as well. So I look atthe baby, we swaddle them up,
(26:40):
and I look at them. And Iexamine them from behind,
because it's really the best wayto kind of get in there and look
at you know, lift up the lip,get underneath the tongue, do a
full oral exam. And I will kindof, you know, if I see something
in the mouth, and if I see ties,I bring the parents right over
and show them what they- what Isee, that this is what I see,
(27:00):
this is what I don't see. Andthen I talk about each area and
how it's impacting theirfeeding. And as, as I said
earlier, pieces of a puzzle. Andthen I talk about the actual
procedure, which I kind ofdescribed before, and I go over
the risk and benefit. And in myexperience with these
procedures, the actual risk isvery low.
(27:22):
The biggest issues I find and Idon't really like the word- to
use the word risk, is that theycan heal back together. And many
people call it quote unquotereattachment, or you know,
meaning those areas healing backtogether a little scar tissue.
And that's really, you know,from a surgical standpoint, what
I see. In my own practice inthose 30,000 cases or whatnot, I
(27:43):
have not even seen an infectionfrom this. And that's what I
tell the parents. We're not nearany major anatomy for the
procedures, as long as you'redoing it with somebody who's
experienced. So we're not seeingany issues with nerve injuries.
We're not seeing any issues withyou know, salivary gland,
injuries. There are reports inthe literature of certain
things. So if you look at thoserisks, and those get listed on a
(28:06):
consent form, so it cansometimes be scary for a family
to see that. But then we say no,this is not what we see.
In my experience, thereattachment is the thing that
we battle. So to prevent that,we have to do some stretching
exercises at home, which arepretty easy to do. And we show
you how to do that. And youknow, where I will have my
(28:27):
families check in with me weeklywith pictures and in between any
texting to know if there's anyquestions or concerns. So that's
the consultation. That's what Iam basically telling you exactly
what I tell the family and myconsultation.
Amanda Gorman (28:40):
Okay, and then would mom and baby expect to
have the procedure done on thesame day?
Dr. Scott Siegel (28:45):
They are, you know, when we always build the
time in, so when I presenteverything to them, and go over
that- what I said to you- andwe're at the end of the
consultation, I'll say, "And itreally it's up to you that those
are indications we wouldrecommend the procedure and it
could be done today if youwanted to. If you don't, there's
absolutely no pressure, you canthink about it, you can come
(29:06):
back." I would say probablyabout 99% of the families have
already made up their mind evenbefore coming into the office
and say, you know, if you seesomething, and it's there that
we want to go ahead and get itdone. So it can be done. And I'm
right then and there. And theparents are welcome to stay
right in the room. As I statedbefore, I welcome that. I prefer
(29:28):
it so that they can actuallystill maintain contact with
their baby and touch them andthen scoop them up as soon as
we're done.
Amanda Gorman (29:37):
Great. And so you mentioned the aftercare
exercises and that you check inwith photographs. Is there any-
anything specific that you wantparents to be looking out for or
to know about post-op other thanthe exercise?
Dr. Scott Siegel (29:53):
The biggest thing is post-op while again we
go over big in a lot of post opinstructions. We're always
talking about pain management,you know, right off the get go
and trying to keep things asminimal and I find the majority
of babies don't have much pain.
But the newborns, I do find thatthey're pretty fussy the first
day, the first six to eighthours or so. So we do a lot of
hand holding, we recommend mom'sa warm bath, skin to skin, you
(30:16):
know tons of skin to skin, andgetting, you know, back in touch
with, with you guys as soon aspossible, you know, make making
sure that they have thelactation support.
From a, from a wound carestandpoint, aftercare is what we
call it, or active woundmanagement. There's a series of
stretching exercises that wehave families do, they're easy.
(30:38):
And basically, the goal is tojust open up the wounds, by
little gentle stretches, justespecially over the first two
weeks, we do it on like a fivetimes a day basis. So it's
usually like at a diaper changeor, or around a feeding time.
And that is, you know, really,we kind of really show them the
(30:58):
families what to do. As far asthe stretches, we have them
videotape how to stretch, weactually have them practice how
to stretch before they leave sothat they feel comfortable with
understanding, you know whatthey need to do.
As far as what to look for,there's really not much. The
wounds will will turn color asit's healing. It's kind of like
a scab inside their mouth, itwill kind of turn yellow, maybe
(31:21):
a little gray looking. And ittakes about two weeks for the
wound to kind of look pink andnormal, or what we call normal
coloring of the mouth at thatpoint. The biggest things we
kind of say what to expect. Andagain, when when I see my
families if they if there's anyquestions or concerns or you're
not sure what it's supposed tolook like, you can text me, you
(31:42):
can take pictures and text it tome in the meantime. So we the
biggest goal is to make surethat they're not feeling all
alone. You know, they have thatsupport system in place.
Amanda Gorman (31:53):
Absolutely. Well, I really can't tell you how
informative this has been. Youknow, we at Nest Collaborative
are firm believers that aneducated mom is the best kind.
And it sounds like that is yoursupport and your mission as
well. So Dr. Siegel, we'rereally grateful that you took
the time to speak with us today.
And how can listeners get intouch with you if they have
(32:15):
questions or want to book aconsult?
Dr. Scott Siegel (32:19):
Right, the the easiest thing to do is either,
you know, you can go onto mywebsite, which is
www.drscottsiegel.com. "drscott, scott siegel,
siegel.com". My email is onthere. That's an easy way to
contact us. My phone number ison there too. That's probably
(32:42):
the best way just even forgeneral questions. Contact me
directly.
Amanda Gorman (32:48):
Excellent. Well, thank you so much again, we
can't wait until you visit usnext time. And we certainly
would love to have you back.
Dr. Scott Siegel (32:56):
It's my pleasure. And you guys are doing
an amazing job. And again, youknow, you're educating, we're
educating, and you know, one onebaby at a time, one mom at a
time, and it's helping everybodymove forward.
Amanda Gorman (33:11):
Yeah. Well, mamas and mamas-to-be that is all that
we have time for today. Don'tforget to check us out on
Facebook and Instagram where wewill provide you with links to a
full transcription of today'spodcast so you don't miss a
beat. As always, we do want tohear from you. So if there's a
topic you'd like to explore, weare all ears. Until next week,
it's me Amanda wishing you wellon your breastfeeding journey.
(33:34):
Boo bye. [Outro] BreastfeedingUnplugged. Breastfeeding
Unplugged.
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