Editor’s Note: This is the second installment in a new column on pediatric chiropractic that began in the November 2025 issue.
The term tongue tie or ankyloglossia is well-known to all pediatric-focused chiropractors. In the past 15-20 years, the prevalence of this diagnosis has skyrocketed. As I mentioned in my first article, studies show that since 1997, there has been an 866% increase in the surgical procedure called frenotomy, in which the frenulum of the tongue is surgically cut to release the tongue. That is likely a low estimate because it only includes procedures performed in the hospital after the delivery and does not take into account any done privately later on.
In recent years, both the diagnosis of and the frequency of frenotomies have been highly scrutinized by prominent medical bodies such as the American Academy of Pediatrics (AAP) and ABM (Academy of Breastfeeding Medicine). As recently as July 2024, the AAP stated:
There are no uniform accepted diagnostic criteria for the diagnosis of Ankyloglossia. There is a lack of consensus for treatment of Ankyloglossia, leading to wide practice variation in the United States and internationally. At the same time, the diagnosis of Ankyloglossia and the frequency of performing a frenotomy has increased recently worldwide. Some medical practitioners and researchers are concerned that infants and children are being over diagnosed.
What this means to the pediatric chiropractor is that we are seeing breastfeeding babies in much greater numbers in our offices. Parents are seeking our help with this mysterious “tongue tie,” as are lactation consultants, pediatric dentists and many other members of the breastfeeding care team. Let’s look at some clinical aspects of this scenario that are well within the chiropractic scope.
Causes / Complications
The whole reason a “tongue tie” is a concern is that it limits the normal motion of the tongue. In order to transfer milk, the tongue has to be able to elevate high enough inside of the mouth cavity to press the breast tissue tightly to the palate (the roof of the mouth) to create a tight seal. It’s this seal that creates a pressure exchange between the milk ducts in the breast and the baby’s mouth, and allows for milk ejection.
Without a tight seal, transferring milk is much harder and excess air can be swallowed by the baby, leading to gas and indigestion. Of course, less milk transfer also means inadequate weight gain by the baby and potential breast infection or reduced milk production by the mother. Now you can see why this is such a big deal!
It is definitely true that sometimes the frenulum is shortened as part of a genetic midline defect. However, there is more than one reason why the tongue’s mobility can be limited.
The Musculoskeletal Connection
I like to explain to new parents in my office that the tongue is like any other muscle group in the body (the biceps or gluteal muscles, for example): it has origin and insertion points on the bony structure. In other words, it’s attached to something!
In the case of the intrinsic tongue muscles, the main attachment points are the styloid processes of the temporal bones, the interior of the mandible, and the hyoid – which sits directly in front of C3 in the upper cervical spine.
Remember that the infant cranium and spine are not solid. The cranial bones are connected by fibrous sutures. The entire occiput is in four pieces, connected by cartilage. This includes the bottommost portion, the foramen magnum, which is in three pieces itself. This forms the cranial base and links securely to the atlas (C1), which is also in three pieces.
This brilliant design allows the atlanto-occipital union to act like a round spring, providing some needed “give” in this region in order to protect the brainstem from injury during the often-excessive forces of birth. Also remember that the occiput is connected to the temporal bones laterally, which are connected to the mandible at the TMJ. What all of this means is that the infant cranium and spine have a lot of potential motion.
An extremely common clinical presentation in the newborn is a head tilt or rotation: torticollis. Because everything is connected and movable in the newborn, this upper cervical imbalance causes a global distortion, affecting each and every one of the origin / insertion points of the tongue muscles!
This global distortion doesn’t only affect the tongue muscles biomechanically. If we look closer at the fibrous foramen magnum, we see that it contains some important foramen, which house cranial nerves that are critical for the ability to feed:
The jugular foramen contains three cranial nerves: CN IX Glossopharyngeal – innervates the muscles used for swallowing; CN XI Accessory – innervates mainly the sternocleidomastoid and trapezius muscles needed for neck control; and CN X Vagus- (the king cranial nerve / the wanderer) – innervates critical life systems such as respiration, cardiac, digestion and more.
The hypoglossal canal (CN XII Hypoglossal) innervates all of the intrinsic muscles of the tongue.
A simple understanding of anatomy shows us that when upper cervical imbalance or “torticollis” is present, it causes a global distortion which not only physically tethers the tongue at the origin and insertion points, but also causes a neurological compromise due to compression of the foramen magnum, containing the crucial cranial nerves needed for feeding.
Adjustments and Infant Feeding Success
Increasing research is being done in the chiropractic profession showing the effectiveness of cranial and spinal adjustments on infant feeding success.
Once study1 followed a nine-day-old female with a history of birth trauma who presented for care with breastfeeding difficulties and concomitant failure to gain weight. The patient was cared for with Diversified Technique (i.e., touch and hold) with adjustment to the atlas and sacrum, along with cranial adjustments.
Following the first visit, the infant attended four visits in two weeks, followed by twice per week. Each visit resulted in more comfortable breastfeeding for the mother-infant dyad, along with increased infant weight as recorded by the parents.
Clinical Takeaway
In my own private practice, I see improvements in feeding success and infant health every single day through chiropractic and cranial care. Fortunately, pediatric chiropractors’ success is gaining the attention of medical providers such as pediatricians, nurse midwives, lactation consultants, and pediatric dentists.
There has never been a better time to increase our skills and knowledge of this specialty work, enabling chiropractors to provide relief and better health to these babies and their families.
Reference
- Williams-Libs S, Alcantara J. Resolution of breastfeeding difficulties and concomitant weight gain following chiropractic care in an infant with birth trauma: a case report & review of the literature. J Pediatric Maternal Family Health Chiro, 2021:46-52.
