Difficulty with your child's eating? The frenulum may be to blame....

The largest group of concerned parents visiting my practice are those who are concerned about their child's eating difficulties. When asked, "What brings you to me?", they most often reply: "Shortened frenulum of the tongue„.

A little impatient and confused, they answer my questions about the pregnancy period, the medications taken, the birth, health problems, jaundice, motor and emotional development. Between the lines I can sense wandering thoughts: "What is all this for? We have a specific problem. Social media is trumpeting that this vein under the tongue is responsible for all this. We want to undercut it and erase all the difficulties our child is facing. As if by magic, all our problems will disappear." Parents are hopeful, they think that's how it works.

And I, after many years of working with children as a paediatric neurologist in Warsaw, I know it is very different - not so easy, not so fast and not so simple.

1. First, I try to explain 'what it's all for'. We sit down comfortably. I begin the first observations of the child, but also the observation of the parent-child relationship.
2. I observe global motor skills, the smallest movements of the body at the periphery, i.e. movements of the arms, legs, fingers.
3. I also glance at the calm-anxious movements of the parents: the pace of pulling out of the car seat, pulling on layer after layer of clothes, the way they carry, hold, dress. Believe it or not, it's all non-judgmental to the attitudes of anxious parents, but strongly diagnostic.
4. I look at the face, the tongue, the distrustful eyes of the toddler. During this fleeting first eye contact, I try to convey to him that he is safe. None of his boundaries will be crossed here today. First child's emotions and the parents are falling down. It will be some time yet until my hands come into contact with this other, smaller and more vulnerable body.
5. We talk. We ask questions. I explain what I will do, what I will check, for what purpose.

I am changing the language of speech to a more accessible one (no more "incorrect voltage distribution in the orofacial area") and then I hear ...

• "It's so hard to wash his neck, it's all red and cracked."
• "Well he's so strong, he's been messing with his head since birth."
• "I'm afraid I'll break her arm one day when dressing her because I can't pull the sleeve," he says.

Diagnosis - why does your child have difficulty eating?

Sometimes we know quite quickly if the culprit of a child's eating difficulties is shortened frenulum of the tongue, and sometimes we need a longer moment and a broader perspective. The problem of evaluation is often those 'borderline' smokes. Should I cut straight away? This is where a lot of doubts arise, because I know how important it is to accurate diagnosis and how many consequences any, even the smallest, interference with the child's physiology entails.

During the examination, the following become apparent irregularitiessuch as:

• Passive lifting of the tongue entails a tense floor of the mouth.
• Lateral tongue movements are often within normal limits.
• Feedings are sometimes worse, sometimes better (here the relevant variables could be listed in dozens... position, arousal state of mother and baby, amount of stimuli, environment).
• Low support in the quality assessment is far from optimal.
• When lying on the back, trunk stabilisation is poor.
• Clenched fists.
• Highly aligned shoulder line.
• Fixed asymmetry, also evident on the facial cranium.

Everything matters. Every little detail helps me to connect the dots and decide - what is best for the little one. And also what action to take to help him.

Frenectomy - a decision well worth thinking about

Several variables need to be assessed before deciding to undercut the frenulum.

1. Will the body - this small-big synchronous machine - functioning at its present level, fully exploit the opportunity, the potential it carries frenulum correction procedure in children (change in mobility, mobility of the structure)?
2. Do the parents express the emotional and task readiness that comes with the procedure? The need to rehabilitate the tissues surrounding the wound and over time the scar itself, massages, stimulation of the orofacial area.
3. And perhaps most importantly - does the problem primarily lie with the frenulum? Have other adaptive or compensatory mechanisms crept in?

Working holistically as a key to therapeutic success

And now boom - more often than not, my reliable girlfriends spring into action, paediatric physiotherapists. They assess independently or we assess together, we consult, we talk. I am very fortunate to work as part of a team - both in Kids Medic Therapy and Diagnosis Centre in Warsaw (Ursus)as well as at the Gajusz Foundation and Hospital. We can consult with each other, support each other, exchange knowledge and therapeutic experiences. And all this is done in order to choose the best path for the child and the parents.

The whole process may take time. I am not promising that it will be easy and quick, but I can assure you that it will be better. Comprehensive, holistic - in order to be more confident that your child's frenulum correction will have the desired effect. To help better, using all the powers I have - all the knowledge and experience I have gained. Through play, through collaboration with parents and other therapists.