The restrictive oral brakes and osteopathy: tongue brake, lip brake, cheek brake

A restrictive tongue lock prevents the tongue from moving, so some sounds are impossible for a child who cannot lift the tongue. In all language disorders, it is important to check for the presence or absence of restrictive oral brakes, especially of the tongue but also of the lip.

It is often because breastfeeding is not going well that we discover the presence of restrictive brakes. The proportion of breastfeeding women being quite low, and the low level of support for breastfeeding in France means that it is often realized later/too late that the baby has one or more oral restrictive brakes.

It is unfortunate that there are not more trained brake personnel in maternity wards. This would help detect problems earlier and allow the mother who wants to breastfeed to continue.

A tongue brake that is too short will block the movement that the tongue is supposed to make on the nipple. Thus, the sucking will not be efficient, and the stimulation will be too weak. The infant will have difficulty staying at the breast, and will quickly get tired of sucking. 

The breast not being properly drained, the mother may feel pain, engorgement and the latch not being good, cracks may appear.

 The lip brake prevents a good grip on the breast, in fact the upper lip will tend to retract and will not completely fit the breast. The suction cup effect will not take place. The child will therefore get tired and the sucking will be less efficient or even ineffective.

A baby with a bad head will get tired, need to be put to the breast more frequently because he will not be full, and his weight gain will be slow. The mother may produce less and less milk because of this poor stimulation.

It is the tongue that shapes the palate. If the tongue cannot press on the palate, we will have a narrower palate, possibly hollow. The palate is made up of the palatine bone in its posterior part, but especially of the upper jawbone on which the teeth are inserted. A palate that is not widened by the tongue will therefore result in a small jawbone and the teeth will not have enough room. Before putting on braces, it is important to check for the presence of brakes.

Concerning the lip brake, it also has its role in the dentition. Firstly, if it is inserted low on the gum, it can cause an inter-incisor space commonly called "the happy teeth". Secondly, it is also because the lip moves that it stimulates the anterior face of the maxilla and allows its enlargement. In cases of a small upper jaw, it is essential to verify the presence or absence of a restrictive lip brake.

In oral restrictive brakes, a child opens his or her mouth and breathes through it instead of through the nose. Mouth breathing increases the risk of fatigue but also of ENT problems such as angina, ear infections, etc.

When you give your little one a spoonful of mashed potatoes, the lip will scrape the inside of the spoon. A lip fixed by a restrictive brake will prevent this movement and the spoon will always be half full. The parents have the reflex to lift the spoon to scrape it off the child's lip and therefore do not think that there is a problem.

When food is in your mouth, your tongue and cheeks will work to guide the food bolus. A tight tongue makes swallowing more complicated and the risk of a false start is greater.

Meals seem endless to parents, children often get tired and don't finish their plates. 

Torticollis, Kiss syndrome, musculoskeletal disorders and indirect flattening of the skull are symptoms associated with oral restrictive brakes. A brake being an embryological residue of the midline, it would seem that it can disrupt the body axis and cause asymmetrical tensions.

A baby with restrictive brakes cannot suck well. He will therefore tend to swallow more air, and milk will flow out of the corners of his mouth, because he cannot create a good suction. This will cause more burping, gas, colic and reflux.

To remove a brake, this is called a freinectomy or freinotomy.

There are two methods: the scissors or the laser.

In both cases, it only takes a few seconds to two minutes, and the results are equivalent.
Personally, I prefer the laser because there is less bleeding and it is therefore less anxiety-provoking for the parents. But the scissors are just as effective.

There is little or no pain during and after the procedure.

If you are breastfeeding, we recommend placing some of your milk in the freezer in ice cube trays (ideally try to find stick-shaped ice cubes). After the freinectomy and in the days that follow, you can place these milk popsicle sticks on the healing area, this will relieve your little one as the ice has an anesthetic effect, and your milk will help the healing process.

You can do them whenever you want, the important thing is regularity. 

• Before the freinectomy, try to do the exercises 3 times a day for a few seconds to 1 minute
• After the freinectomy: it is recommended to do the exercises 5-6 times a day for the first 3 weeks and to insist in the morning when the brake has not been worked for a long time. Many specialists recommend continuing the exercises for up to 6 weeks. You can then do the exercises for the next 3 weeks 3 to 4 times a day. But in summary, the more you do it the better.

There is no age to undergo an operation on the brakes, even as an adult. But of course, if the operation takes place early, the repercussions on the palate, the face, the cervicals and the rest of the body will be less.

If you find it difficult to access your toddler's mouth, particularly under his tongue, you can use specially designed tools, such as a small teething octopus. Using the octopus's tentacles, you can gently slide under your child's tongue to lift it. What's more, you can gently tickle his tongue to one side or the other to encourage your little one to move his tongue.

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