Lip and Tongue Tie
In cases of lip or tongue tie, an infant is born with a piece of tissue (frenulum) that connects too tightly to the gum (in the case of the lip) or the floor of the mouth (in the case of the tongue). In some cases, this may cause restriction in movement that can result in difficulty with breastfeeding or eventually, with dental health and/or speech.
Early in life, there can be a wide variety of symptoms, including poor ability to latch, poor weight gain, and maternal nipple pain/damage. In most cases, families are referred from their pediatrician or lactation consultant.
Diagnosis is based on the physical exam, where examination of the lips, gums, and tongue is performed to determine if a tight frenulum is present.
The location and method for dividing the tissue will vary based on the patient’s age and the thickness of the frenulum. Some cases can be managed in the office setting, while others are performed in the operating room under sedation.
Current Ongoing Clinical Research
We are actively recruiting infants with symptomatic lip and tongue tie to identify whether office-based procedures are as effective as operative procedures. For more information, please email email@example.com.
Gastroesophageal reflux disease (GERD), also known as reflux, occurs when acid from the stomach and lower gastrointestinal (GI) tract moves up into the esophagus and, sometimes, upper airway, causing irritation and inflammation. Some degree of reflux is normal, but when it is more than usual or lasts longer than usual, it can cause bothersome symptoms, such as heartburn, acid taste, or trouble swallowing.
When symptoms are present, antacid medication is often started and the control of symptoms while on these medications can help to establish the diagnosis. A study that can be used for evaluation of acid reflux is a 24-hour esophageal pH monitor.
An antacid medication (proton pump inhibitor or PPI) is often the first line of treatment for GERD and is safe for very young children. Sometimes, another type of antacid (antihistamine) may be used. The goal of these medications is to stop the production of acid.
Another medical treatment for GERD is the use of pro-motility agents to increase the speed that substances move through the GI tract.
Lifestyle management such as changes in diet or positioning during feeding can sometimes be added to help improve symptoms.
If these changes do not help symptoms, surgical options may be offered.
Eosinophilic Esophagitis (EoE)
Eosinophilic esophagitis (EoE) is a build up of inflammation in the esophagus, causing a wide range of symptoms, including: cough, wheezing, trouble swallowing, vomiting, poor feeding, failure to gain weight, and chest or abdominal pain.
To diagnosis EoE, we take small samples of tissue from the esophagus and send it to our laboratory to look for inflammation. It is important that your child has been on an antacid medication (proton pump inhibitor or PPI) for at least six weeks before the biopsy is taken. If a child is not on a PPI, then he/she will need to have a pH probe study done at the same time. Both of these options are needed to rule out reflux (GERD) as a cause of the inflammation. During the scope and while under anesthesia, allergy blood work may be obtained to determine whether the child has food allergies.
Treatment for EoE begins by examining the diet and removing certain types of food that may be causing inflammation. This is done even if there is no known food allergies. The foods that are removed are then slowly given to the child, carefully watching for symptoms with certain foods. If symptoms are not relieved through an elimination diet, a course of swallowed or inhaled steroids may be prescribed.