Tongue-tie, also called ankyloglossia is common, affecting nearly 5% of all newborns. However, it is three times more common among baby boys. It can affect both breastfeeding and bottle-feeding in babies. Read on to find out exactly what it is, signs and symptoms of tongue tie and possible treatments.
What is Tongue Tie?
We all have a frenulum - it’s a piece of tissue under your tongue that stretches from the underside of your tongue to the floor of your mouth. Tongue-tie occurs in babies when the frenulum either extends forwards towards the tip of the tongue, is attached close to the lower gum, or is short and tight so it interferes with normal tongue movement.
Tongue-tie can range from mild, with only a tiny fold of tissue holding the tip of the tongue, to severe, in which the entire bottom of the tongue connects to the floor of the mouth. It can present at birth. Doctors do not know what causes it but it may be genetics and may run in families. So if you suffered from this as a baby then make sure to tell your doctor or midwife.
Signs and Symptoms your Baby might have Tongue-tie
Depending on the severity of tongue-tie, it can have a range of different symptoms for both mom and baby. These symptoms can again differ for breastfed and bottlefed babies.
When breastfeeding, a baby needs to be able to open their mouth wide, extend their tongue beyond their bottom lip and create a seal in order to suck and remove milk from the breast. Due to this you may experience some of the following symptoms when breastfeeding:
- Difficulty establishing breastfeeding or baby refuses to latch.
- Difficulty in maintaining a latch, with your baby frequently coming off the breast or slipping back to the nipple
- Shallow latch
- Clamping down on the breast
- Clicking noises while feeding
- Unsettled behavior during feeds
- Baby doesn’t seem satisfied after a breastfeed.
- Very frequent feeds.
- Excessive weight loss or slow weight gain for your baby (may not occur if topping up)
There are a number of symptoms mom might notice about herself if baby has tongue-tie:
- Persistent very sore or damaged/blistered nipples – however it’s important to note that there may be no nipple pain/trauma.
- Compressed nipples (change in shape) and/or blanching after feeding.
- Low milk supply
- If your baby isn’t draining your breasts adequately, this can lead to engorgement, blocked ducts and mastitis.
- Long, tiring feeds
If you are bottle-feeding your baby, you might notice a few of these symptoms:
- Refusal or slow to take a bottle
- Chomps on the teat
- Extremely regular feeds
- Falls asleep quickly and then wakes hungry as soon as bottle is removed
- Cannot maintain a seal at the bottle, often has gaps at corners of mouth which milk may spill out from
- Gagging - even when you slow the feed down
- Can only manage a teat that has a very slow flow
How is Tongue Tie Treated?
In some cases, children don’t have any symptoms or problems from tongue-tie and they won’t need treatment. Over time, the frenulum can stretch, giving the tongue enough freedom to move normally and allowing the child to speak clearly.
If a baby is struggling with breastfeeding and some of the previously mentioned symptoms are present, there are treatments available. Most cases of tongue-tie are treated as soon as they are diagnosed. The condition can be treated in two ways:
- Frenotomy: if tongue-tie is discovered in a newborn (less than 3 months) this simple procedure can often be carried out in the doctor’s office. The physician examines the frenulum and then snips it free with sterile scissors. The procedure is quick and usually bloodless. Most of the time, local anesthesia isn’t used because discomfort is minimal due to few nerve endings and blood vessels in the frenulum. After the procedure, the baby will breast feed while in the office. Breast milk acts as a natural pain relief and antiseptic.
- Frenuloplasty: For older children or if the frenulum is too thick for a simple frenotomy, a frenuloplasty may be recommended. This procedure is slightly more extensive and requires general anesthesia and surgical tools to free the tongue from the thick band tied to it. The wound is closed with stitches that absorb on their own within a couple of weeks. Your child will go home the same day as the operation and will most likely not need to stay in the hospital overnight.
What else might help with feeding difficulties due to tongue-tie?
Some babies may be able to improve their feeding without a tongue-tie division. Babies who are fed in a supine position are more comfortable, can extend their mouth wider, and get a larger mouthful of breast. However, because some babies are unable to extend their tongue far enough to scoop the breast into their mouth, this position does not facilitate feeding. A side-lying position or koala hold may also be beneficial. Babies can also benefit from a 'exaggerated latch.' Simply hold your baby close to but below the breast and lift your nipple with your forefinger.
Bottle-fed babies may find it simpler to feed if timed bottle feeding techniques are followed. Babies with tongue ties may find it challenging to form a seal around the bottle teat. A high palate, which is frequently coupled with tongue-tie, can set off the baby's gag reflex. Teats that are shorter, wedge-shaped, or flatter may be simpler for babies with tongue ties to drink from.
What happens if I don’t seek help?
Every tongue-tie is different and the range of issues it causes can vary from very mild to severe. So weighing up your options will be difficult, but ultimately, the decision to release a tongue-tie should be between a doctor and the child’s parents.
If you’re experiencing issues with breastfeeding or think your baby has a tongue-tie, contact your doctor, midwife, or lactation consultant. They will be able to perform an evaluation and refer you for treatment.