Tongue tie is a fairly common condition in newborn babies; more so in boys than girls. The skin joining the tongue to the bottom of the mouth is shorter than normal, which can cause difficulties in breast or bottle feeding. It’s considered a hereditary condition, seeing as there are no known causes.
Tongue tie can be easily corrected using a quick and simple surgical procedure. The tongue is separated by cutting the skin below it. In most cases, this can be carried out without anesthetic, as there are hardly any nerve endings under the tongue, and feeding can go back to normal within 24 hours.
Signs That Your Baby Might Have Tongue Tie:
- Difficulty lifting their tongue up or moving it from side to side
- Difficulty sticking their tongue out
- Tongue looks heart-shaped when they stick it out
However, if you are breastfeeding, you may notice the following signs:
- Have difficulty attaching to the breast or staying attached for a full feed
- Feed for a long time, have a short break, then feed again
- Be unsettled and seem to be hungry all the time
- Not gain weight as quickly as they should
- Make a "clicking" sound as they feed – this can also be a sign you need support with the positioning and attachment of your baby at the breast
Is Tongue Tie Painful For A Baby?
No. However, when particular tongue movements are performed, several tied adults have reported a burning feeling (depending upon where the tie is). Many babies indicate discomfort when their tongues are lifted if they are tied, thus it is safe to presume that the baby is bothered by this restriction.
A baby's tongue must have complete motility in order to breastfeed efficiently; not only does the tongue need to cup the breast and be able to elevate in order to conduct a proper suck/swallow pattern (without inhaling too much air), but it also needs to undulate during feeding in order to provide the negative pressure that equals milk transfer. To cause subsequent milk ejections, they must be able to maintain this throughout the meal.
When it comes to bottle feeding, the baby must form and maintain a seal, as well as transfer the bolus to the throat in an orderly manner for swallowing. Feeds can be extremely slow or excessively fast and ‘gulpy' if this is not the case. Gaps in the corners of the baby's mouth may be evident, causing him to leak milk (sometimes abundantly) or simply intake air with each suck, resulting in excessive flatulence or trapped wind.
What makes diagnosis even more difficult is that other things can impact on oral function beyond tongue tie. As the nerves that control the tongue and jaw run through the head and neck, compression can inhibit the jaw and tongue movement. This may be from positioning in the womb, a long first stage or a difficult or traumatic delivery – resulting in the infant displaying similar symptoms to those described above.
In addition, other oral differences can occur with a tie, or as a result of birth or genetics; these include a bubble, narrow or high palate or a lip tie. All are more common in a baby with tongue tie – the tongue smooths to help shape the palate in utero and repeated incorrect pressure once born can also impact on the oral cavity. This means the palate can often give important clues as to what else may be going on! However it should also be noted that a high arched palate can also be found without a tie, and a tie can be found with a palate that appears typical – see why it really takes someone specialising in this field?
What other problems can an undiagnosed or untreated tongue tie cause?
As discussed above, not all ties need intervention to breastfeed, however parents should be aware that a tongue tie can impact in other areas at a later stage – when treating is a much bigger procedure.
- Ongoing colic/wind/reflux or unsettled sleep patterns
- Dribbling/drooling – which may be prolonged and continue into childhood.
- Dental problems which may be severe and wide ranging due to the palate.
- Speech may be unclear due to several aspects, especially coordination.
- Ongoing acid reflux/indigestion.
- Eating difficulties – as the tongue requires a full action to process food, infants with tongue restriction may refuse spoons, gag/choke easily, or refuse to move on from runny foods.
It's crucial to realise that not all ties need to be treated in order to allow effective feeding; some newborns have a stretchy tie that doesn't obstruct the tongue's function. Tongue tie practitioners should evaluate whether the tongue, mouth, and lips move normally, and whether the baby is eating properly or compensating on the breast or bottle as a result of the limitation.