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 snipping the skin attached to the underside of 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 right away.
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
- Acting unsettled and seem to be hungry all the time
- Don’t gain weight as quickly as expected
- 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, a baby must be able to maintain this action throughout the feed.
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 factors beyond tongue tie can have an impact on your baby feeding efficiently. The nerves that control the tongue and jaw run through the head and neck and any compression of these nerves can inhibit the jaw and tongue movement. Compression can occur from the baby’s positioning in the womb, a long first stage of labour or a difficult or traumatic delivery – resulting in the baby 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 specializing in this field to help diagnose any issues?
What other problems can an undiagnosed or untreated tongue tie cause?
As discussed above, not all ties need intervention in order for a baby to be able 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.
Tongue-tie is typically diagnosed during a physical examination. Your doctor might use a screening tool to score various aspects of the appearance of your baby’s tongue and its ability to move.
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.
Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. The tight strip of skin under the tongue known as the lingual frenulum may loosen over time, resolving tongue-tie. In other cases, tongue-tie persists without causing problems. For some babies, consultation with a lactation consultant can assist with breast-feeding, and speech therapy with a speech-language pathologist may help improve speech sounds. Surgical treatment of tongue-tie may be needed for babies if tongue-tie causes significant problems. Surgical procedures include a frenotomy or frenuloplasty.
A simple surgical procedure called a frenotomy can be carried out with or without anesthesia in the hospital nursery or doctor's office. The doctor examines the lingual frenulum and then uses sterile scissors to snip the frenulum free. The procedure is quick and discomfort is minimal since there are few nerve endings or blood vessels in the lingual frenulum. If any bleeding occurs, it's likely to be only a drop or two of blood. After the procedure, your baby can breast-feed immediately. Complications of a frenotomy are rare — but could include bleeding or infection, or damage to the tongue or salivary glands. It's also possible to have scarring or for the frenulum to reattach to the base of the tongue.
A more extensive procedure known as a frenuloplasty might be recommended if additional repair is needed or the lingual frenulum is too thick for a frenotomy. A frenuloplasty is done under general anesthesia with surgical tools. After the frenulum is released, the wound is usually closed with sutures that absorb on their own as the tongue heals. Possible complications of a frenuloplasty are similar to a frenotomy and are rare — bleeding or infection, or damage to the tongue or salivary glands. Scarring is possible due to the more extensive nature of the procedure, as are reactions to anesthesia. After a frenuloplasty, tongue exercises might be recommended to enhance tongue movement and reduce the chances of scarring.
If you believe your baby has tongue tie, observe how this affects them and don’t hesitate to contact your doctor for advice if you are concerned.