Tongue-tie (ankyloglossia) is a congenital disease that limits the range of motion of the tongue.
A tongue tie ankyloglossia is a condition that affects the way the tongue attaches to the floor of the mouth. This can cause difficulty with breastfeeding, speaking, and eating. In some cases, a tongue tie can also lead to speech problems or dental issues. If you are concerned that you or your child may have a tongue tie, it is important to seek medical attention. In this blog post, we will discuss the causes, symptoms, and treatment options for tongue ties.
What is A Tongue Tie?
In some babies, the tongue is restricted by a thin membrane underneath it. This can make the tongue look forked, shortened, or heart-shaped when the tip is lifted.
Tongue-tie is characterized by an abnormally short, thick, or tight band of tissue (lingual frenulum) that connects the bottom of the tongue’s tip to the floor of the mouth, potentially interfering with breast-feeding. Tongue-tie sufferers may have difficulties putting out their tongue. Tongue-tie can also have an impact on how a youngster eats, talks, and swallows.
Tongue-tie may not always be an issue. In some circumstances, a minor surgical operation may be required to fix the problem.
How is Tongue Tie Diagnosed
Recent studies have shown that some tongue-tied babies don’t feed well, and will benefit from having the tie snipped by someone suitably trained. The Department of Health has recently issued guidelines on treating tongue-tie in breastfed babies. It is important to see your pediatrician and assess tongue function.
The following are signs are tongue tie symptoms:
- Difficulty moving the tongue from side to side or elevating the tongue to the upper teeth
- Tongue tie causes difficulty extending out the tongue past the lower front teeth
- When stuck out, a child’s tongue that appears notched or heart shaped
- Clicking sound when feeding
- Tongue-tie can make it difficult to do tasks such as licking an ice cream cone, trouble sticking your tongue out, licking one’s lips, kissing, or playing a wind instrument.
- Failure to gain weight
If your child is displaying symptoms of tongue tie and is having trouble breastfeeding then it is vital you contact your child’s pediatrician or healthcare providers
How Does Tongue Tie affect feeding?
Babies need free tongue movement to feed and swallow comfortably. When breastfeeding, they need to press the tongue-tip into the breast, with the nipple far back in the mouth, against the soft palate. If the tongue movement is restricted, they may not attach to the breast fully, or at all. Incomplete attachment to the breast results in lower fat content of the milk, as some parts of the breast are not fully drained.
When bottle feeding, babies need to keep the teat in the mouth and push easily against it.
Possible problems in baby include the following breastfeeding problems:
- trouble latching to the breast and/or staying attached
- very frequent and/or long feeds
- difficulty in swallowing and greater intake of air
- colicky symptoms from increased intake of milk sugar (because fat content is lower, more volume of milk is needed to give the same calories, and this means more lactose in the gut, causing indigestion)
- dribbling at the bottle
- poor weight gain even with copious intake
Later on:
- difficulty in chewing and swallowing lumpy food
Potential issues with child’s speech resulting in the need to see a speech language pathologist as certain sounds are hard to make when they don’t have full movement of a child’s tongue
- tooth decay
- Someone who has tongue-tie might have difficulty sticking out his or her tongue.
Possible problems in mother:
• sore, damaged nipples and nipple pain
• over-supply to compensate for the reduction in milk fat (see above)
• reduction in supply over time from the difficulties encountered
• mastitis from poor drainage and nipple trauma
• exhaustion from frequent, long feeds
Other factors which may aggravate the condition or give similar symptoms:
• long labour, and/or difficult birth (eg ventouse, forceps, breech presentation, caesarean birth) causing tension or compression in the head, which may affect tongue movement and make it harder for baby to open the mouth
• swollen breasts from fluid in tissue behind nipple (eg from high blood pressure) or from milk engorgement around 3-4 days
• very large, long or inverted nipples
How is tongue tie treated?
We recommend that you do all you can to improve feeding while feeding is under review, or while awaiting referral for treatment. Skilled support in getting your baby into a closer position to attach to the breast more easily will improve symptoms, and may mean that no treatment is needed.
An experienced midwife or health visitor, or a breastfeeding counsellor, lactation consultant or other breastfeeding specialist can help with this. Its worth discussing all of this with lactation consultants who can give you personalised advice.
Trying different teats for a bottle-fed baby may help. Cranial osteopathy may relieve compression of the head or discomfort from a difficult birth. As your child grows, it may become easier for the baby to compensate for a shortened tongue, and the tie may break later on an older child.
Get Treatment to Fix His or Her Tongue Tie
Getting good help before treatment also means that any snipping of the tongue-tie will show whether it was actually a factor in the feeding problem.
If there is little improvement from the above measures, the tie can be snipped. Tongue tie treatment is a simple surgical procedure following a physical exam to confirm she has tongue tie. This does not damage the tongue at all, takes only a few seconds, and causes little if any pain or bleeding. Whilst surgical treatment sounds scary, it is simply dealing with some minor blood vessels
No anaesthetic is needed, and the baby can feed immediately afterwards. Often the feeding problems improve or resolve. If not, your baby will need to be reviewed for other possible causes of feeding problems.
Where can I get the tongue-tie snipped?
In some areas, treatment is easily available. Ask your maternity unit if there is an Infant Feeding Adviser to arrange treatment. You could ask your GP to refer you to the paediatricians or oral surgeons, but if there are feeding problems, you will need to ask for an urgent referral. You may need to work hard to get support.
The National Health Service in the UK offer this medical procedure for babies with tongue tie. A complete examination takes into account not just the Coryllos grade, but also how effectively the child’s tongue can move. Tongue function can be assessed using the Hazelbaker assessment tool for lingual frenulum function (HATLFF) or a comparable instrument.
What can happen if the tie is not treated?
Some mothers are unable to continue direct breastfeeding if there are severe difficulties, but expressed milk could be given if baby can manage the bottle well. In some babies, the tie loosens or breaks on its own, so there is no way of predicting whether a tongue-tie will affect chewing or speech later.
Children with tongue tie may have difficulty with speech and pronunciation, as well as problems eating lumpy textures.
If you are having difficulties with your baby’s feeding, please seek help from a professional who can assist you in getting your baby into a closer position to the breast and offer other treatments that may be available to you.
Later older kids may need speech therapy if their tongue tie has not been treated. Older children who have had their tongue tie snipped may still experience some of these symptoms, but they should not be as severe. They may also suffer from dental problems. A throat doctor may be needed to diagnose and treat these problems.
What happens after treatment?
Most babies show improvement in feeding, but this may take some time, particularly if other factors are involved in the problems (see above). It is good to give feedback to all the health professionals involved in monitoring the baby’s progress, so we learn how tongue-tie can affect feeding, and how simple and effective treatment can be.
