Tongue Tie In Babies: Causes, symptoms And Treatment

Tongue Tie In Babies

Image: Shutterstock

You have started breastfeeding your baby, but the baby has difficulty latching onto the nipple. This could be because of a condition called tongue-tie in babies, which may not be immediately apparent. Thankfully, the condition can be spotted in early infancy.

Here, MomJunction tells you all about tongue-tie in infants, how to identify it and address it.

What Is Tongue-tie?

Tongue-tie, medically called ankyloglossia, is a condition where the tongue is literally tethered to the floor of the mouth.

The tissue strand that connects the tongue to the floor of the mouth is called the frenulum. In healthy infants, the frenulum recedes to the back of the tongue and is noticeable when you raise the tongue to look under it.

What Is Tongue-tie

Image: Shutterstock

In tongue-tie infants, the frenulum extends up to the tip of the tongue, binding it to the floor of the mouth tightly (1). It inhibits the mobility of the tongue, thus leading to ankyloglossia or tongue-tie.

Doctors classify tongue-tie depending on the extent of the frenulum. The condition is sorted into four classes. Class I is mild ankyloglossia, Class II is moderate ankyloglossia, Class III is severe ankyloglossia, and Class IV is complete ankyloglossia.

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What Causes Tongue-tie In Babies?

Experts believe tie that faulty genes can cause tongue-tie since the condition often runs in families. Tongue-tie is also congenital, which means the baby is born with it and does not develop it later in life.

[ Read: Tonsillitis Symptoms In Babies ]

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How Common Is Tongue-tie In Babies?

About 5% newborns are born with the condition, and it is three times more common among boys than in girls (2).

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What Are The Symptoms Of Tongue-tie In Babies?

Here are the signs and symptoms indicating that your baby has tongue-tie (3):

  1. Trouble latching to the breast: A tied tongue makes it difficult to maintain suction on the nipple. A baby with tongue-tie may not suckle for long and seem to withdraw often. If your baby is primarily formula-fed or drinks expressed breast milk from a bottle, then you may not notice the condition as bottle nipples slide easily into the mouth.
  1. Nipple pain during breastfeeding: Tongue-tie babies tend to chew or bite the nipple while trying to latch on to it. This can cause pain and discomfort every time you breastfeed.
  1. Poor weight gain: Since your baby is not getting adequate milk, they will display poor growth.
  1. V-shape of the tongue: The tongue, which is attached to the base, develops a kink at the center. So when the tongue-tie baby cries, you will notice a ‘V-shaped’ tongue with a deep, vertical crease at the center.
  1. Loss of interest in breastfeeding: Breastfeeding becomes a painful chore both for the mother and the baby. The baby loses interest in feeding, and the mother finds it painful, eventually leading to bottle feeding.
  1. Dental problems: Tongue-tie can result in misalignment of lower central incisors (bottom-front teeth) and a gap between the two teeth. A tongue-tie baby may also be unable to remove any food debris from the mouth to prevent dental cavities.
  1. Speech problems: If tongue-tie is undetected early on, then your baby may have trouble enunciating syllables such as r, d, t, sh, th, z, and l. Articulation of these sounds requires a complex tongue movement referred to as rolling, which is not possible for a tongue-tie baby.
  1. Difficulty eating certain foods: Older toddlers, who can eat a wide variety of food, may not be able to do so properly. For instance, the toddler will not be able to lick an ice cream or a lollipop or a Popsicle.
  1. Gagging and choking: The tongue helps to slide the food into the throat in a controlled manner. A tied tongue cannot do that, making swallowing hard and sometimes leading to acute gagging and choking.
  1. Problem chewing: Food gets rolled and moved between the teeth by the tongue. A rigid tongue cannot perform any of these actions making it harder for an older toddler to chew solid food.

It is good to identify the problem and get it diagnosed for timely action.

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[ Read: Best Baby Latching Positions ]

How Is Tongue-tie In Infants Diagnosed?

A doctor may or may not check for the presence of tongue-tie at birth. However, once you start breastfeeding and notice problems, they may check for the condition before you are discharged from the hospital.

Tongue-tie may get overlooked either because it is not severe or the baby somehow manages with the tied tongue. Eventually, tongue-tie is likely to be noticed by parents when they see their baby’s tongue while crying or notice other symptoms of the condition. If you suspect tongue-tie, take your baby to a pediatrician, who may refer you to an otolaryngologist, also called an ear, nose, and throat (ENT) specialist. The doctor will then use the following steps to confirm ankyloglossia:

  • Examine the tongue: An examination of the tongue is most likely to be sufficient for the doctor to detect tongue-tie. Class III and IV tongue-tie are severe and are apparent.
  • Learn about the baby’s feeding habits: The doctor will ask about the feeding habits of the baby and if they ever had problems latching to the breast nipple. Poor weight gain may also support tongue-tie diagnosis.
  • Test speech and tongue movement: In the case of older toddlers, the doctor may ask the toddler to perform some actions like roll the tongue or say some simple words to detect limitations in tongue movement.

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How Is Tongue-tie In Babies Treated?

Freeing the tongue by surgically trimming the frenulum is the only way to treat the condition. The procedure is called frenotomy, also referred to as frenulotomy or frenulectomy. Another surgical procedure called frenuloplasty may be required in severe cases of tongue-tie.

Keep reading for more information about each procedure (4).

Frenotomy

  • The doctor can perform the surgery soon after the baby’s birth if the tongue-tie is detected.
  • No anesthesia is needed since the frenulum is a thin tissue with very few pain-triggering nerve endings. However, in severe cases of ankyloglossia, the doctor may choose to give local anesthesia. Older infants and toddlers undergoing frenotomy may require local or general anesthesia.
  • The doctor cuts the excess frenulum using sterile scissors, and the surgery is complete.
  • Frenotomy takes a few minutes and requires no stitches. There is little (no more than a drop or two) of blood loss during the operation.
  • You can breastfeed right after the surgery. It has two advantages: the doctor can check for improvement in latching, and the baby gets some relief from pain since suckling is soothing. Antibodies in the milk also act as an antiseptic to the wound.

[ Read: When Can Babies Talk ]

Frenuloplasty

  • If the frenulum is very thick or attached in a manner that requires additional tissue removal, then the baby will have to undergo a frenuloplasty.
  • The procedure is the same as frenotomy, but the infant will require a local or general anesthesia.
  • The doctor cuts the tissue using sterile scissors and closes the wound with absorbable sutures (stitches). Some hospitals use a laser to cut the frenulum, which leads to lesser inflammation and eliminates the need for stitches.
  • The time taken for the anesthesia to wear off and the baby to regain sensation of the mouth and the tongue is longer in this procedure. The doctor will let you know the ideal time to resume breastfeeding.

Risks of surgery

Complications are rare in frenotomy and frenuloplasty but cannot be ruled out completely. A few possible complications include (5):

  • Excessive bleeding
  • Infection in the surgery wound
  • Severe swelling
  • Damage to the tongue and the salivary glands
  • Scarring
  • Reattachment of frenulum to the base of the tongue

Some babies may also have an allergic reaction to anesthesia. But these complications seldom happen, and your baby is going to have improved mobility of the tongue after the operation.

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Can The Baby Live With Tongue-tie And Avoid Surgery?

Yes, but only if tongue-tie does not cause problems or interfere with the healthy growth and development of the infant. Some infants may do well with tongue-tie and require no intervention. That said, only long-term observation can determine if tongue-tie is not a problem.

The tongue plays an essential role in speech development and ingestion of solid foods. Children with a tongue-tie may require speech therapy and regular tongue exercises. If parents choose frenotomy or frenuloplasty when the baby is older, then the operation could require general anesthesia. The risk of complication is also higher since frenulum gets thicker as one grows older.

According to researchers, it is not clear if frenotomy is imperative or if it is okay to leave the baby with the condition (6). Also, if tongue-tie is not addressed, the mother may want to stop breastfeeding as early as the first week and resort to bottle feeding to avoid pain (7).

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[ Read: Baby Sore Throat Treatment ]

While a doctor may check for tongue-tie at birth, it is parents who make the first discovery of the symptoms. Getting a diagnosis at the earliest and treating the problem with surgery ensures minimal complications and faster recovery.

Do you have any more tips on how to identify tongue-tie in babies? Share them in our comments section.

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Rohit Garoo

Rohit Garoo took writing as a profession right after finishing his MBA in Marketing. Earlier he graduated with a Bachelor’s degree in Botany & Zoology from the autonomous St. Xavier’s College in Mumbai. Rohit has also done a Stanford University certification course on breastfeeding. This botanist-zoologist turned writer excels at life sciences, and at MomJunction he writes everything about pediatrics and maternal care. In between writing and being overly curious, he spends time cooking, reading, and playing video games. LinkedIn profile – linkedin.com/in/rohit-garoo-263115aa
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