Tongue-tie, medically called ankyloglossia, is a condition where the tongue is 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.
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 which affects the way a baby eats, swallows, and speaks. Thus, parents often look for corrective measures that could help resolve the condition.
In this post, we discuss the causes of tongue-tie in infants, its identification and proper management.
What Causes Tongue-Tie In Babies?
The lingual frenulum separates from the tongue before -the baby’s birth. However, in some babies, it does not happen. The etiology is not complete and some cases have been associated with certain genetic factors (2) (3).
A congenital defect is usually considered to be the cause of tongue-tie, as more research is needed to determine if genetics can indeed cause this condition.
What Are The Symptoms Of Tongue-Tie In Babies?
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.
- 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 could 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.
- 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.
- Poor weight gain: Since your baby is not getting adequate milk, they will display poor growth.
- 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.
- Loss of interest in breastfeeding: Breastfeeding becomes a painful chore for both the mother and the baby. The baby loses interest in feeding, and the mother finds it painful, eventually leading to bottle feeding.
- 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.
- 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.
- Difficulty eating certain foods: Older toddlers, who can eat a wide variety of foods, 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.
- 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.
- 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 treatment.
How Is Tongue-Tie In Infants Diagnosed?
If you suspect tongue-tie, take your baby to a pediatrician, who may refer you to an otolaryngologist, also referred to as an 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 (5).
- Learn about the baby’s feeding habits: Poor weight gain may also support tongue-tie diagnosis. The doctor will ask about the feeding habits of the baby and if they ever had problems latching to the breast nipple.
- 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.
Does Tongue Tie Need To Be Treated?
Unless tongue-tie is leading to problems in feeding, doctors sometimes follow a wait-and-watch policy. In many cases, the tongue-tie is asymptomatic; the condition may resolve spontaneously or affected individuals may learn to compensate adequately for their decreased lingual mobility. In such cases, no specific treatment is done. However, as the babies grow, doctors evaluate the impact of tongue-tie on the baby’s speech or personal or social development. If any issues are observed, prompt action is recommended to resolve the issues.
In some instances, surgical procedures might be needed.
Also, as the tongue plays an essential role in speech development and the ingestion of solid foods, the children may require speech therapy and regular tongue exercises.
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).
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 (8).
- 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 may be asked to breastfeed right after the surgery so that 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.
- 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 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 the sensation of the mouth and the tongue is longer in this procedure. The doctor will let you know the ideal time to resume breastfeeding.
Complications of surgery
Complications are rare in frenotomy and frenuloplasty but cannot be ruled out completely. A few possible complications include (9):
- Excessive bleeding
- Infection in the surgery wound
- Severe swelling
- Damage to the tongue and the salivary glands
- 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. Also, the risk of complications is higher as one grows older, when frenulum gets thicker.
Frequently Asked Questions
1. How common is tongue-tie in babies?
According to the National Health Service, UK, around 4-11% of newborn babies are affected by tongue-tie. It sometimes runs in families and is found to be more common in boys than girls (10).
2. 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.
3. Are treatments for tongue-tie safe for babies?
Yes, treatment for tongue-tie is considered safe for babies. Although rare, some complications might occur.
While a doctor may check for tongue-tie at birth, it is the parents who usually 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.
2. Tongue and Lip Ties; La Leche League International
3. Tongue-tie; Better Health Channel; Victoria State Government
4. Tongue-tie (Ankyloglossia); Otorhinolaryngology – Head & Neck Surgery; The University of Texas
5. Tongue-Tie; Health Link BC; British Columbia
6. Surgery for tongue tie shows some benefits; more research needed; Vanderbilt University
7. Ricke LA et al.; Newborn tongue-tie: prevalence and effect on breast-feeding.; National Center For Biotechnology Information (2005)
8. Frenotomy; Stanford Medicine
9. Tongue-Tie (Ankyloglossia): Management and Treatment; Cleveland Clinic
10. Tongue-tie; National Health Service, UK
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