While conversations around tongue-ties in children have increased dramatically in recent months, the understanding of what they are and how they should be treated and prevented is still under discussion.
A tongue-tie (also called ankyloglossia) occurs when the frenulum band under the tongue fails to separate from the tongue before birth. The band stays connected as the child grows because it's unusually short or thick, creating a tightness to the tongue that limits its mobility.
Not only can a tongue-tie impact a baby's ability to properly breastfeed, but research has also found that it can lead to breathing dysfunctions and sleep issues as children age. Tongue-ties can cause a number of issues including:
breastfeeding challenges and feeding issues with infants
fussy feeding, chewing/swallowing issues, and chronic reflux
speech development, delay, and articulation issues
impacting oral-facial development
mouth breathing, snoring, teeth grinding, and obstructive breathing during sleep
increases in neck pain, shoulder tension, migraines, and chronic headaches
SYMPTOMS AND SIGNS OF TONGUE-TIES
Tongue-ties are typically diagnosed during a physical exam by a pediatrician or pediatric airway-centric dentist. More and more they are being noticed by myofunctional therapists and lactation consultants. Diagnosis depends on a combination of visual review, infant symptoms, and a feeding assessment.
Signs and symptoms of tongue ties can vary, but typically include:
Inability to latch or shallow latching during feeding
Gumming or chewing on the nipple during feeding
Noisy clicking or smacking sounds during feeding (indicating a poor seal)
Colic, reflux, excess gas, or gulping of air
Frequent feedings --- unable to satisfy; poor weight gain
Frequently falling asleep during feeding
Visible frustration with trying to latch or pulling off
Chronic snoring, congestion, or abnormal breathing; chronic mouth breathing
Minimal tongue life when crying
Heart-shaped indent or forking of the tip of the tongue
Trouble speaking or licking an ice cream cone in older children
Infants and children with tongue-ties are unable to demonstrate proper oral posture as their tongues are unable to rest on the roof of their mouths when closed.
BREASTFEEDING AND TONGUE-TIES
A baby with a tongue-tie will often have trouble breastfeeding. This can be discouraging for both new moms and babies. Babies with tongue-ties have trouble latching, tend to have prolonged feeding episodes, and often cause nipple discomfort for their moms.
According to the book Breathe, Sleep, Thrive by Dr. Shereen Lim, when mobility is restricted and a baby's tongue is restricted due to a tongue-tie, a baby may compensate by overusing their lips and cheeks. This can cause pain for the breastfeeding mom as well as impact the oral-facial development of the infant.
Tongue tie can range from mild, with only a tiny fold of tissue holding the tip of the tongue, to severe, in which the entire bottom of the tongue connects to the floor of the mouth.
There are two main types of tongue-ties:
Anterior tongue-tie describes a prominent restrictive frenulum that can be seen more easily towards the front of the tongue.
Posterior tongue-tie (also known as "mild ties") describes a restrictive frenulum that is further back underneath the tongue. This type of tongue-tie is often overlooked as it still allows the tongue to extend forward somewhat.
Babies may also be born with a lip or cheek tie. A lip tie is a condition where the skin of the upper lip is attached to the gums in a way that prevents lip movement and makes breastfeeding difficult for babies. Cheek ties (or buccal ties) connect the cheek to the bony ridge on the upper jaw.
Doctors don't fully understand what causes tongue ties in babies. There is research that demonstrates there is a tendency for the condition to run in families, and it is more common in boys than in girls.
TREATMENTS FOR TONGUE-TIES
The first line of defense will come from your baby's care team (typically a pediatrician, airway-centered dentist, ENT, lactation specialist, myofunctional therapist, and/or speech therapist). Together they can evaluate your child's tongue or lip tie and decide the best course of action based on the level of severity, the child's age, and other medical considerations.
Should surgery be deemed the best course of action, the ENT or dentist will typically perform one of the following:
Frenotomy or Frenulectomy: The doctor snips the frenulum with a scalpel, laser, or scissors. It is a quick procedure often performed without anesthesia in babies younger than 3 months old as the area has few nerve endings or blood vessels. It's safe to do this in an outpatient office setting.
Frenuloplasty: Typically performed on older children or if the frenulum is too thick for a simple frenotomy, the doctor will do surgery to free it. The child gets general anesthesia to sleep through the procedure. If stitches are used to close the incision, they will dissolve on their own.