Independent midwife and lactation consultant Christine Klynhans guides you through tongue ties and what you can do to help your baby.
Did you know the tongue is the only muscle in the body that has one loose end that can move freely? During a baby’s early development in the uterus, the tongue is attached to the floor of the mouth. The attachment reduces naturally from the tip towards the base of the tongue, and the small piece that may stay behind is called the frenulum. Sometimes, this attachment fails to loosen and disappear, leaving the tongue partially attached to the floor of the mouth. This is called a tongue tie, or ankyloglossia.
If the tongue can’t move around normally, it has major effects that will start immediately after birth and can last a lifetime. Keep your tongue at the bottom of your mouth while trying to talk (some sounds are impossible to make), drink from a straw (noisy and ineffective), remove a piece of food stuck between your teeth (not happening), or French kissing (just not the same).
Choosing a healthcare professional
If your child has tongue-tie, the moment you start asking questions you will be confronted by the vast differences in opinion on the topic. Knowledge of this issue has boomed in the past decade, so much of the research is fairly new and, in some areas, more research is needed.
This means not all healthcare professionals are up-to-date on the diagnosis and management of tongue ties. Most ties are missed or ignored at birth while the problem is also over-diagnosed and unnecessary treatment can be as harmful as no treatment at all.
If you suspect your baby has a tongue tie, it’s crucial to seek treatment from a healthcare professional skilled and educated in all types of tongue ties. If you experience latching and feeding difficulties with your newborn, you’re likely to seek the help of a lactation consultant, who may spot some signs and symptoms, but will have to refer you to a dentist, ear nose and throat specialist or maxillofacial surgeon who works with tongue ties for diagnosis and treatment. Some paediatricians and paediatric surgeons may also assist.
Tongue ties and feeding
The first area where a tongue tie can cause problems is breastfeeding. The tongue plays a major role in how a baby latches and sucks from the breast.
Tongue ties are linked to various breastfeeding problems, including:
- A complete inability to latch in severe cases
- Painful feeding and cracked nipples
- A baby constantly “slipping off” the breast
- Noisy feeding and clicking sounds
- A baby feeding for long periods without getting full
- Colic, excessive gassiness and reflux, as a tongue tie influences swallowing
- A baby who gets frustrated while breastfeeding, or falls asleep halfway through
- Slow weight gain
- Blocked ducts and mastitis in the breastfeeding mom, as the baby doesn’t manage to properly empty the breasts.
Over time, these feeding difficulties can lead to low milk supply and early weaning. Many mothers end up feeling guilty and experiencing postnatal depression, because they feel they have failed to nurture their baby. In fact, they have done nothing wrong.
Although feeding from a bottle requires less effort from your baby than breastfeeding does, babies with tongue ties may still struggle to maintain suction and are often very noisy, messy feeders with excessive gas.
In the long-term
- An undiagnosed tongue tie may cause an array of breathing, dental, digestive, eating and sleeping problems. With the tongue not putting pressure on all the correct spots, crooked teeth and other orthodontic problems can develop.
- As the tongue is unable to move properly, speech problems like lisping are common in children and adults.
- During sleep, the tongue is supposed to move forward and away from the upper airways. An untreated tongue tie can block the air passages and prevent proper swallowing during sleep. A build-up of saliva in the mouth can cause frequent middle-ear infections. The partially obstructed airway also leads to snoring, bed-wetting and grinding of teeth. The effect of the constant mild oxygen shortage to the brain can lead to symptoms similar to that of ADHD in children, which affects the child’s development and learning.
- Older children and grown-ups with tongue ties can struggle to properly chew and swallow food.
- All of the above can cause emotional distress for the child and the parents.
There are various signs and symptoms indicating a tongue tie in a baby. An anterior tongue tie (in which the restriction is easily visible and sometimes reaches the tip of the tongue) is fairly easy to see and assess. Only in recent years has another type of tongue tie been identified, called a posterior tie. These are not as visible as the restriction sits at the base of the tongue.
Spot the signs:
- Any of the previously mentioned feeding difficulties.
- A frenulum clearly visible when the baby opens his mouth or cries.
- Your baby never pushing his tongue beyond his gums or lower lip.
- Your baby’s tongue appears heart-shaped when pushed out.
- Speech problems in older children.
A tongue tie can be released through a procedure where the frenulum is cut. Some doctors do the procedure in their rooms, while others do it under general anaesthesia. The method chosen will depend on the type and severity of the tie. The doctor who does the procedure will give you information on aftercare to prevent the frenulum from reattaching, and exercises to train the tongue’s movements again.
A release is a potentially traumatic procedure and can cause complications like bleeding and infection. In a breastfeeding baby, it’s best to try non-invasive measures to solve breastfeeding difficulties, like implementing techniques for a deeper latch. Parents should also know there is no guarantee a release will solve breastfeeding problems completely.
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