Soo… What’s a Tongue Tie?
Congratulations on welcoming your little one! Enter the postpartum period and transition into parenthood, you are beginning the process of getting to know your baby for the first time.
As you carefully navigate those first feedings, diaper changes, and snuggles, adjusting to your brand-new reality, a care provider enters the room to assess your baby and asks, “has anyone mentioned that your baby may have a tongue-tie?” Your heart sinks. you look at your baby and see ten precious fingers and toes, the sweetest face, and a perfect squishy body – everything as it should be. You try to peek into your baby’s mouth and think to yourself, “what in the world is a tongue-tie and what does this mean for me and my baby?”
So… What Is a Tongue-Tie?
In your own mouth, you have probably noticed the thin piece of soft tissue that runs along the underside of your tongue. This small piece of tissue anchors your tongue to the floor of your mouth and is called the ‘lingual frenulum'. While everyone has a lingual frenulum, there can be wide variations in the shape, size, and function of this structure between individuals.
When the lingual frenulum is shortened or thickened or tethers the tongue too close to the tip and restricts its mobility and functioning, it is called a “tongue-tie” (though you may hear it referred to as “ankyloglossia,” in fancy medical terminology).
There are different types of tongue ties.
Anterior tongue-ties are positioned towards the front of the tongue and tend to be more obvious.
Posterior tongue-ties are a little bit trickier to notice, as they are positioned towards the back of the tongue and are somewhat hidden under the mucous lining of the tongue/mouth.
However, the position of the tie in the mouth is not directly correlated to function, and posterior ties can lead to significant symptoms as well as those that are more anterior.
How Common Are Tongue-Ties?
Tongue-ties are present at birth and often run within families. It is estimated that tongue-ties occur in approximately 5-10% of babies, and studies find that they tend to occur more frequently amongst baby boys than baby girls.
How Might This Impact Me and My Baby?
To breastfeed effectively, your baby must extend and cup their tongue underneath your nipple and breast, drawing it deeply into their mouth (to the junction of the soft and hard palate – further back than you may think!). By cupping your nipple and elevating their tongue, they establish a seal on the breast. They must then move their tongue in a wave-like pattern (from front to back), creating negative pressure within their mouth to draw milk out of your breast and swallow it safely. This requires the ability to extend, elevate and move the tongue in a sequential pattern. tongue mobility and a proper seal are also needed for safe and effective bottle feeding (although sucking mechanics can vary significantly between breast and bottle feeding).
When the tongue is held tightly to the floor of the mouth by a short or tight lingual frenulum, the tongue does not have the mobility to create a seal and draw milk out of the breast or bottle efficiently. To compensate, your baby may use their lips, cheeks, or jaw muscles to hold the breast or bottle teat in place inside their mouth.
When it comes to breastfeeding, this may cause a shallow or pinchy latch and a chompy disorganized suck, leading to nipple pain and damage, blocked ducts and/or mastitis, and decreased milk production for you, as well as long and/or frequent feedings, inefficient milk transfer, and/or slow weight gain for baby.
As your little one may have trouble maintaining their latch on the breast or bottle, you may hear a clicking sound coming from their mouth during feeding; this is the sound of their tongue losing suction and popping off the nipple. milk may leak out the sides of their mouth. With a suboptimal latch, they may also have difficulty coping with let downs or fast milk flow, prompting them to pull away from the breast or bottle, sputter, or choke. Being unable to maintain suction on the breast or bottle may also cause baby to take in more air when they are feeding, leading to gas, reflux, and general fussiness.
Later in life, other problems related to an unaddressed tongue-tie can occur. Proper tongue mobility and functioning are required not only for safe and effective breast and bottle feeding in early life, but also for eating solid foods, speaking, breathing, and developing physiologically appropriate structures of the face, oral cavity, and beyond.
When the tongue is held to the floor of the mouth and is not able to assume an optimal resting posture on the roof of the mouth, the palate may be high or arched. This consequently reduces the size of the nasal cavities, as the roof of the mouth is also the floor of the nose. The tongue is also unable to push against the roof of the mouth to clear the sinuses as it normally would. For this reason, children with tongue-ties may experience problems with nasal congestion, as well as more frequent upper respiratory infections.
An older child with a tongue-tie may also experience problems with developing straight and healthy teeth and/or maintaining a closed mouth posture at rest and during sleep. Breathing through the nose while awake and asleep is important for normal structural development of the face, filtration and humidification of inhaled air, and appropriate gas exchange (getting oxygen to the brain and other tissues of the body). Disordered breathing during sleep can impact sleep quality, which can in turn affect behaviours such as attention and focus.
It is amazing how greatly the functioning of the tongue can impact growth, development, and wellness overall.
Did You Know?
Your tongue is connected all the way down to your toes via a thin layer of connective tissue called fascia (a protective layer that provides structural support to your muscles, bones, nerves, and organs). Given this connection, it makes sense that a restriction under the tongue may impact things like breathing, posture, mobility, and gait.
When there is tightness under the tongue, this can translate to tension all throughout the body!
Treatment Modalities and Steps Forward
Now let’s shift our focus and talk about your options for your little one moving forward.
It is important to emphasize that function should always be considered over appearance when it comes to assessing and addressing tongue-ties.
In other words, any practitioner you see to assess your baby’s tongue-tie should look at how your little one’s lingual frenulum is impacting the movement of their tongue, along with other elements of the clinical picture (including your overall feeding experience), before jumping to conclusions based solely on how the tongue may look.
If your baby’s tongue-tie is negatively impacting their feeding by breast or bottle or is likely to be contributing to any of the other symptoms discussed above, surgical revision of the tongue-tie can be an option to explore.
There are a couple of different options for surgical tongue-tie release. a ‘frenectomy’ refers to the lingual frenulum being removed using a laser (often by a pediatric dentist) or being cut using sterile scissors or a scalpel (by a dentist, pediatrician, or ears/nose/throat specialist).
Based on an individualized assessment of your baby’s tongue tie, your baby’s dentist or doctor will advise which of these procedures will likely work best. Only a licensed physician can officially diagnose a tongue tie.
Both procedures are quick (lasting just a few seconds to a minute) and baby is free to feed immediately afterwards. If accompanied by appropriate preparation, aftercare, and ongoing support, these procedures can be effective in mitigating many of the symptoms associated with a tongue-tie, with the comfort and effectiveness of feeding often being the first notable change.
However, as with any procedure, results are not guaranteed. It is always up to you to decide whether surgical tongue-tie release is right for you and your little one. Some prefer to take a “wait and see” approach.
Finally, it is important to recognize that, given the tongue’s relationship to the rest of the body (remember that tongue-to-toes connection), treatment of a tongue-tie should also involve body work (performed by a family chiropractor or osteopathic manual practitioner) to release tension and optimize the functioning of the tissues surrounding and associated with the tongue.
Exercises such as suck training, stretching the tissues surrounding the tongue-tie, tummy time, and reverse tummy time (called the guppy position) are other exercises that can be performed at home with your little one, and can also be very beneficial.
As an IBCLC, body work and these home exercises are things we would highly recommend before and after a tongue-tie release (in fact, exercises pre- and post-release can be crucial to success), and especially if a release is something you have decided not to pursue for your little one at this time.
We at the wellness hub are dedicated to supporting you and your little one as you navigate this journey. We are committed to taking an individualized, multidisciplinary approach to ensure that you and your family receive the care and guidance you deserve.
We are here for you every step of the way!
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This blog post was written by The Wellness Hub’s lactation consultant, Dylan Milko.