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I treat a lot of babies and children in the practice and a condition that I see from time to time is tongue tie, or ankyloglossia, to give it its medical name. Although the name tongue tie conjures up visions of a tongue which is wildly disfigured, this condition is often hard to identify and requires quite a simple procedure to correct it.
Tongue tie occurs when the thin piece of skin under the baby’s tongue called the “frenulum” is abnormally short and can restrict the movement of the tongue. We all have this piece of skin under our tongue, joining it to the floor of the mouth, but in about 3% of babies, the frenulum is shortened or restrictive.
In mild cases, the tongue will only be bound to the floor of the mouth by a thin mucous membrane and this may resolve itself over time, but in severe cases the base of the tongue is fused to the floor of the mouth.
So what are the indicators of a significant tongue tie to look out for?
There are some common signs that health professionals will look for when assessing if a significant tongue tie is present. These can include:
- when the tongue cannot extend beyond the baby’s lips
- sideways movement of the tongue is lacking
- the tongue can appear notched or heart-shaped at the tip
- when extended, the tip may look flat or squared off instead of pointed.
What are the most common issues associated with breastfeeding and tongue tie?
A baby with a tongue tie will often struggle to breastfeed effectively. Things to look out for are:
- babyprolonged feeding times/falling asleep on the breast
- a misshapen nipple post feeding
- unsuccessful attachment on to breast and loss of suction
- a clicking noise heard whilst feeding
- nipple pain and/or damage
- not gaining weight
So what is the remedy for tongue tie?
Many health professionals such as osteopaths will initially be able to diagnose that a tongue tie is present, but they will refer you to a lactation consultant or experienced clinician for a thorough assessment of the baby’s tongue mobility.
As an Osteopath myself, I often treat babies who have feeding issues, suffer with irritability and have problems settling. During my case history and examination, I get the chance to look for things like tongue ties, which in some cases may be exacerbating the baby’s presenting symptoms. In conjunction with my treatment if required, I would refer the baby to the appropriate clinician for a second opinion, to assist the parents in getting the best result possible.
If a lingual frenotomy is required, this is a simple procedure which is normally performed without anesthesia on babies from birth up to 4 months of age. For older infants who have a tongue tie or babies who have a thick frenulum, a general anesthetic may be required. The procedure involves releasing the frenulum with a pair of sterile scissors. A small amount of bleeding is customary, but often a baby will settle quickly afterwards and it is recommended that breastfeeding happens shortly afterwards.
How common is tongue tie and is it hereditary?
Tongue tie may only occur in 3% of babies but it has been found to run in families. If you are expecting and have a history of it in your family it is well worth looking out for this condition when your baby arrives and book in with Dr Vanessa Fisher if you want to get a quick assessment.
Please contact me if you have any questions related to any matters raised in this blog. Alternatively, other people that could help are your lactation consultant, child health nurse and paediatrician. If you would like more advice on breastfeeding click here to link through to the Australian Breastfeeding Association.