Tongue Tie

What is a tongue tie?

Simply put, tongue tie or ankyloglossia is a condition where the tongue is restricted by the frenulum which is the piece of tissue holding the tongue to the floor of the mouth. It is estimated about 4-10% of babies will be born with a tongue tie but not all babies will need treatment.

Why is this an issue?

The tongue is one of many muscles in the mouth which are used when a baby feeds. It is crucial for a baby to have good tongue function to be able to coordinate sucking, swallowing and breathing at the same time. If not, the baby may be unable to make a seal around the breast to create the correct pressure to remove milk or to swallow it properly.

Not all tongue ties necessarily affect a baby’s ability to feed, and it is difficult to tell which tongue ties will affect eating solids, speech and dentition later on in life. What is really important is that a mother who is experiencing problems with breastfeeding is listened to, and that a proper breastfeeding assessment is carried out.

Babies who are unable to attach properly at the breast are often unable to remove milk effectively and therefore may have issues with weight gain, digestive issues such a reflux symptoms or appear to be constantly hungry or unsettled. For mothers, feeding a tongue tied baby can cause sore, damaged nipples, blocked ducts, mastitis, low milk supply, exhaustion and poor mental health. Where tongue tie is suspected, the baby should have a thorough but gentle oral exam to assess tongue function. It is important to note that tongue tie cannot be diagnosed or dismissed by simply looking into a baby’s mouth. Similarly, an apparently insignificant tongue tie could cause the same issues as one which is glaringly obvious. Only a thorough assessment of tongue function alongside a breastfeeding assessment can provide the information required to consider treatment options.

Tongue tie can be classified in a few different ways, depending on which assessment tool is used. You may read or hear the terms anterior, posterior, submucosal, or a percentage may be used to define the severity of the tie. Some health professionals may be unfamiliar or sceptical of some terms if they are inexperienced or have not received adequate training to diagnose and treat tongue ties. What is important is that a qualified practitioner, preferably also an IBCLC, is able to carry out a thorough oral examination whilst explaining optimum function compared to your baby’s tongue function. Only when this is demonstrated and explained to you should you make the decision to treat or not.

What is the treatment for tongue tie?

In babies, the simplest way to treat a tongue tie is to carry out a safe and effective procedure called a frenulotomy. During this procedure, the baby will be swaddled and the head will be gently held still. The tongue is lifted up so that the frenulum can be clearly seen and then cut with a pair of sterile scissors. The practitioner should check that all the tie has been divided with a gloved finger before placing the baby at the breast. There should be very little bleeding from this small cut and the risk of infection is exceptionally small. It is not necessary to administer any anaesthesia for this quick and simple procedure and it is not necessary for this procedure to be carried out in hospital.

Of course, after all the information has been provided, you have the option to leave the tongue tie undivided. There is no evidence that a babies grow out of tongue ties or that they stretch with time, but there are ways in which you could position the baby to maximise the breast he/she is able to take.

Is it always tongue tie which causes problems with breastfeeding?

No. For this reason it is important for someone who is skilled in breastfeeding support to carry out a full breastfeeding assessment. An IBCLC will have the knowledge of the anatomy and physiology involved with feeding and will be able to recognise if there is another issue which is causing problems.

Other treatments.

There is a growing body of research which suggests that osteopathic treatment is both safe and effective for babies who have difficulty latching. More robust research is needed in this area, but it is sensible to conclude from the existing research that babies could benefit from the techniques offered, particularly those babies displaying symptoms of birth trauma.

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