What is Ankyloglossia (Tongue-Tie)?
Ankyloglossia, commonly known as tongue-tie, is a common condition for newborn babies, (approximately 4% to 11% of all newborns are born with tongue-tie), that is present at birth.
When a child is born with tongue-tie, there is an unusually short, thick, or tight band of tissues (lingual frenulum) that tether the bottom of the tongue’s tip to the floor of the mouth. This restricts the movement of the tongue and its range of motion.
A baby with tongue-tie may have:
- Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side
- Trouble sticking their tongue out past the lower front teeth
- A tongue that looks notched or heart-shaped when stuck out.
Tongue-tie can affect the way a baby eats, speaks, swallows and eventually, their oral development. It can lead to:
1 Breast-feeding problems
Breast-feeding requires that a baby keep his or her tongue over the lower gum while sucking. If the tip of the tongue has poor tongue mobility or issues keeping it in the right position, the baby may start chewing instead of sucking on the nipple, causing substantial nipple pain for the mom. Tongue-tie can also interfere with a baby's ability to get breast milk and the mother’s ability to produce ample milk supply, leading to receiving inadequate nutrition and poor weight gain.
2 Speech issues
Tongue-tie can interfere with the child’s ability to make certain sounds such as "t," "d," "z," "s," "th," "r" and "l."
3 Challenges with other oral activities such as making sounds
When to See a Doctor
Tongue-tie doesn’t necessarily cause problems or complications. However, if it goes undealt with, it can cause gum recession later on in life. If your baby has bothersome signs of tongue-tie that cause issues in day to day life, such as difficulty with breastfeeding, it’s important to see your doctor.
If there are no symptoms noticeable at birth which results in tongue-tie going undiagnosed, symptoms may develop later on in life. As your child grows older, their speech may be affected, or they may complain of tongue issues that interfere with performing simple tasks like eating, speaking, or touching the back of their teeth with their tongue. If this occurs, make sure to visit a health professional.
The cause of tongue-tie is unknown, but in some cases, it has been associated with certain genetic factors. Normally, the lingual frenulum naturally separates before a baby is born, allowing the tongue a free range of motion. When a baby is born with tongue-tie, that lingual frenulum remains attached to the bottom of the tongue instead of separating.
Any baby can be born with tongue-tie, but it is more prevalent in baby boys. It can also run in families.
Tongue-tie diagnosis can easily be made during a physical exam. For newborns, a health professional may use a screening tool to score various aspects of the child’s tongue appearance and ability to move.
Tongue-tie Treatment can be controversial. Some pediatricians and lactation consultants recommend performing a tie release before the newborn is even discharged from the hospital to avoid any long-term tongue-tie affect. Other medical advice recommends to wait-and-see.
The lingual frenulum may loosen naturally over time, resolving tongue-tie. But in other cases, tongue-tie can exist without causing any problems. In other cases, consulting a lactation consultant can help with breast-feeding and a speech pathologist can help improve speech sounds. Others require surgical treatment of tongue-tie if tongue-tie causes problems. Surgical procedures include a frenotomy and frenuloplasty:
A frenotomy is a simple surgical procedure that can be done with or without anesthesia in the hospital nursery or doctor's office.
The doctor will examine the lingual frenulum and use sterile scissors to snip the frenulum free. The procedure is quick, and there is very little discomfort, since there aren’t many nerve endings or blood vessels in the lingual frenulum. After the procedure, the baby should be able to breast-feed immediately.
Complications of a frenotomy are very rare, but could include bleeding, infection and damage to the tongue or salivary glands. There can also be scarring and in some instances, the frenulum can reattach to the underside of the tongue.
A more extensive procedure known as a frenuloplasty may also be recommended if additional repair is needed or the lingual frenulum is too thick for just a frenotomy.
A frenuloplasty is performed under general anesthesia with surgical tools. After the frenulum is released, the wound is closed with sutures that absorb on their own as the tongue heals.
Possible complications of a frenuloplasty are similar to a frenotomy and are rare. After a frenuloplasty is performed, tongue exercises might be prescribed to enhance tongue movement and reduce the possibility of scarring.
If you think your newborn is suffering from tongue-tie, you are not alone. It can be frustrating when your little one isn’t able to feed properly and is keeping you up longer than necessary with their cries! But as you can see, there are many courses of treatment, and with the right care, your baby will develop normally and not suffer any serious ramifications of the condition.
To learn more about keeping your baby healthy, see: Baby & Toddler Health & Safety