Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. But Tongue-tie is the non-medical term for a relatively common but often over-looked physical condition, that limits the use of the tongue. The medical name for tongue-tie is ankyloglossia.
Tongue-tie affects 5-10% of new-born babies and is more common in boys than girls. Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the lingual frenulum. In babies with tongue-tie, this piece of skin is unusually short and tight, restricting the tongue’s movement. Tongue-tie can run in families, with some only mildly affected, and others function is severely affected.
The biggest effect of a tongue-tie in a newborn baby, is on the breast-feeding baby. To breastfeed successfully, the baby needs to latch on to both breast tissue and nipple, and the baby’s tongue needs to cover the lower gum, so the nipple is protected from damage. Babies with tongue-tie are not able to open their mouths wide enough to latch on to their mother’s breast properly. They tend to slide off the breast and grind on the nipple with their gums. This is very painful, and the mother’s nipples can become sore. Some babies feed poorly and get tired, but they soon become hungry and want to feed again.
Many Mums who experience this type of difficulty with breast-feeding will look for advice from a Lactation Consultant. Tongue-tie should always be out ruled or diagnosed by a Health Professional in breast-feeding mums who are having feeding difficulties.
Of course, bottle-fed babies can also have a tongue tie. While feeding is less dependent on the good movement of the tongue, very often these babies can take in a lot of air when feeding. They can gulp their feed and will be on and off the teat often during the feed. We frequently see babies who have symptoms very similar to Reflux as a result of Tongue Tie. For this reason, it is always worthwhile checking for the possibility of tongue or lip tie in babies with reflux symptoms.
Symptoms of Tongue-Tie
Baby Symptoms may include;
• Falls asleep while feeding
• Poor latch
• Slides off nipple/teat during feeds
• Audible clicking noise while feeding
• Reflux Symptoms
• Poor weight gain
• Gumming/Chewing of mum’s nipples while feeding
• Short sleep episodes requiring feeds every 2-3 hours
• When baby cries the tongue can be seen to be suspended in the mouth with the sides curled upwards at the edges.
Mum’s signs and symptoms may include;
• Cracked, bruised and blistered nipples
• Creased, flattened, or blanched nipples after breastfeeding
• Bleeding nipples
• Severe pain when baby attempts to latch
• Poor or incomplete breast drainage
• Mastitis or nipple thrush
• Plugged ducts
Although it is often overlooked, tongue-tie can be an underlying cause of feeding problems that not only affect a child’s weight gain but lead many mothers to abandon breast feeding altogether.
A lip tie is very similar to a tongue tie. With a lip tie, the piece of tissue connecting the upper lip to the gum is too tight. This prevents the upper lip from flaring out and creating a good seal on the breast. In some cases, a baby may even have difficulty feeding from a bottle. Treatment for a lip tie is to release it by cutting the frenulum connecting the upper lip to the gum. Many children who have a lip tie can also have a tongue tie. Both can be released at the same time.
How to correct Tongue-Tie.
Once a Tongue Tie has been diagnosed by your Lactation Consultant, Osteopath or GP, it’s then time to get treatment. We have listed the people we refer to at the end of this article, but your Lactation Consultant or GP will be able to give you contact details for someone in your area who treats Tongue Tie.
A Frenotomy is a surgical incision of the lingual Frenulum, a band of tissue that connects the base of the tongue to the floor of the mouth. It is done with a sterile scissors or by laser. In older children, a mild general anaesthetic or sedative may be given, while a local anaesthetic gel is applied to the area under the tongue in babies. Most babies will cry a little during the procedure due to the lifting up of the tongue to access the area. The procedure takes as little as 1 minute. Once the frenotomy is done, baby can breast feed immediately.
Very often, a Lactation Consultant will see you after the procedure to advise you about feeding positions and to ensure that baby is now feeding better than before the procedure. You will be advised about pain relief for your baby as it is very important to keep baby comfortable while the wound is healing so that they can tolerate the mouth work required and that they will continue to feed and move their tongue.
You will be given very specific exercises to do with baby to prevent the tongue tie re-attaching. When doing these exercises, it’s very important to pick a time of day when baby is most settled and has had pain relief. For a small baby, mid feed is a good time.
How Paediatric Osteopathy can help Tongue-Tie.
Frank will often see babies when they have had a frenotomy (tongue tie) correction done. The key to treatment is the re-balancing of muscular tension in the front and the back of the neck. Prior to having the frenotomy, the baby’s tongue has been anchored to the floor of the mouth and unable to form a good latch. The neck and jaw muscles have been used to create the latch and that becomes exhausting for the baby when feeding.
Once the tongue tie is released the baby will learn to orientate the movement of the tongue to deepen the latch. Frank uses very gentle techniques to ease tension in the muscles of the neck and the jaw to allow the baby’s latch to improve. Re-balancing of the neck muscles will allow the baby to rotate to both sides more easily and have the head in a neutral position for feeding. Improving ribcage movement, allows an improved suck-breath-swallow mechanism to occur when baby is feeding.
We recently spoke to Dr Justin Roche and his wife Kate Roche from The National Tongue Tie Centre on our podcast about tongue tie in babies and older children. If you think your child may have a tongue tie, we would really recommend that you listen to Episode 8, links below.
For more information about Tongue Tie contact:
Dr Justin Roche at https://www.drjustinroche.com/
Deirdre O Leary at https://tonguetiecork.ie/