Tongue Tie: The Facts

Tongue Tie: The Facts

Breastfeeding is a combination of vacuum and pressure, resulting in the release of milk from the breast. In order to do this, a baby needs a certain amount of tongue mobility. Sometimes babies lack this tongue mobility due to ankyloglossia or tongue tie. We have listened to various experts (such as Carlos González) speak on this subject and have done our own research and put together a short post for parents or parents-to-be who might not be aware of this relatively common problem.

What is tongue tie?

Tongue tie is a result of the frenulum (the band of tissue connecting the bottom of the tongue to the floor of the mouth) being too short and tight, meaning that the movement of the tongue is restricted.

Tongue tie is present at birth (congenital) and hereditary. Between 0.2% and 2% of babies are born with too-tight frenula.

There are four categories of tongue tie: Posterior, Anterior 1&2 and Submucosal. No one category is ‘worse’ than the other- all four categories can have varying degrees of severity. You can see some images and descriptions of the different types of tongue tie here

When is tongue tie an issue?

The consequences of tongue tie vary over time but a very imminent problem can be with breastfeeding. As stated at the very beginning of this post, a vacuum needs to be created in the baby’s mouth, in order to extract milk from the breast. The main tool used to do this is the tongue (fascinating image material can be found here, if you are interested!). Of course, if the tongue is lacking the necessary movement to efficiently extract milk from the breast, problems occur.

A few of the signs that might indicate an inadequate latch due to tongue tie are:

  • Hollow cheeks when sucking on the breast
  • Sore or cracked nipples (as baby may use the gums to compress the breast, rather than the tongue)
  • Very long feeds
  • Baby appears to be still hungry at the end of a feed
  • Very frequent nursing (on average a newborn baby in a Western country will nurse 10-12 times per day for 10- 20 minutes on each breast)

Being the brilliant things that they are, our bodies detect that the baby drinking on the breast doesn’t have an efficient latch, more oxytocin is released and the milk flows faster so that the baby still gets what it needs. However, more milk and a faster flow can result in engorgement and mastitis for mum and gagging, vomiting, ‘colic’ and a gassy tummy for baby.

Whilst many babies with severe tongue ties fail to gain the necessary weight to be considered healthy, some babies may gain weight well but are often a little fussier than babies who aren’t working as hard to get the nutrition they need to thrive.

In the long-term, a tongue tie can cause speech issues and can interfere with the growth of the teeth so that a later correction is required. Dental caries may also become an issue due to the malformation of the teeth and there are cases of minor respiratory problems due to asymmetry of the nasal cavity. Even bottle feeding, a baby with a tight frenulum can be tricky and when it comes to weaning/introducing solid foods, babies may have some trouble moving food around their mouths.

What is the solution for tongue tie?

If you suspect that your baby has a tongue tie, it’s really important to speak to an expert in this field. Many hospitals have an in-house lactation consultant who can advise further. However, many parents discover their baby’s tongue tie once they have left the hospital. A good tip for preparation for the time after the birth would be to find out about your local breastfeeding groups and local IBCLC (International Board Certified Lactation Consultant) who you can contact in case you need breastfeeding support.

Cutting a tongue tie was already documented on Egyptian papyrus over 3000 years ago so it’s nothing new. However, for some reason there are not near enough doctors who know how to recognize a tongue tie, let alone how to release one. The important thing is that the tongue tie is fully released: If a doctor doesn’t dare to cut sufficiently deep, the frenulum will reattach itself. It’s also very possible that there are multiple categories of tongue tie in one mouth and so investigation (and expertise) is required.

Once a frenulum is cut, exercises are needed in order to limit scar tissue and prevent reattachment. This may be a simple matter of pushing gently down on the floor of the mouth and lifting the tongue.
Babies who have had a frenotomy will need some level of ‘suck training’ so that they learn how to breastfeed with their newly-discovered tongue mobility. Ensuring good positioning and latch with the help of a good lactation professional will help your baby to re-learn breastfeeding quickly and will hopefully lead to a long and mutually enjoyable breastfeeding journey!

Did your baby have a tongue tie? We would love to hear your experiences!

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