Sunday, July 25, 2021

Tongue Tie

This is an INFORMATION page, verified by physician

Most babies will have no problem latching straight after birth. Within few days mother and baby will discover the comfort of breastfeeding. Unfortunately, in some cases it is not as smooth, and babies can struggle to latch and feed properly.

One reason for inadequate latch is when babies are born with what is called ‘tongue tie’ (medical term is ankyloglossia). It is important to identify the issue as early as possible. Because it may lead to poor weight gain, unsettled baby and upset mother.

Tongue-tie occurs when the thin membrane under the baby’s tongue (called the lingual frenulum) restricts the movement of the tongue. Some babies with tongue tie can latch and feed adequately. But in some instances, the tongue is not free or mobile enough for the baby to attach properly to the breast. Tongue-tie occurs in 4-11% of newborns.

You may notice the following if your baby has a tongue tie:

In the newborn period:

  • Your baby struggles to latch, despite trying different positions.
  • Your baby seems to be latching, but it is very painful for you.
  • It appears that your baby is constantly nursing and is still not satisfied.
  • You experience shooting pains in your breasts, your nipples may get cracked or turn white after nursing with throbbing pain
  • Your baby is ‘gulping’, ‘choking’ and seems to be always fussy on the breast.
  • You can hear ‘clicking’ noise whilst nursing your baby.
  • Your breasts may become engorged and swollen, and you may develop mastitis.

Beyond newborn period:

  • Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side.
  • Trouble sticking out tongue past lower gum line or the lower front teeth.
  • Signs of acid reflux (Gastro-esophageal reflux).
  • Food and texture aversion and difficulties in the weaning period.
  • Difficulties licking ice cream.
  • Trouble whistling and playing wind instruments.
  • Unclear speech and problems with certain sounds (lisp) – t, d, l, n.
  • Tooth decay, even with diligent tooth brushing, and orthodontic problems.

Tongue tie may be mild, moderate or severe. Below is widely accepted classification.

  • Class 1(classical): on the very tip of the tongue
  • Class 2 & 3: attached close to the middle of the tongue
  • Class 4 (posterior): short tongue, must be felt to be diagnosed
baby-classical-tongue-tiebaby-posterior-tongue-tie
Classical Tongue TiePosterior Tongue Tie

Tongue tie may be associated with upper lip tie. Upper lip tie is when the piece of tissue behind your baby’s upper lip (called the frenulum) is too thick or too stiff and keeps the upper lip from moving freely. Unless it is very restrictive, the condition does not interfere with breast feeding. Later in life it can cause tooth delay, orthodontic and speech problems.

What to do:

Worried about your baby latch or unsettledness? Discuss with your Paediatrician or lactation consultant. They will perform a thorough assessment and will let you know whether an intervention is needed.

Treatment is Tongue tie release (medical term is frenotomy). In Cayman it is done by ENT doctors. Most of the time it is a simple visit to the doctor’s office as it is a quick and free of pain procedure. You will be able to breast feed straight after the procedure so that latch be evaluated. Post-surgery it is important to arrange a follow up by your pediatrician. They will advise on appropriate exercises and massage to allow proper healing and prevent scaring.

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about the author

Dr Jasmina Marinova

MRCPCH, MD

SPECIALIST PAEDIATRICIAN & NEONATOLOGIST

Dr Marinova is an experienced paediatrician with a special interest in neonatal medicine, having been trained in both paediatrics and neonatal medicine in Europe before spending 15 years in the United Kingdom, both at the world-renowned John Radcliffe Hospital in Oxford and in the busy district hospital in Kettering.



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