June 20: Tongue-tie in babies

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The topic of Tongue-tie often comes up in discussions in my baby massage classes so I thought that you may be interested in this article which discusses tongue tie (ankyloglossia) and the impact it has on babies in breastfeeding.

What is tongue-tie? Tongue-tie, or ‘ankyloglossia’ to give it its medical term, describes a condition that affects the way the tongue moves in the mouth.

For some babies (between 3 &10%), their frenulum, the cord-like skin joining the underside of the tongue to the floor of the mouth, limits the movement of their tongue. This is called ‘tongue-tie’. It often means that the baby can’t stick their tongue out beyond their lower lip, and may not be able to move it fully up and down or side-to-side. Some babies suck extra strongly to compensate for the restricted tongue movement.

In the most easily visible tongue-ties, the frenulum is joined to the tip of the tongue, which looks heart-shaped when the baby tries to extend their tongue, but the frenulum can be joined anywhere along the underside of the tongue.

What problems does tongue-tie cause for babies? Some babies with tongue-tie have difficulty breastfeeding and, occasionally, a bottle-fed baby with tongue-tie has difficulty feeding too.

To breastfeed effectively, babies need to latch onto both breast tissue and nipple, but babies with tongue-tie may not be able to latch on properly. Some babies with a tongue-tie seem unable to open their mouths really wide. Not only can this can result in feeding difficulties for the baby but also squashed, sore and damaged nipples for mum. Improving the baby’s latch is sometimes enough for them to feed well and for mum to find breastfeeding comfortable, so action is not always needed if a baby has tongue-tie.

Bottle-fed babies can have difficulty in creating a good seal on the teat which can result in ineffective sucking. This may lead to milk leaking out of their mouths and them swallowing air, resulting in a ‘windy’ baby.

If you think your baby may have a tongue-tie, or if you have unexplained feeding problems, do ask an infant feeding specialist, breastfeeding counsellor, your midwife or health visitor to check. Perhaps look yourself.

The impact of tongue-tie was overlooked for much of the latter part of the 20th century and some healthcare professionals may not be confident in what they’re looking for. Do keep asking questions or request a second opinion if you’re not entirely satisfied after your baby’s first check.

Tongue tie symptoms: Can I see if my baby has ankyloglossia? If you look into your baby’s mouth when they are yawning or crying, you may be able to see a tie. Tongue-ties at the back of the tongue (posterior) are much harder to see than the ones tying the tip of the tongue. However, the effect on feeding is not related to how easy it is to see the tie. Some babies with the frenulum attached near the tip of the tongue manage to breastfeed well, while others with a small tie that is hard to see may really struggle to feed.

Do I need to have my baby’s tongue-tie fixed? Not necessarily. If your baby appears to have tongue-tie, but neither you nor your baby is experiencing any problems then you don’t need to do anything.

Tongue tie treatment: What can be done to treat my baby?  The frenulum can be cut (sometimes called ‘divided’) by someone trained to do the procedure. It’s quick and simple, and young babies usually don’t need any pain relief. The procedure releases the tie, and allows the tongue to move more freely. It is preferable if the baby goes to the breast immediately after the tongue-tie division, as breastfeeding is both calming for them and provides an opportunity to try out their freer tongue movement.

Although some babies may cry briefly, the procedure doesn’t seem to cause discomfort or distress. As with all procedures, there are some risks, such as significant bleeding rather than a few drops of blood when the cut is made, but the chances of this happening are small. The procedure is normally only carried out if it seems very likely that feeding will improve as a result.

How can I find someone who would do this? Ask your health visitor, midwife or local breastfeeding counsellor. At present, the procedure is only available in some places through the NHS, and the service is variable so treatment may be offered within a week or two or your baby may be put on a waiting list.

It is important to seek help quickly though as a tongue-tie causing problems needs to be treated promptly, so that baby can feed properly and, if mum is breastfeeding, that this is comfortable for her.

There are private tongue-tie services offered in some areas. As with all private services it’s important to check the practitioner’s background and qualifications.

Does the treatment resolve the problems? Yes, research has shown that if babies have difficulty breastfeeding due to a tongue-tie, division results in improved feeding for the majority of babies.

Occasionally, a tongue-tie may need snipping more than once, because of a tendency to re-attach. Often a baby’s feeding can be improved if their parents are also shown how to do oral exercises that encourage them to move their tongue.

Further information:

NCT’s helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.