Medical News Today: Tongue tie (ankyloglossia): What you need to know

Tongue tie or ankyloglossia is when the strip of skin that connects the tongue to the bottom of the mouth is shorter than usual.

Tongue tie is a condition that occurs at birth and the issues it leads to can vary. Some babies who are born with tongue tie are unaffected by it, while others experience restricted movement of the tongue.

What is tongue tie?

Mother breastfeeding child.
Tongue tie is often diagnosed and treated in infancy, as it may cause problems when breast-feeding.

The strip of skin that connects the tongue to the bottom of the mouth is called the frenulum. Tongue tie occurs when the frenulum is too short.

Mild tongue tie is when the tongue is connected to the bottom of the mouth by a thin strip of tissue called a mucous membrane. In severe cases, the tongue can be fused to the bottom of the mouth.

Tongue tie can be diagnosed during the routine check done after a baby is born, but it can be difficult to spot. It often does not become apparent until the baby starts to breast-feed.

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Breast-feeding and tongue tie

A baby needs to latch onto the nipple to breast-feed. Their tongue will need to cover the lower gum to protect the nipple.

Tongue tie can cause problems with breast-feeding as the baby may not be able to suck well. The nipple of the mother can also become dry and cracked as a result.

Babies may also compensate by sucking and can also appear to have difficult opening their mouth wide.

Other problems that can occur in babies who have tongue tie include:

  • difficulty attaching or staying attached for the duration of the feed

  • feeding for a long time and only having a short break before feeding again

  • seeming hungry all the time

  • not gaining weight as quickly as they should

  • making a clicking sound when they feed

  • biting or teeth grinding

  • vomiting straight after feeds

As well as sore and cracked nipples, a mother who is breast-feeding her baby may have a low milk supply and inflammation of the breast, known as mastitis, as a result.

It is important to remember that problems with breast-feeding can occur for a variety of reasons and are not usually caused by tongue tie. Anyone having issues with breast-feeding should seek assistance from a midwife or other medical professional.

Other symptoms and complications

Tongue tie (ankyloglossia). <br>Image credit: Klaus D. Peter, Wiehl, Germany, (2011, March 7.)</br>
Tongue tie is often diagnosed and treated in infancy, although it may be difficult to identify.
Image credit: Klaus D. Peter, Wiehl, Germany, (2011, March 7.)

Around 4 to 11 percent of newborn babies are affected by tongue tie. It is more common in boys than girls. Only around half of those display significantly reduced tongue function that causes problems with feeding.

If the tongue is attached to the bottom of the mouth near the tip it may appear blunt, forked, or heart-shaped.

However, tongue tie is not always that easy to spot and the tongue can be connected to the bottom of the mouth anywhere along its underside.

The infant may not be able to stick their tongue out beyond their lower lip as a result of tongue tie. And, moving the tongue side to side or up and down can also be a problem.

Later on, tongue tie can cause problems with speech once the infant begins to talk. Pronunciation of letters that involves elevation of the tongue, such as ‘t,’ ‘n,’ or ‘d,’ may be particularly difficult.

Identifying and diagnosing tongue tie must be done by a doctor. The diagnosis will be made using a physical examination and by looking at the medical history of the mother and baby, and at any difficulties there have been with breast-feeding.

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Mother with newborn baby speaking with pediatrician.
If tongue tie is preventing the baby from feeding properly, then a small and painless surgery may be required.

Treatment for tongue tie is only necessary if it causes problems for the baby when feeding.

If treatment is required, a doctor can perform a simple operation to cut the frenulum. This is sometimes known as tongue division, or frenulotomy.

A specially trained doctor will snip the piece of skin connecting the underside of the tongue to the bottom of the mouth in a quick, simple, and often painless procedure. The baby may not require any sort of pain relief, as the procedure generally does not seem to cause distress or discomfort.

The procedure releases the tongue and allows it to move more freely. A woman may be advised to encourage her baby to breast-feed immediately after the procedure as it can help calm the infant.

A small amount of bleeding may occur after the procedure. In rare cases, bleeding can be excessive.

Older babies

If the baby is over 6 months old, the procedure will be done using general anesthetic. It may take up to 10 days for the tongue to heal following surgery and the baby may experience some discomfort.

A white patch may also form under the tongue but should heal within 24 to 48 hours after the procedure.

Other treatment options include:

  • Laser surgery: This can be done in 2 to 3 minutes and heal within 2 hours. No anesthetic is required.

  • Electrocautery: This is suitable for mild cases of tongue tie and can be done using local anesthetic.

Tongue tie in older children and adults

Untreated tongue tie can cause problems for children and adults because of the tightness that may occur as the mouth develops. However, for infants who have had no difficulty feeding, tongue tie may not cause any symptoms as they get older.

If there is a limited range of motion in the tongue, it may cause speech problems and issues when a person eats certain types of food.

Older children and adults can still undergo surgery to treat tongue tie, but it will usually require general anesthetic and stitches. Speech therapy may also be recommended in some cases, following tongue tie surgery in older children and adults.

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