In recent years, the topic of tongue-tie in babies has become increasingly popular. Tongue-tie, or ankyloglossia, is a congenital condition, which means it may be present at birth. Tongue-tie is characterised by a short, tight band of soft tissue, the frenum, which connects the tip of the tongue to the floor of the mouth. This band of tissue can be shorter or tighter than it should be, which means the tongue may not be able to move properly.
There are a number of frenums present in the mouth from birth. Another couple which can be easily seen are the labial frenums which attach the upper and lower lips to the gums.
It’s estimated that around 4-11% of newborns have tongue-tie. We don’t really know what causes it to happen, though genetics may play a role and it can often run in families. Tongue-tie typically affects more boys than girls.
What’s the problem with tongue-tie?
Tongue-tie can cause problems with breastfeeding. This is because the tongue can’t extend beyond the baby’s lower gums to create a firm seal on the mother’s nipple. However, many babies have a short or tight frenum and don’t have any problems with feeding.
In adults, a tongue-tie can cause problems with some speech sounds, typically the sibilant sounds like s, z, sh and zh. To make these sounds the tongue needs to go to the roof of the mouth and be positioned behind the upper, front teeth. Tongue-tie can also cause problems with tooth alignment, when playing a woodwind instrument and for adults, being able to kiss passionately (tongue kissing).
How would I know if my baby has tongue-tie?
You may not know until the baby is checked by a midwife or doctor. Or, you may suspect your baby has tongue tie-if they’re having trouble attaching or staying on your nipple.
If you are breastfeeding:
- Your baby’s latch causes you pain.
- Your baby can’t create a firm latch on your nipple and doesn’t stay attached.
- They make a clicking sound when they feed.
- Your baby isn’t thriving and failing to gain weight.
- After your baby detaches, your nipples look as if they’ve been squashed.
- Your nipples look sore or are damaged.
Look for these signs in your baby:
- A heart-shaped tongue when they stick it out.
- The tip of their tongue can’t reach the roof of their mouth.
- Their tongue can’t reach further than the edge of their lower lip.
- Their tongue can’t move sideways.
What is the treatment for tongue-tie?
The first goal is to have a proper assessment done. There are a few tongue tie assessment tools which can be used, many based on the Hazelbaker tool. Your GP, paediatrician, speech pathologist, dentist or lactation consultant will be able to do an assessment.
It’s important to know that the lingual frenum should be considered normal if there are no issues for the baby in using their tongue. This applies even if their frenum looks tight or restricted.
Ideally, non-surgical treatment is tried before doing anything else.
If you are breastfeeding, seek advice on:
- Positioning and latch
- Feeding frequency
- Lactation support
- Using breastfeeding aids e.g., nipple shields or supply lines
- Potential problems with offering dummies and bottles/teats
Surgical treatment
Sometimes surgery is needed in cases of genuine tongue-tie and when a baby isn’t feeding well. Occasionally, adults choose to have surgical treatment for tongue tie. The goal of surgery is to improve the tongue’s function; however, there is no guarantee that it will work.
Surgical treatments for tongue-tie can include a frenectomy, frenotomy or frenuloplasty. These treatments are based on cutting the lingual frenum to try and create better tongue movement. Although it may seem like a simple and quick procedure, all surgical procedures come with risks, including surgical tongue-tie release. The doctor or dentist doing the treatment will use a pair of scissors or laser to cut the frenum.
Written for Infacol by Jane Barry, Midwife and Child Health Nurse, August 2023.
