The Trouble with Tongue Tie

If you know anything about Tongue Tie, you’ll know one thing for sure; for the mothers and babies whom it’s affecting, breastfeeding can become a real challenge. Let’s explore a bit more.

Tongue tie describes the tightness of the connecting band of skin under the tongue that connects the tongue to the floor of the mouth and jaw (called the frenulum). Tongue ties can be described as anterior or posterior. An anterior tongue tie is usually very easy to see as it holds down the tip of the tongue and can make the tongue look almost heart shaped. A posterior tongue tie is found near the base of the tongue so is very often harder to notice.

Tongue tie, also known as ‘ankyglossia’, is sometimes described as a short tongue. Lip tie is another restrictive condition in the new-born’s mouth that is located between the upper gums (where the two front teeth would be) and the upper lip. In both conditions, baby does not have enough mobility of the tongue or lips to create an adequate seal around the breasts for effective and efficient breastfeeding.

Who can diagnose the condition and how does it affect breastfeeding?

More often than not, the mother may complain of painful feeds and difficulty with latching baby on, or it may be noticed that baby is not thriving and gaining adequate weight, despite frequent feedings. On review of the breastfeeding history, the midwife, breastfeeding specialist, paediatrician, and/or Ear Nose & Throat specialist (ENT) may be the professionals to examine baby and diagnose the tongue tie.

Challenges that can be faced due to Tongue Tie:

• Poor latch resulting in sore and cracked nipples

• Engorged or overfull breasts due to being insufficiently drained by baby

• Mastitis or breast abscess due to being insufficiently drained by baby

• Baby having static weight gain, or actual weight loss due to not receiving adequate nourishment

• Baby’s stool and urine reduced to less than 1-3 daily (respectively) and stool still green or brown coloured.

• Gassiness, extra spit-up and reflux symptoms due to extra air swallowed when feeding.

• Stressed mother potentially giving up on breastfeeding due to the difficulties faced

• Longer term challenges may include speech development issues, dental problems and more.

Treatments and solutions for Tongue Tie:

Correct diagnosis by a trained professional is key, as there may be other issues creating the breastfeeding challenges and not tongue tie at all. It’s also important to bear in mind that not all tongue ties need treating. Some babies may have a very obvious tongue tie but it does not cause any restriction to babies’ tongue mobility, baby is feeding regularly and thriving well, causing no pain or feeding challenges for the mother. Treatment decisions should be made on an individual basis. (NICE 2005)

• SNIPPING FRENECTOMY

Usually takes less than 10 mins to perform from start to finish and mothers are encouraged to breastfeed straight away after the procedure. Sterile scissors are used to snip the frenulum; there are apparently no nerve fibres in the tongue-tie so it is not thought to be painful for baby. Breastfeeding immediately afterwards apparently helps to minimise any bleeding, which tends to settle after a few minutes.

Rare risks include slight bleeding, infection, and recurrence of the tongue tie over time.

• LASER TREATMENT SURGERY

Takes less time than when using a scissors or scalpel. There is also less bleeding as the laser helps cauterize the tissue. The laser is also said to reduce any post-op complications such as infection.

• POST OPERATION EXERCISES

Daily stretching is vital after the frenectomy, to prevent the tongue or lip from reattaching. The person who carries out the procedure will advise on how to properly perform the correct tongue/mouth stretches for your baby.

In some cases, a tongue tie may correct itself and the accompanying problems may disappear, but it’s not just about the tongue tie or the act of breastfeeding alone. Mothers trying to feed a tongue tied baby may experience pain, anxiety and mental distress due to the, challenges, and concerns about whether their baby is nourished and thriving, especially when weight gain is slow or if there is weight loss. The time that a tongue tie may take to correct itself naturally could very well involve months of underfeeding, stress and worry; replacing the bonding, love and connection mother and baby should be experiencing in baby’s first weeks and months of life.

Resources and professionals that may offer support in Barbados are-The Breastfeeding & Child Nutrition Foundation (The BCNF), your polyclinic midwife, paediatrician, or ENT Specialist.

Always ask for the support you need.