When parents notice their baby struggling with breastfeeding or hear a clicking sound during feeding, it might raise concerns about a common condition known as tongue tie. This condition involves a tight piece of skin beneath the tongue that can restrict movement and affect feeding.
Knowing the signs of tongue tie and the treatment options available, both surgical and non-surgical, can help you decide the best choice for ensuring your baby’s comfort and normal development.
What is Tongue Tie?
There is a normal strip of tissue under the tongue and in the middle called the lingual frenulum. This tissue forms part of the normal attachments of the tongue to the floor of the mouth. A tongue tie (or ankyloglossia) occurs when this strip of tissue is shorter, tighter or thicker than usual.
This condition can interfere with the tongue’s ability to move normally. In infants, this can make it difficult for the baby to latch on when breastfeeding. In older children, a tongue tie can also affect how a child eats, speaks or swallows as they grow.
How Common is Tongue Tie?
Studies have found that the prevalence of tongue-tie varies widely depending on age, ranging from as low as 0.1 percent to as high as 10.7 percent.
Studies show that tongue tie is more common in newborns (affecting as many as one in 10 babies) than in older children, teenagers and adults. Some milder cases of tongue tie may resolve naturally over time, which might explain the lower prevalence rates observed in older age groups.
Recent years have seen an increase in referrals to diagose and treat tongue ties or other alleged forms of oral ties. However, this is a poorly researched area and a lot of the published new opinion does not meet the minumum criteria to justify surgical intervention. Unfortunately, this has led to misdiagnosis and unnecessary surgeries in the wider community.
Signs of Tongue Tie
To determine if your baby might have tongue tie, first pay attention to whether or not they have difficulty breastfeeding, such as struggling to latch properly or making a clicking sound while nursing.
Signs and symptoms of tongue tie in newborns and babies can include:
- Difficulty with breastfeeding for infants, which might show as trouble latching, a clicking sound while nursing, sucking in a lot of air during feeds, insufficient weight gain due to low milk intake or frequent feedings
- Symptoms in the breastfeeding mom such as cracked nipples, pain and low milk supply
- Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side
- Trouble sticking out the tongue past the lower front teeth
- A tongue that appears notched or heart-shaped when stuck out or when the child cries
Older children and adults can also have a tongue tie if it’s never corrected when they are younger. For older children and adults, tongue tie can cause:
- Challenges with speech, particularly articulating sounds that require the tongue to reach the roof of the mouth (such as when pronouncing “t,” “d,” “s,” “th,” “n” and “l”)
- Trouble swallowing normally
- Issues with oral hygiene, as the tongue tie can make it difficult to sweep food debris from teeth
Treatment Options for Tongue Tie
Not all tongue ties require surgery. Depending on the severity and symptoms experienced, non-surgical options might be recommended to help the baby feed and develop properly.
Non-Surgical Treatments
Many health professionals, such as pediatric surgeons and specialists, advocate for non-surgical approaches for tongue tie first, especially for minor cases where the tongue tie might not severely impact the child’s ability to feed or develop speech.
Non-surgical options for managing tongue tie can include:
- Breastfeeding support from lactation consultants who can offer techniques and positions to help improve the baby’s latch, such as those that encourage a deeper latch
- Exercises and positions that can encourage better tongue mobility, such as those that require the baby to lick and stick out the tongue
Surgical Treatments
In cases where non-surgical treatments do not help fix difficulties caused by a tongue tie, surgical options, such as a frenotomy (also called frenulotomy), might be considered.
This procedure involves snipping the tight band of tissue under the tongue. It’s performed by a pediatric surgeon or pediatric otolaryngologist with minimal discomfort and quick healing. It is often performed without the need for anesthesia in newborns.
Considerations Before Tongue Tie Surgery
Tongue ties are often over-diagnosed and not every diagnosed case requires surgery.
Many infants adapt and overcome feeding issues as they grow, and the condition may not hinder their speech or dental development as once feared.
Before opting for tongue tie surgery, it’s important to assess all of the child’s symptoms and consider second opinions if necessary. Non-surgical remedies should be explored fully, given that many children adjust naturally with time and proper feeding support.
For parents considering surgical options for tongue tie, consultation with the specialists at Stony Brook Children’s Pediatric Surgery and Stony Brook Otolaryngology can provide further guidance. Our team is equipped to assess and treat tongue ties, ensuring that each child receives care tailored to their specific needs. For more information or to schedule a consultation, call (631) 444-2045.
