What is Tongue-tie?
Well, in order to answer this we have to look at the anatomy of the tongue first. We all know what a tongue is, but do you know just how big it is? The part at the front is just the tip of a much bigger structure that extends lower into the mouth and further into the throat than you may have thought.
The tongue is held in place by several different muscles and connective tissues that enable it to change its shape and move around the mouth. This movement of the tongue is very important. Not only do we move our tongues ourselves but it also moves without us knowing. It’s a vital component of chewing, sucking, swallowing, speech, laughter, singing, breathing and comedy (blowing raspberries and sticking your tongue out).
It moves thousands of times a day (and night).
One of these structures anchors the tongue to the floor of the mouth and is called the frenulum. Tongue-tie, or Ankyloglossia as it’s clinically called, is diagnosed when the frenulum is too tight to allow freedom of movement of the tongue.
It can range in severity from mild to severe and is commonly picked up during the early weeks of life. However, it can affect anyone of any age. So the first myth busted is that tongue-tie is not just found in new born babies.
However, for the sake of this blog I’ll focus on tongue-tie in infants.
Diagnosis
Common signs of a possible tongue-tie are:
👶🏼 A clicking sound when feeding
👶🏼 Difficulty latching to the breast or sucking on a teat
👶🏼 Not able to fully open the mouth
👶🏼 Coming on/off the breast or bottle during a feed
👶🏼 Problems with weight gain
👶🏼 White milk residue on the tongue
👶🏼 Problems with wind/bloating
👶🏼 Generally unsettled
In addition to the above, a tongue-tie can cause problems for the mother if breastfeeding.
👶🏼 Painful breasts
👶🏼 Sore or cracked nipples
👶🏼 Fluctuations in supply
👶🏼 Mastitis
These are some of the signs you can pick up on yourself, but tongue-tie should be diagnosed by a medical professional with expertise and additional training in the subject.
The movements of the tongue are assessed in all ranges to look for restrictions or deficits. This is more than just looking to see if the child can poke their tongue out. The tongue makes many shapes when on the breast or bottle and the ability to do this is what makes feeding a success or something that becomes stressful for mother and baby.
I mentioned above that the issue can arise whether on the breast or bottle. Another myth busted. Tongue-tie isn’t just prevalent with breastfed babies. Bottle fed babies can be equally affected. If the tongue isn’t able to curl around the teat or nipple then suction is weak. A clicking noise can be heard as the tongue releases and this makes babies more prone to taking on air when feeding. This, in turn, can lead to gastric discomfort and difficulty passing wind.
However, there may be other reasons for difficulty feeding. An imbalance around the jaw or the muscles of the neck can make opening the mouth more restricted. The tiny muscles controlling movement of the tongue can be weak or imbalanced and ‘bad habits’ form as baby tries to feed.
Untreated, a tongue-tie could pose further problems for the child. It could affect speech as the tongue won’t freely move, or could affect their ability to chew food. Mouth breathing is common in children with tongue-tie and it can also affect jaw/dental development. Having a proper assessment is important to determine what treatments are required.
Treatment:
👶🏼 Conservative, physical therapy is the first line of treatment; here at Cricklade Osteopaths, our Paediatric Osteopath, Kelly Haines, will assess the jaw, neck and muscles around the area to look for restrictions and imbalances. Tension can be eased and joints can be balanced using the gentlest of osteopathic techniques. You may be shown some techniques to try at home to help continue the treatment outside of clinic.
👶🏼 If this doesn’t help then a tongue-tie division will be carried out and we can refer you on for this. This procedure is called a frenulotomy. The tight tissue under the tongue is cut to release the tension. This is done by a Doctor, Midwife or another qualified Infant Feeding Specialist. It is a very quick process with little to no pain experienced by baby (Source: NHS).
👶🏼 As with any clinical procedure there are risks. Care must be taken that the small wound heals well and doesn’t become infected. In a few cases the tongue-tie can grow back.
It is worth noting that even after a frenulotomy, problems with feeding may continue until underlying structures and tissues are balanced. Parents and baby may need additional support with position/holds and technique when feeding as they adjust to the changes. Therefore physical therapy (the point above) will be as important after the division as it is prior to the procedure.
In most cases tongue-tie can be helped and families report that feeding is very much improved with appropriate treatment.
So there we have an explanation of tongue-tie. The facts and some myths busted:
👶🏼 Tongue-tie can affect both breast and bottle fed babies
👶🏼 It can affect anyone of any age
👶🏼 Cutting the tongue-tie isn’t always necessary
👶🏼 With treatment, it can be successfully treated
If you suspect your baby may have a tongue-tie then book online here to make an appointment with Kelly Haines.