If you take a moment to focus and move your tongue around the inside of your mouth, you’ll notice that you can reach almost every part of your mouth. This is a sign of a regular, healthy tongue with a full range of motion. This range of motion allows us to make different sounds when we speak, swallow our food, and keep our mouths clean by sweeping away pieces of food in our mouth. If this range of motion is impeded in any way, it can create several problems. My Baby Nursery is your one-stop baby product store.
In children, there is a slight stretch of tissue known as the lingual frenulum. It connects the underside of the tongue to the bottom of your mouth. If there is a problem with the lingual frenulum, it can cause a condition known as tongue-tie, formally known as Ankyloglossia. The lingual frenulum may be too short and tight, or its attachment point could be near the tip of the tongue. In these situations, the language becomes tied in place and is unable to move around freely. Children with this condition have difficulty breastfeeding as newborns and eventually have further issues with eating and speaking as they grow up. Sometimes, this condition may go undetected; however, it can still be treated later in life.
Breastfeeding your newborn might seem like a natural thing, but it doesn’t always come naturally or easily to you or your baby.
Some babies might have more difficulty breastfeeding because of a tiny, barely noticeable extra bit of tissue under their tongue. This condition is called tongue-tie, and it can make breastfeeding more of a challenge for both of you. Your healthcare provider or lactation consultant might recommend tongue-tie surgery, a small procedure that helps remedy this usually minor condition. Other experts don’t recommend tongue-tie surgery, though.
What Is a Newborn Tongue Tie?
Newborn tongue tie (or ankyloglossia: “tie” “tongue”) is a pretty uncommon condition where a baby’s frenulum tightly holds the bottom of the tongue to the floor of the mouth.
Their friend-what?? Let’s back up for a second.
The frenulum is a little flap under the tongue that anchors it to the floors of the mouth. (Touch your tongue to the roof of your mouth and under the tongue—about halfway back—you’ll feel a little bit of tissue stretching between your tongue and the bottom of your mouth. That’s your frenulum!) Frenulum comes from Latin for “little bridle”—and indeed, it acts as an itty-bitty harness that holds your tongue in place.
For tongue-tied infants, the frenulum is too short or thick, tethering the tip of the tongue so that the baby can’t stick it out. Doctors and lactation consultants now recognize that having a tongue tie can seriously interfere with breastfeeding.
About 10 per cent of babies (primarily boys) are born with a tongue-tie, called Ankyloglossia in medical terms.
Some of these babies might find it harder to latch on or suck in a coordinated way during breastfeeding. However, other newborns with tongue-tie may have no problems breastfeeding.
Everyone has a flap or fold of tissue or membrane connecting the underside of their tongue to the floor of their mouth. This membrane is called the lingual frenulum (or frenum). Typically, it gets thin and stretchy or mostly goes away before birth.
In babies with tongue-tie, the frenulum attaching the underside of the tongue to the floor of the mouth is still mostly there or still thick and short. When this happens, their language can be tethered or held down tightly and might not move as it should.
In addition to breastfeeding issues, signs and symptoms of a tongue-tie in newborns can include the following:
- Their tongue looks shorter or doesn’t stick out as much.
- The tip of their tongue looks heart-shaped or is differently shaped when it moves forward.
- Their language looks like it’s pulled downward in the centre when it’s lifted.
- Their language can’t reach the roof of their mouth.
- You may be able to see or feel firm tissue or a membrane attaching the baby’s tongue to the floor of their mouth.
A posterior tongue-tie happens when the membrane attaches at the back of the tongue. A posterior tongue-tie can be harder to see visually, but it can still affect the function and coordination of your baby’s tongue.
Here’s Why Infant Tongue Tie Interferes with Breastfeeding
During nursing, the baby opens the mouth widely, latches onto the breast, and sticks out the tongue. Cupped under the nipple, the language then darts in and out, stripping milk out of the breast and pulling it to the back of the throat to be swallowed. So, if the tongue is tied down, the baby won’t efficiently pull the milk out. She will seem to be sucking but won’t be drinking very much milk. That means the baby’s pee will get darker; she won’t have many poops or gain weight well.
Baby tongue ties can also hurt the mom. The bunched-up tongue can’t move in long strokes. Instead, it has tiny little back and forth movements, rubbing and rubbing on the same spot…until it gets blistered and raw. Also, since the baby isn’t emptying the breast well, tongue-tie often results in engorgement, plugged milk ducts, and mastitis.
How is it detected?
Typically, the lingual frenulum separates from the tongue before birth. Tongue-tie is caused when this piece of tissue doesn’t separate. The reason for this lack of separation is unknown to doctors, but they suspect that there may be a genetic cause. Baby boys are three times more likely to be tongue-tied than girls.
Usually, tongue-tie is detected in newborns who are being breastfed. You may notice that your child is having difficulty latching on or cannot perform the correct sucking motion. Tongue-tied babies have a problem sucking and, therefore, seem fussier when being fed, don’t gain weight as expected, and always seem to be hungry. These babies put in the effort to provide; however, their sucking motion is restricted, and, therefore, feeding becomes difficult for them.
Attempting to breastfeed a tongue-tied baby is not only difficult for the child but also the mother. The unsuccessful sucking motion produced by tongue-tied babies can leave the mother’s nipples bruised, cracked, and in some cases, infected, which ultimately affects the mother’s milk supply.
Tongue-tie can not only be detected during feeding time but also by the appearance and motion of your child’s tongue. If you find that your child cannot move their tongue very far from side to side, up or down, or if their language forms a V-shape at its tip when they stick out their tongue, you may want to consult a doctor confirm whether your child has tongue-tie.
What is Tongue-Tie Surgery?
Some babies need the frenulum to be snipped or cut with a laser to relieve newborn tongue tie. This frenotomy (or frenotomy, or frenectomy) is a speedy and straightforward procedure. The word ‘snipped’ might make you cringe—but don’t worry —babies cry very little and then calm when put to the breast. Moms often notice an immediate improvement in the baby’s sucking and swallowing…and an immediate reduction of pain.
Is tongue-tie surgery recommended?
Traditionally, healthcare providers recommended tongue-tie surgery very soon after a newborn was diagnosed. This was because they believed it would improve breastfeeding problems.
Tongue-tie surgeries increased tenfold between 1997 and 2012.
In the last few years, research has started to look more closely at how beneficial surgery is. Many lactation consultants and other providers have now started exploring other therapeutic interventions rather than jumping straight to recommending surgery.
A 2019 study that looked at 115 newborns with a tongue-tie found that 63 per cent of babies didn’t need tongue-tie surgery to improve breastfeeding if they had a thorough examination with a pediatric speech and language pathologist (SLP).
Other problems like: caused their feeding issues
- infant reflux
- poor latching
- low milk supply
If parents worked with the SLP to address their particular difficulties, breastfeeding typically improved, and surgery wasn’t necessary.
On the other hand, some research shows that tongue-tie surgeries can be helpful.
A clinical study in 2019 found that out of 345 newborns with problems breastfeeding, 116 had a tongue-tie. The babies with a tongue-tie typically had more severe breastfeeding problems than babies without.
In the tongue-tie group, 30 babies had surgery. According to researchers, the surgery group showed significantly more breastfeeding than babies with tongue-tie who didn’t have the procedure.
Here are some pros and cons of tongue-tie surgery in newborns:
- may help improve breastfeeding problems
- babies may feed better and gain weight more quickly post-surgery
- may prevent nipple pain for nursing parents
- may prevent dental problems later in life
- may avoid speech issues later in life
- may not help improve breastfeeding problems
- may cause infection and swelling
- may ultimately be unnecessary
- requires daily exercises and stretching after the procedure to prevent the condition from reoccurring
Should you get your baby’s tongue tie snipped?
Lately, some people have worried that doctors have become a bit too eager to do tongue-tie releases. According to one estimate, these surgeries have increased tenfold between 1997 and 2012, with more than 12,000 tongue-tie surgeries performed in 2012.
Has the pendulum swung too far in the other direction? A 2019 study from the Massachusetts Eye and Ear Infirmary looked at 115 babies referred for tongue-tie surgery and found that 63% ended up not needing the procedure. Another recent study found a short-term reduction in breast pain but inconsistent positive effects on breastfeeding.
If your baby is having difficulty latching, staying attached to your breast, and you are battling nipple pain, frequent engorgement, or other breastfeeding issues due to newborn tongue tie, then speak with your pediatrician. Your doctor will help figure out if the baby tongue-tie is the culprit and suggest other ways to alleviate breastfeeding pain. Because a baby has got to eat…but mama shouldn’t have to suffer! Online baby product directory at My Baby Nursery
Kinds of tongue-tie surgery
Tongue-tie surgery is no longer a one-size-fits-every-baby procedure. And there are different kinds of tongue-tie surgeries.
Fortunately, the frenulum doesn’t have many nerves and blood vessels, so the surgery won’t usually cause much pain or a lot of bleeding.
If you decide on tongue-tie surgery, your healthcare team will help you choose the best procedure for your baby.
A note on terminology: “Frenotomy,” “frenectomy,” and “frenulectomy” are all terms that tend to be used interchangeably. They’re not precisely the same, but they’re all used the same way.
This traditional procedure involves snipping or cutting the frenulum with a small scalpel to free the tongue. Most babies don’t need numbing (anesthesia) and can feed right away after the surgery. Healing may take a few days.
These surgical procedures involve cutting the lingual frenulum. This procedure is performed by holding the tongue upwards towards the roof of the mouth, which will help tighten the frenulum and make it visible. A cut is made through the white, fascia-like tissue along a parallel line to the tongue. The amount is made quickly, in a single swift motion, and the procedure does not require anesthesia. There is a chance of excessive bleeding; however, there is a shallow risk of this.
Tongue-tie laser surgery
Laser surgery for tongue-tie is similar to a frenotomy except that a laser is used instead of a scalpel or knife. Using a laser may help make tinier snips or cuts. This may allow the area to bleed more petite and have a faster healing time.
A type of laser surgery that is used to separate the frenulum from the tongue. This laser surgery is relatively quicker and safer compared to other cutting methods. Laser frenectomy is not an intrusive procedure; parents can remain with their babies to help keep them calm during the process. Bleeding during the procedure or infection is very rare. The recovery time and postoperative complications are non-existent, and babies can start feeding successfully immediately after. Overall, the use of a laser has been found to produce more exact results and stop blood flow more effectively.
Electrocautery surgery uses electricity to heat and cut. This method is similar to frenotomy for a tongue-tie, except electricity is used to release the tongue instead of a scalpel. It may help reduce bleeding and speed up healing time.
This kind of surgery is for more complicated tongue-tie cases. It involves cutting and reattaching the frenulum with sutures. This surgical procedure consists of rearranging tissues or adding grafts after creating an incision and then closing the incision in a specific way to lengthen the anterior tongue. This procedure is generally more invasive and usually performed in older infants and children and requires general anesthesia.
There are new non-invasive procedures that can be used to help manage the effects of tongue-tie. These non-surgical approaches include lactation interventions to help babies latch on and breastfeed effectively, as well as speech therapy.
Possible complications and side effects of surgery
In rare, complicated cases, your baby may have a longer healing time after tongue-tie surgery. The procedure may also cause complications and side effects like:
- inability to feed
- weight loss
- damaged tongue muscles
- damaged salivary (spit) glands
- breathing problems
Recovery after tongue-tie surgery
Healing and recovery after tongue-tie surgery depend on the type of tongue-tie your baby has and what kind of surgery was needed to treat it.
Some procedures may have a longer healing time, leading to a further delay in breastfeeding. Or your little one may find it easier to breastfeed right away after surgery.
Regardless of how the procedure is done — with a scalpel or laser — you’ll need to do oral exercises and stretches with your baby multiple times every day for several weeks afterwards. This helps prevent the frenulum from regrowing in a restricted way.
Your doctor will show you which exercises to do and how to do them. It may feel uncomfortable to you at first — you’ll be stretching an open wound. But the exercises are an essential part of finding success with the procedure.
A clinical study from 2018 followed 30 newborns that had tongue-tie surgery before they were 12 weeks old. Immediately after the surgery, 90 per cent of the mothers reported improvement in breastfeeding and nipple pain. After two weeks, 83 per cent of the mothers said there was an improvement.
Tongue-tie is a minor condition that some newborns have at birth. In some cases, it doesn’t cause any problems at all. Other babies may have problems breastfeeding.
Tongue-tie can also cause problems later in life, like difficulty speaking or changes to the shape of the mouth. Tongue-tie surgery is a minor procedure that can help some babies with breastfeeding. My Baby Nursery is your one-stop baby product store.
But new research shows that surgery isn’t needed to improve breastfeeding in babies with tongue-tie in some cases. This can be especially true if parents see a lactation specialist for evaluation and nonsurgical treatment recommendations. Your lactation consultant or healthcare provider can advise you on the best treatment for your little one and give you all the options if surgery is needed.