Some may be surprised to discover that the state of being ‘tongue tied’ is not just a lyric used in songs with romantic overtures, but also an issue that confuses many (including health professionals).
So, what actually is tongue tie (or ankyloglossia)?
WA Health Service defines tongue tie as a condition where:
“the frenulum, or piece of tissue, which bridges the gap between the underside of the tongue and the floor of the mouth is short, either stopping the tip of the tongue from protruding beyond the lower gum and/or restricting the normal movement of the tongue.”
While tongue tie only affects a small percentage of babies (4-11%, according to the Australian Breastfeeding Association), it has become overdiagnosed and is often prematurely treated before other feeding issues have been properly explored.
Tongue tie symptoms and overdiagnosis
Some of the issues that could be caused by tongue tie include:
- Difficulty attaching or a shallow attachment on the nipple
- Nipple pain
- Slipping off the breast
- Milk leaking
- Low or no weight gain in the baby
- Reduced milk supply
The kicker is that many of these are also symptoms of other issues. An assessment by a Lactation Consultant and GP is needed to determine if there is indeed a tongue tie, and what treatment (if any) is recommended.
There is currently a lack of scientific evidence to suggest that tongue-tie causes
- poor oral hygiene
- difficulties with speech
It is therefore important to seek advice from someone objective and experienced.
Assessment and diagnosis of tongue tie
According to Dr Leon Levitt:
“It’s a bit of a confusing issue. Health professionals are a little confused by it as well. Just because you can see a stringy little bit beneath the tongue, does not mean that it has to be released. The whole area has so little scientific evidence behind it that it leaves it open to confusion and emotional decisions.”
The ADA, in their Ankyloglossia and Oral Frena Consensus Statement, cite the following prerequisites for diagnosis of tongue tie:
- Thorough case history
- Objective functional assessment of tongue function using a diagnostic system
- Complete assessment of functional issues impacted by the suspected ankyloglossia by a qualified professional
This statement goes on to assert that “the anatomical appearance of oral frena can demonstrate considerable variability without functional issues. Therefore, diagnosis of ankyloglossia should not be based solely on anatomic appearance.”
My baby has a tongue tie – now what?
Per Dr Leon Levitt’s advice, there are 2 simple guidelines when determining tongue tie, and following them means we won’t end up operating on babies unnecessarily.
1. If the tongue tie is mild, ONLY release if there are significant feeding problems.
The options for dealing with a mild tongue tie are plentiful, and somewhere around a third of babies who visit the Baby Steps Tongue Tie Clinic do not require a release in order to feed normally.
While many mums are desperate to deal with a baby that cries from what seem like tongue tie-related issues, jumping at the opportunity to ‘fix’ it should be discouraged. There are non-surgical management strategies that can be effective in the management of functional limitations related to tongue tie.
These may include:
- Positioning
- Latch optimisation
- External tools (e.g. nipple shields)
- Supply support
- Parent education
2. Very severe tongue tie, where the tip of the tongue is actually stuck down to the mouth (regardless of if there are issues feeding or not) should always be released.
The procedure for releasing the frenulum (a ‘frenectomy’) is actually very straightforward, but should still be treated as a last resort reserved only for severe tongue ties or where feeding is very difficult.
A frenectomy in a nutshell
- The frenulum is cut with either small scissors or a laser
- Baby is gently restrained and it’s unclear whether crying comes from pain or this restraint (as there is less blood and nerve supply in a baby’s mouth)
- Breastfeeding after the procedure is encouraged both to comfort the baby and allow the milk to aid in wound healing
- The wound will turn white/cream coloured – this is normal, not a sign of infection
At the Baby Steps Health Centre, a frenectomy can be performed at no additional cost if deemed necessary after a Tongue Tie Assessment. Our focus is on providing objectivity and fostering trust, without our patients having any further worry.
Advice from Dr Leon Levitt
“The urgency to diagnose and treat a tongue tie is often clouded by other factors. It’s really important to get your baby examined by a professional who is both experienced and objective.”
In summary:
- Always get your baby examined by an objective health professional for a proper diagnosis
- Follow the 2 simple guidelines: only ‘fix’ if feeding problems are significant, and for severe tongue ties, always release
To book a tongue tie assessment with a GP and International Board Certified Lactation Consultant, click here.
