Tongue Ties

Tongue-tie (ankyloglossia) is a condition present at birth where the strip of skin connecting the bottom of the mouth is shorter than usual, restricting the range of motion. In some cases, the baby will not seem to be bothered by it. In other cases however, it can make it harder to breast feed. The condition can also cause problems for the mother such as sore/cracked nipples, inflammation of the breast (mastitis) and reduced milk supply.

Causes of Tongue Tie

There are different types of tongue-ties. Some are very obvious due to the appearance of the tongue. Tongue-tie is caused by an unusually short, thick or tight band of tissue (lingual frenulum) which ties the bottom of the tongue’s tip to the floor of the mouth.

Usually, the lingual frenulum detaches before birth, allowing the tongue complete movement. When tongue tie is present, the lingual frenulum remains attached to the bottom of the tongue. Why tongue-tie occurs is unknown, although it appears more common in boys than girls and has been associated with certain genetic and hereditary factors.

Symptoms of Tongue Tie

Sometimes tongue-tie may not cause complications or show symptoms, but some cases may require a simple surgical procedure for correction. Signs and symptoms related to tongue-tie can be experienced in mother and child. Children and mothers may experience the following symptoms:

For the mother

• Misshapen, ridged or blanched nipples following feeds
• Tender, blistered, cracked, bleeding, bruised nipples
• Mastitis and blocked ducts (mastitis- inflammation of the breast tissue)
• Low milk supply or over supply of milk
• Exhaustion from repeated/endless feeding

For the baby or child

• Limited tongue movement- inability to poke their tongue out or lick their lips.
• When crying the tongue may stay on the floor of the mouth or just the edges may curl up.
• Unable to open their mouth wide when fastening to the breast, leading to biting or grinding
• Fussy behaviour and latching to the breast when being fed
• Coughing during feeds
• Trouble staying locked to the breast
• Falling asleep before the end of a feed
• Frequent or extended feeds
• Extreme early weight loss or poor weight gain
• Clicking noises and dribbling during feeds
• Colic, wind, hiccoughs
• Difficulty lifting the tongue up and moving it side to side
• Trouble sticking the tongue out past the front teeth
• The tongue may look notched or heart shaped when stuck out

In later life tongue tie may increase the risk of tooth decay. It may also affect how your child pronounces certain words, can cause difficulty playing wind instruments and cause problems when trying to stick their tongue out.

Diagnosis of Tongue Tie

Newborn babies are checked for a range of abnormalities. However, this check does not include assessment for tongue-tie. There are tools and techniques available for assessing tongue-tie in children, some as simple as sweeping a finger under the tongue to see if you can feel resistance. The ATLFF (assessment tool for lingual frenulum function) is the only tool that has demonstrated reliability and validity in babies up to 12 weeks of age.

Tongue-tie is typically diagnosed during a physical exam. The doctor might use a screening tool to score various aspects of the tongue’s appearance and agility. Your child will need to be seen by the doctor prior to the operation to confirm the tongue tie diagnosis.

Treatment of Tongue Tie

Surgical procedures include a frenotomy or frenuloplasty.

Frenotomy

A simple surgical procedure called a frenotomy can be done with or without anaesthesia and is carried out on a day case basis. The doctor examines the lingual frenulum before using sterile scissors to snip the frenulum free. The procedure is quick and, since there are few nerve endings or blood vessels in the area, pain or discomfort is minimal. The procedure only takes a few seconds and some babies even sleep through it. If any bleeding occurs, it is likely to be only a very small amount of blood and the baby will be able to begin breastfeeding immediately after the procedure. They may develop an ulcer under their tongue; this could take up to a week to heal but it should not bother the baby.

Frenuloplasty

Frenuloplasty may be recommended if extra repair is required or the lingual frenulum is too thick for a frenotomy.

A frenuloplasty is performed under general anaesthesia with surgical tools. After the frenulum is released, the wound is usually closed with stitches that dissolve on their own as the tongue heals. This procedure is more commonly used on older children with teeth.

Older Children and Adults

Adults and older children can still have surgery to treat tongue-tie, but it will typically require general anaesthetic and stitches. Untreated tongue-tie may not cause any problems as a child gets older, with the possibility any tension in the lingual frenulum may loosen and resolve itself as the mouth develops and matures.

In certain cases, it can affect the way a person speaks or pronounces words; therapy with a speech-language pathologist can often help to improve speech sounds.

Post-Operative Care and Recovery

The procedure may leave your child experiencing a little discomfort or achiness, particularly after a few feeds. Some babies will not express any obvious signs of discomfort at all but, if they do, some light pain relief will be necessary although not always effective.

Following the surgery, babies may suddenly be able to take much larger volumes of milk. Some will swallow this easily whilst others, depending on how they have become used to drinking, may cough or splutter and appear to be shocked. As well as baby, mother may also feel some aching which is caused by the child pulling the nipple further into the mouth whilst not using the right action.

Following the procedure, the baby should be fed at the first sign of hunger as opposed to being left to cry. If crying persists during feeding, there is a chance that you may catch the sensitive area under the baby’s tongue with your teat or nipple, causing some blood to ooze out.

Complications

Frenotomy procedures are typically low risk and straightforward, complications are a rarity but, if they do occur, are likely to be:

• Bleeding 
• Infection 
• Damage to the tongue 
• Scarring 
• Frenulum reattaching to the base of the tongue

Frenuloplasty complications are similar to those of a frenotomy in both rarity and manifestation, including:

• Bleeding
• infection
• Damage to the tongue or salivary glands
• Scarring (due to the more extensive nature of the procedure) 
• Reactions to anaesthesia

After either procedure, tongue exercises might be recommended to enhance tongue movement and reduce the potential for scarring.

Outlook

A tongue-tie is not uncommon in new born babies and is normally not considered to be a cause for concern. They are easy and generally safe to correct, with most babies able to breastfeed successfully after a frenotomy and rarely experiencing further complications in later life.

Need Help?

At One Healthcare we can book you in to see a specialist Paediatrician, usually within 48 hours, for an initial consultation.  Treatment for tongue ties is available at One Ashford Hospital in Kent.

You can use your private medical insurance or pay for your Tongue Ties treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• 0% and low finance options**
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

**Terms and conditions apply

Contact us and find out more

If you live in and around the Kent area and would like to visit our One Ashford Hospital please click here

If you are based in and around Hertfordshire and would like to visit the One Hatfield Hospital please click here.