What is a tongue tie?
Tongue tie is a relatively common finding affecting up to about 10% of newborns.
There is much interest in the potential impact that a tongue tie may have on a baby’s feeding and there appears to be a recent trend for early treatment.
A tongue tie is a membrane/band of tissue that extends from the undersurface of the tongue to the floor of the mouth. It is formed as part of the normal development of the tongue and provides direction for the forward direction of growth of the tongue.
Normally the membrane disappears but in some instances it persists as a tongue tie.
Does a tongue tie cause any problems?
Most tongue tie’s do not cause any difficulty and stretch over time.
However a tongue tie may affect a baby’s ability to breastfeed causing difficulty with latching on. This can result in nipple discomfort for the mother and some babies will struggle to feed leading mothers to switch to bottle feeding.
It is also thought that babies with a tongue tie will swallow air causing them to have a lot of “wind” and abdominal discomfort.
Will a tongue tie affect my child’s speech?
It is unusual for a tongue tie to have an impact on speech and as most stretch over time it is impossible to predict the potential impact on future speech development in a baby with a tongue tie. In older children it may become clearer that the tongue is restricting movement causing speech issues. This may not simply be the inability to protrude the tongue to beyond the teeth but also a restriction in side movements and rolling the tongue back against the palate causing slurring of speech and difficulty with pronouncing the letter “r.”
What other problems can a tongue tie cause?
Later in life a tongue tie can restrict the ability to lick ice cream, kiss and play wind instruments. It is also thought that a tongue tie may cause a gap between the lower incisors but this is unusual.
Should my baby have their tongue tie divided?
If your baby is having difficulty latching on and it is uncomfortable to breast feed then dividing the tongue tie is likely to make a difference.
For those babies who can latch on but are fussy and appear to have a lot of “wind” the decision to divide a tongue tie is not always so straightforward and it is helpful to take the advice of a lactation consultant.
Do you need a general anaesthetic to divide a tongue tie?
In babies under 12 weeks division of a tongue tie (frenectomy) can be carried out without the need of a general anaesthetic. However in older infants it is best to have the procedure carried out under a general anaesthetic.
How is the procedure carried out?
Dividing a tongue tie in an awake baby is a very different scenario than carrying this out under general anaesthetic. In an awake baby the division is only a simple snip through the membrane, whilst under general anaesthetic the division is carried out down to the muscles of the tongue and the incision is closed in the opposite direction (frenuloplasty) to minimise rescarring.
In our clinic the tongue tie division is carried out by a Consultant Surgeon assisted by a Paediatric nurse using good illumination and sterile instruments.
The Paediatric nurse swaddles the baby in a sheet keeping the head still. The surgeon exposes the tongue tie using a specially designed retracter and then divides the tongue using special blunt tip scissors that crush the tissue, as it is being cut, to minimise bleeding. Despite what is reported, the procedure is uncomfortable for the baby but the discomfort settles fairly quickly once the baby is breastfed. Breast feeding itself appears to have an analgesic effect (ref) and babies settle within a few minutes.
What can go wrong?
Complications following tongue tie division are unusual.
There is a potential risk of bleeding, infection and inadvertent damage to the submandibular ducts (these are tubes that drain saliva under the tongue). The infection may be local at the site of division but may also result in an infection within the lymph nodes in the neck that drain the area under the tongue.
There is also a chance of the tongue tie reforming as it heals and this is usually dependant on how much is divided.
We believe that by using sterile instruments, carrying out the procedure in a clinic environment with Paediatric trained nurses and surgeons these risks are minimised.
After the procedure:
Most babies will latch on quickly after having the tongue tie divided. However some mothers may wish to have the support of a lactation consultant over the few days after the tongue tie division.
Breastfeeding Is Analgesic in Healthy Newborns
Larry Gray, Lisa W. Miller, Barbara L. Philipp, Elliott M. Bla