What is a tongue tie?
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. Normally the membrane disappears but in some instances it persists as a tongue tie.
It 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 well being but this needs to be balanced against the possible but rare risks of the procedure
Tongue tie and breast feeding
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 by causing difficulty with latching on. This can result in nipple discomfort for the mother and some babies will struggle to feed with subsequent issues with weight gain.
It is also thought that babies with a tongue tie will tend to swallow air causing them to have a lot of “wind” and abdominal discomfort but this may also be due to “colic” or reflux.
What other problems can a tongue tie cause?
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.”
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 has not been validated by studies.
Should I have my baby’s tongue released?
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.
Please be aware that as Teaching Hospital Paediatric ENT specialists we are familiar with the potential hazards of surgical procedures no matter how seemingly minor they may appear, such as a division of tongue tie. We are therefore very conservative in our approach and will provide a balanced judgement as to whether this will be a suitable procedure for your baby. We conduct regular comprehensive audits on our results of tongue tie division..
Tongue tie release – how is it done?
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. It is difficult to divide a tongue tie in a baby over 2 months of age.
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 helps with pain control and babies settle within a few minutes.
What can go wrong after tongue tie division
Most tongue tie divisions are straightforward. However complications can rarely occur, some of which are potentially serious
bleeding - this is the most common and potentially serious downside of having a tongue tie division. This occurs immediately after the tongue tie is divided. If it fails to settle then pressure is applied. If this fails a dressing that encourages clotting is applied. If this fails then the site of the procedure is cauterised with a sliver nitrate stick. This is quite painful and the whole are goes black. Should this fail then you will need to take your baby to Accident and Emergency by ambulance but this is an extremely rare event
reformation - all tongue ties will reform to a degree. Breast feeding as much as possible after the division helps prevent this but sometimes this is inevitable
Infection - this may present with a lump in the neck that may progress to an abscess. Urgent medical attention is needed should a lump in the neck appear after a few days