Understanding Tongue Tie in Babies: Symptoms, Treatments, and Long-Term Implications
Doctor explains what a tongue tie in babies is, its implications for feeding, and available treatments. Learn the signs to watch for and how a simple procedure can significantly improve your baby's feeding experience.
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Topic Breakdown
If your baby is struggling to feed, they might have an issue called a tongue tie. In this post, I'm going to explain what a tongue tie in a baby is, what the implications are for both you and your baby, and what treatment options are available.
Tongue tie, known medically as ankyloglossia, is a condition present at birth that restricts the movement of a baby's tongue. The underside of the tongue is connected to the floor of the mouth by a piece of tissue known as the lingual frenulum. In babies with a tongue tie, the frenulum is thicker, tighter, or shorter than usual, restricting the movement of their tongue and causing problems with feeding.
A tongue tie can involve the entire underside of the tongue or just part of it. It's relatively common, seen in almost 1 in 10 babies, and typically more common in boys than girls. About half of babies with a tongue tie have someone else in the family who also has one, such as a sibling.
So, how might you know if your baby has a tongue tie? If you're breastfeeding, you might notice that your baby has difficulty attaching to the breast or staying attached. They might feed for a long time or take short breaks and then feed again. They can be unsettled and appear to be hungry most of the time, might not gain weight as quickly as they should, or could be very windy with excessive hiccups or flatulence. You may also notice that they have difficulty controlling milk flow, often coughing or choking, and making clicking noises when feeding. As a parent, you might experience sore or damaged nipples, low milk production, frequent mastitis, and general exhaustion from frequent feeding and having an unsettled baby.
If your baby is bottle-fed, you might find that they take a long time to feed, only take a small amount of milk at each feed, dribble a lot during the feed, and are very windy. They may also not gain weight as quickly as expected.
Of course, many of these symptoms are common in new babies, and having them doesn't necessarily mean your baby has a tongue tie. If you have any concerns, especially about how your baby is feeding or gaining weight, it's essential to speak to your healthcare provider.
If a tongue tie is suspected, a feeding assessment can take place. With your permission, a referral will be made to a tongue tie specialist. A referral doesn't mean your baby will definitely be offered treatment, but the specialist will look at various factors and discuss the findings and available options with you.
So, how is a tongue tie treated? Tongue tie release is a straightforward procedure, particularly in babies under six months of age. The procedure usually takes only a few seconds and doesn't require an anesthetic. Babies might cry immediately after the procedure, but most cry for less than a minute. It is considered a safe and simple procedure, often demonstrating significant improvements in feeding, particularly breastfeeding, where reductions in nipple pain and improved ability to latch onto the breast are consistently identified.
Before the procedure, your doctor will discuss it in more detail, including the reasons for doing it and possible risks, and will ask for your consent. In the UK, your baby must have had either a vitamin K injection or the second dose of oral drops more than 24 hours before the procedure. You'll also need to confirm that your baby is fit and well with no known medical conditions at the time of their feeding assessment.
If you or your baby's father has a blood clotting disorder or there's a family history of such disorders, please discuss it with the medical team during your baby's feeding assessment.
During the actual tongue tie release procedure, the team will wrap your baby securely in a blanket and hold them gently to keep their head still. Some babies may not like this and might cry a lot. The doctor will then release the tongue tie using sterile, round-ended scissors and apply pressure underneath the baby's tongue to stop any bleeding using a piece of sterile gauze, typically resulting in only a few drops of blood.
Once the tongue tie is released, your baby will be unwrapped and encouraged to feed right away. This helps the baby's tongue to move and may prevent the tongue tie from re-fusing. Typically, you'll be able to remain with your baby during the procedure, or if you prefer, your midwife can take your baby to a separate room for the procedure.
Deciding to have your baby's tongue tie released is a personal choice. If you choose not to have the procedure, you will still receive feeding support. If at a later date you're concerned about your baby's feeding, you can always speak to your doctor for a reassessment and possibly another referral if needed.
After the procedure, a small white blister might develop under your baby's tongue in the first couple of days. This is typically painless and doesn't usually interfere with feeding. Your baby might also be fussy and unsettled for a few days, and it can take a few weeks before they are fully comfortable when feeding. Occasionally, the procedure may not improve a baby's ability to feed.
There are some possible risks, such as excessive bleeding, infection, pain, or damage to the tongue and surrounding structures. Very occasionally, a tongue tie might reoccur if the frenulum re-fuses, possibly requiring another procedure.
Long-term, there are usually no problems, but some children with a tongue tie may have difficulty producing certain sounds when they learn to speak. If you notice any speech difficulties by the time your child reaches three years of age, speak to your doctor or health visitor, who can refer your child to a speech and language therapist for a full assessment.
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