What Every Parent Needs to Know About Tongue Tie: A Complete Guide

I see babies daily in my clinic, presenting with tongue tie (ankyloglossia) and associated feeding difficulties. In many cases, tongue tie is detected at birth, however it often goes unnoticed for days, weeks and sometimes months. This guide aims to empower parents with a clear understanding of tongue tie, its implications, symptoms, diagnosis, and available treatments. With the right knowledge, you can better advocate for your child's health and well-being.

What is Tongue Tie?

Tongue tie refers to a short, thick or restrictive frenulum that impacts the function of the tongue. A lingual frenulum (strip of skin you see in the mirror when you lift your tongue) is normal anatomy- we all have one! When doing its job well, it should anchor the tongue, extending from the floor of the mouth to around 50% or less of the underside of the tongue; allowing the tongue to move and function as it should. Sometimes when the lingual frenulum is attached further forward either to the gum ridge or just below, or it occupies a significant portion of the underside of the tongue or is thick and tight, it can cause difficulty with tongue function and this can sometimes lead to feeding issues. Tongue tie practitioners in the UK currently assess and treat tongue tie when it is impacting feeding however we know that poor tongue function can affect dental health and speech. Research is ongoing!

Common Symptoms of Tongue Tie

Identifying the symptoms of tongue tie early is crucial. Common signs include:

Feeding Difficulties: Infants might struggle to latch onto the breast or bottle and as a consequence may suffer with excess wind, colic symptoms, reflux symptoms and generally become unsettled during and after feeds. Feeding may be "noisy" or "messy" as a loss of suction and poor seal can result in "clicking" sounds when feeding and/or milk pouring from the sides of the mouth when feeding. Pain when breastfeeding is also a symptom of tongue tie and this may often result in early cessation of breastfeeding. Mastitis, blocked ducts, frequent/prolonged feeding
Poor Weight Gain: When a baby cannot feed effectively due to tongue tie, it can result in inadequate weight gain. Infants with feeding difficulties are at a higher risk of falling below their expected growth percentiles. When breastfed babies struggle to drain the breast effectively, this can lead to diminished milk supply which then further exacerbates the poor weight gain and can result in formula supplementation.

How is Tongue Tie Diagnosed?

Most tongue tie practitioners in the UK will use an evidence based assessment tool to determine whether a lingual frenulum in appearance and function is restrictive and requires surgical intervention. This will be done alongside history taking and feeding assessment to determine whether your baby would benefit from frenulotomy. Frenulotomy is not always clearly indicated and so parents have the option for conservative management or a "watch and wait" approach. In my opinion, it is good practice to offer feeding support and alternative therapy in the first instance where function scores are borderline or satisfactory even if the appearance suggests a potential restriction. It is important for your practitioner to feel confident and competent in ruling out alternative diagnosis for example; oral tension, high palate and short tongue.

Treatment Options for Tongue Tie

If tongue tie is diagnosed, various treatment options may be explored based on its severity:

Observation: If tongue function is reasonable and feeding difficulties can be overcome with expert feeding support, there is always the option for conservative management. Some parents choose not to surgically intervene even if their baby has a significant tongue tie.
Frenulotomy: This minor surgical procedure involves snipping the frenulum to improve tongue mobility. The procedure itself takes seconds and recovery is usually non complicated and swift. Of course every surgical procedure carries risk, this is best discussed with your practitioner so that you are able to make an informed choice.

Potential Complications of Untreated Tongue Tie

Whilst there is sufficient evidence to suggest tongue tie can impact feeding- therefore supporting frenulotomy in this instance, there is limited evidence that considers long term impact of untreated tongue tie and the impact on introducing solids, sleep, dental health and speech.

The Role of Lactation Consultants

Many parents find it helpful to work with a lactation consultant if tongue tie is suspected. As an IBCLC, I am able to provide parents with tailored strategies to help parents navigate breastfeeding challenges.

When to Seek Help

Parents should reach out to healthcare providers if they observe any mentioned symptoms. Understanding that tongue tie varies significantly among children is vital; treatment is not one-size-fits-all. Early intervention can lead to more favourable outcomes, making prompt consultation essential.

The Importance of Parental Advocacy

Parents are key advocates for their child’s health. If you suspect tongue tie or experience feeding difficulties, do not hesitate to voice your concerns to your healthcare provider in the first instance. Being well-informed and seeking second opinions when necessary can empower you to make informed treatment decisions.