Tongue tie, also called ankyloglossia, is caused by abnormal connections of the tongue to the floor of the mouth. These connections “tie” the tongue in place so it cannot move freely. This may prevent a newborn from latching onto the breast. Other similar problems include posterior tongue tie and lip tie. There are many misconceptions about tongue tie which are not based on clinical evidence. They can lead to unnecessary worry, a false diagnosis, and even unnecessary surgical procedures. Understanding the facts about tongue tie can prevent harm.
Breastfeeding a newborn baby is difficult. It is rarely as we see on TV or in movies, where the sun is shining, birds are singing, and the infant (portrayed by a chubby 4-month-old) is content. In real life, there may be pain, tears, and sleepless nights at first. In the first few days of life, newborns don’t always feed or gain weight easily. In fact, even with proper technique and support from a lactation specialist, it can take up to 2 weeks for breastfed newborns to regain their birth weight. During this challenging time, parents are understandably sleep-deprived, frustrated, and searching for answers. It is easy to buy into a false belief if it offers a potential solution to the problem. Many nurses, lactation specialists, other hospital staff, and family members are quick to blame a tongue tie for what are actually normal newborn struggles. Parents may become fixated on this diagnosis and explore time-consuming, expensive, and invasive measures in an attempt to solve the problem.
Tongue tie is a common problem affecting up to 10% of babies, but it is not nearly as common as some might suggest. In our experience, an absurdly high percentage of newborns (over 25%) are discharged from the nursery with a presumed diagnosis of tongue tie. We believe the majority of these diagnoses are false. We are therefore frequently tasked with undoing false information regarding tongue ties that parents have received in the nursery. By the time we meet them, sometimes our patients have already been referred to private, out-of-state, or cash-only (not covered by insurance) procedures or therapies. While the intent may be good, this is a red flag that the therapy or procedure lacks an evidence basis.
Tongue tie is a difficult diagnosis to make. This is because experts don’t always agree on the definition and because not much good research is available on the topic. Signs of tongue tie include:
- Short frenulum (the piece of tissue holding the middle of the tongue to the floor of the mouth)
- Inability to lift the tongue to the upper gums
- Inability to stick the tongue out a little past the lower gums
- Inability to move the tongue side to side
- Tongue that looks notched or heart-shape when it is stuck out
If there are signs of tongue tie, plus problems with breastfeeding, despite support from a lactation specialist, the infant may benefit from a frenotomy (cutting of the tongue tie). Some experts believe that the tongue tie will stretch out and improve on its own, without surgery. It is important to note that there is no evidence to suggest that untreated tongue ties lead to speech delay in older children.
At Pediatric Associates of Cheshire (PAC), we believe tongue tie is a medical diagnosis, and therefore should be made by a trained pediatrician or pediatric specialist such as a pediatric ENT doctor, who is taking the big picture into consideration. We are fortunate at PAC to have many expert consultants available to our patients, including lactation specialists and ENT doctors. We will make use of these resources to ensure that your baby gets the best medical care. If a frenotomy is needed, we prefer that the procedure be done by a pediatric ENT doctor.
- Tongue tie is a common and sometimes controversial problem without solid evidence to guide diagnosis or treatment.
- It is best not to jump to conclusions about tongue ties while in the nursery, since most infants struggle to some degree with breastfeeding, and this does not mean they have a tongue tie.
- Be cautious of the advice of nursery staff, friends, or family members who are quick to tell you that your baby has a tongue tie. These individuals may be giving advice derived from narrow clinical training and that lacks supporting evidence.
- A physician should be the one to diagnose a tongue tie, taking input from all sources into consideration.
- Frenectomy can help babies with tongue ties that prevent breastfeeding or make breastfeeding very difficult.
- Ideally, an ENT doctor should be the one to perform a frenectomy.
- Feel free to contact our office with any questions about tongue tie.