Is breastfeeding causing you a lot of pain, even if you've attended classes, consulted with friends and family, or visited a professional? So your baby may be tongue-tied.
What is a tongue-tied child? Let's go through this topic in detail so you will know exactly what is happening to your baby and if you should seek treatment.
What Is a Tongue-Tied Baby?
Tongue binding or ankyloglossia is classified as a midline defect, which is present at birth. The condition prevents the tongue from moving freely within the mouth and can cause a number of problems. Depending on how severe it is, it can interfere with breastfeeding, speech, and oral hygiene.
Tongue-bound babies have a short, narrow membrane or band of tissue that connects the bottom of the tongue to the floor of the mouth. Depending on the type of baby, it can interfere with how she breastfeeds or prevent her tongue from sticking out. Sometimes, a child with a tie to the tongue does not show any symptoms or experience problems along the way.
Many cases of tongue tongue are noticed immediately after birth, during the first examination in the nursery of newborns. If it is significant enough to affect nutrition, the pediatrician may recommend a simple outpatient procedure to release the lanyard at the first or second outpatient visit. It is a much simpler procedure if done within the first few weeks of life, and this avoids further feeding difficulties.
Types of Tongue Tie
1. Anterior Tongue Ties
The first and most recognizable type of tongue ligation is called anterior ligature. Doctors divide it into three classes depending on how far back the tie is.
Class one: If your child has a first class tongue, the membrane binds the tip of the tongue to the floor of the mouth. It is a common occurrence and is typically what parents imagine when they talk about this condition.
Class two: With class two, the fabric band is a little further back. It is still simple to recognize.
Class Three: Ties classified as class three will be further back, around the base of the tongue. This class is a little more complicated for parents to recognize.
2. Posterior Tongue Tie
The posterior tongue is difficult to spot and is often misdiagnosed as a short tongue. The fascia sits deep in the mouth, much further below the tongue than the anterior ties.
The two types cause the same problems, although the back isn't as visible and it may be easier to live with (source).
Is Tongue Tie Common?
Tongue binding has always been a common occurrence. However, for a long time it was not talked about as a problem.
During the Middle Ages, it was common for midwives to keep a long, sharp nail. When a baby was born with one or two class one tabs, they used it to cut the membrane at birth.
Centuries later, when bottle feeding was considered a superior alternative to breastfeeding, mothers were often encouraged to stop breastfeeding.
Doctors and bottle makers even used the tongue strap as a reason why mothers should wean their babies on bottle. At that point, it was no longer seen as a defect and the reasonable reasons why it should be removed were overlooked.
Once breastfeeding became a preferred method again, tongue binding re-emerged as a problem that requires a solution. However, only the earlier links were recognized for a while, as they were easier to spot. During this time, it was also a challenge to find a doctor who was willing to remove the tie.
Only recently has the connection with the language received attention again. More awareness has been brought to the condition, particularly for back ties. Hence, the tab has always been around, even if it has been ignored for a while.
Causes of Tongue Tie
The exact reason why tongue binding occurs is unknown. However, some cases are linked to specific genetic factors.
What happens is that during gestation, the lingual frenulum (membrane between the tongue and mouth) does not separate as it should. Typically, it should dissipate before birth, allowing the tongue to move freely.
Instead, it stays put, causing what we know as bonds. It can also occur on the lips, which is known as a lip tie.
Does My Baby Have Tongue-Tie?
Not all babies will have noticeable symptoms from their tongue. Many do not, and perhaps it is only the nursing mother who suffers.
For others, symptoms may not show until late when your child's teeth come in or start talking. Some common signs include:
Problems with attachment while breastfeeding.
Difficulty lifting the tongue over the upper teeth and moving it from side to side.
A jagged or heart-shaped tongue when you stick it out.
Difficulty reaching the tongue beyond the lower front teeth.
You should be able to locate it by gently lifting your baby's tongue and examining it with a flashlight. If your child has a front tie, you will be able to spot him immediately.
When the tab causes problems with the attachment, other indicators are likely to appear, such as:
Constant hunger.
Colic.
No or slow weight gain.
Fussiness.
Cracked or bleeding nipples.
Sore nipples.
A decrease in milk production.
Moving away from the breast while breastfeeding.
Breastfeeding Troubles
Possible Complications
1. Trouble with Breastfeeding
To breastfeed successfully, the baby must latch on correctly. This requires your baby to keep his tongue on his lower gums while breastfeeding.
However, due to limited mobility, your baby is unable to put his tongue in the right position. In an effort to compensate, your baby may use more force when sucking, or he may choose to chew on the nipple. This can cause significant pain and limit the baby's ability to express milk.
Over time, poor breastfeeding will result in inadequate nutrition, which can cause growth failure. It is not uncommon for mothers to choose to stop breastfeeding because of the problems and pain.
Before giving up breastfeeding completely, we recommend that you consult a nurse or lactation specialist. They can give you tips for relieving pain and getting a better fit. However, they won't always find intervention necessary if your little one is gaining weight and is still happy and healthy.
One study revealed that although tongue release improves pain, it did not have a significant effect on breastfeeding success.
Cases where it has been shown to amplify the attack have been where the tie was released before the age of one month.
Breastfeeding is important, not only for nutrition but also for oral structure and bonding, so if in doubt, contact your pediatrician.
2. Speech Difficulties
Speech difficulties aren't noticeable until your little one enters infancy. From here, they can have a hard time making specific sounds.
Problems arise with those sounds that require the tongue and tip to touch the roof or floor of the mouth.
These sounds include:
The roof of the mouth: T, D, N, S, L and Z.
The floor of the mouth: mainly the sound R.
A clinical note about speech clarity
3. Difficulty with Oral Activities
Tongue binding can interfere with ordinary activities like lip licking or ice cream licking. It can have a significant impact on swallowing foods that require your baby to lick or drink.
Afterwards, your child may find it difficult to play wind instruments and even kiss each other.
4. Poor Oral Hygiene
As your child grows, their oral hygiene may decline due to the condition. Since the tongue cannot reach the mouth, it can be difficult to brush the food debris from the teeth. This can lead to tooth decay and gingivitis, an inflammation of the gums.
Another problem that can cause tongue ligation is a gap between the two lower front teeth. This is due to the fact that the tongue is always in a low position. Your child can correct it later in life if they so wish.
5. Sleep Issues
Tongue binding has been shown to lead to sleep disturbances, although it may not become a problem until decades in your child's life.
If your little one has a short lingual frenum, it can cause orofacial growth disturbances during early childhood. It occurs if your baby is mainly breathing through the mouth instead of the nose, particularly during sleep.
This can impact the flexible upper airway, reducing its width and increasing the risk of it collapsing. Developmental problems like this can trigger sleep breathing disorders, such as sleep apnea.
6. Increased Chances of TMJ Pain
The location of the tongue tied inside the mouth can cause excessive pressure on the muscles of the temporomandibular joint (TMJ). It can be painful, causing jaw pain and migraines.
When to See a Doctor
As soon as you have any doubts, contact your doctor. If any of the following occur, in infancy or when the child is older, see your pediatrician:
The tongue is causing problems: You notice that the condition is starting to cause problems, such as with breastfeeding.
The child complains of tongue problems: The older child begins to complain of problems that interfere with eating, reaching for the teeth or speaking.
Your child's speech is affected: The condition causes problems with your child's speech.
How Doctors Diagnose Tongue-Tie
Anterior tongue ligation is relatively easy for a doctor to diagnose during a physical exam of the tongue and mouth. They are likely to use a device to measure the length of the lingual frenum.
A back link, however, can be more challenging, especially since its most common symptom is often related to other problems as well.
Since the most common symptom of a posterior link is difficulty feeding, doctors must rule out other causes. So, unless the link is obvious, further investigation is needed.
In addition to seeing your pediatrician, it's a good idea to speak to a lactation consultant. They can do a full assessment of how your baby latches on and feeds.
Treatment of Tongue Tie
Doctors have different approaches when it comes to language ties. Some advise to correct it as soon as possible, perhaps even before the baby is discharged from the hospital. Others take a more relaxed approach and will tell you to wait and see.
It is not uncommon for the lingual frenulum to loosen over time, improving, if not resolving, the condition.
In cases where it persists, specialists can help reduce symptoms. Lactation consultants can advise with breastfeeding, and speech therapy can improve your child's speech sounds.
If the condition is causing problems, doctors might consider surgical treatment. Procedures include frenuloplasty or frenotomy.
1. Frenotomy
A frenotomy is a simple surgical procedure that is usually done in the doctor's office or hospital daycare. Doctors can do this with or without anesthesia and it only takes a few minutes.
After the examination, the doctor uses sterile scissors to cut the loose tissue. Discomfort is minimal, even without anesthesia as the area contains only a few nerve endings and blood vessels. If it starts to bleed, it's usually just a few drops and your baby can breastfeed immediately afterward.
Complications are rare, but with bleeding there is always a risk of infection. Scarring is also possible or the tissue may reattach over time.
2. Frenuloplasty
Frenuloplasty is a more invasive procedure, which may be needed if the lingual frenum is too thick or requires additional repair. This procedure is performed while the patient is under general anesthesia. Doctors use surgical instruments to cut the frenulum and then close it with sutures.
Possible complications are similar to phrenotomy, such as bleeding and infection, and are also rare.
Following the procedure, it is common for tongue exercises to be recommended to improve movement and reduce the chances of scarring.
The Takeaway
When first diagnosed, parents often wonder, "What is a tongue-tied baby?" Now that you know what it is, you can relax a little. While it can be an inconvenience and a mild cause for concern, it is highly treatable.
Treatment is not always necessary: sometimes, the language problem resolves over time. If not, the surgical procedures are relatively mild and your baby should recover in no time.
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