What is a Tongue-Tie Restriction?
“Ankyloglossia is a congenital anomaly characterised by an abnormally short lingual frenulum; the tip of the tongue can not be protruded beyond the lower incisor teeth. It varies in degree, from a mild form from which the tongue is bound only by a thin mucous membrane, to a severe form in which the tongue is completely fused to the floor of the mouth. Breastfeeding difficulties may arise as a result of the inability to suck effectively, causing sore nipples and poor infant weight gain”
(NICE interventional procedures guidance 2005 www.nice.org.uk/guidance/ipg149/chapter/1-guidance?print=true )
“A procedure for excising a frenulum; such as the excision of the lingual frenum from its attachment to the mucoperiosteal covering the alveolar process to correct ankyloglossia.”
(Mosby’s Medical Dictionary 5th edition, Elsevier, 2009)
Some pictures of frenulums and post procedure wounds can be seen here: GALLERY
What is a tongue-tie?
Tongue tie is a problem that occurs in babies who have a tight piece of skin between the underside of their tongue and the floor of their mouth.
The medical name for tongue tie is ankyloglossia, and the piece of skin joining the tongue to the base of the mouth is called the lingual frenulum.
It can sometimes affect the baby's feeding, making it hard for them to attach properly to their mother's breast. Tongue tie is a birth defect that affects 3-10% of newborn babies. It is more common in boys than girls.
Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the lingual frenulum. In babies with tongue tie, this piece of skin is unusually short and tight, restricting the tongues movement.
This prevents the baby from feeding properly and also causes problems for the breastfeeding parent.
To breastfeed successfully, the baby needs to latch on to both breast tissue and nipple, and the baby's tongue needs to cover the lower gum so the nipple is protected from damage.
Infants with a restrictive tongue tie are not able to open their mouths wide enough to latch on to their breastfeeding parent's breast, or form a seal on a teat/dummy/pacifier properly.
Breastfed infants tend to slide off the breast and chomp on the nipple with their gums. This is very painful and the breastfeeding parent's nipples can become sore, with ulcers and bleeding. Some babies frequently feed but inefficiently and get tired, but they soon become hungry and want to feed again.
In some cases, these feeding difficulties mean the baby fails to gain much weight.
Some further details on a Tongue tie restriction, can be found here: TONGUE TIE
How will a restrictive tongue tie affect our feeding experience?
The presence of a tongue tie may not affect your baby at all, however some babies may have restricted tongue movement that may not allow your baby to feed properly.
Affects on Breastfeeding Your baby may:
Have difficulty getting attached to your breast deeply enough
Have difficulty staying attached
Feed for prolonged periods
Be unsettled and not satisfied
Make clicking noises when feeding
Suffer with excess wind, colic or reflux
May dribble milk when feeding from the breast
May choke when feeding
A breastfeeding parent may have:
Low milk supply
Some breastfeeding parents and babies may have some of the above symptoms and problems while others may have them all. Some of the issues may be related to the way your baby is feeding and not the tongue tie. This may be improved by optimising your technique.
Bottle-feeding Your baby with tongue-tie may:-
•Find it difficult to attach to the teat
•Take a long time to feed or feed very quickly
•Drink only small amounts with frequent winding (paced feeding)
•Dribble a lot of milk during feeds
•May not be able to keep a dummy in
•Make clicking noises
•Suffer from excess wind, colic and reflux
When your baby starts to eat solids
Eating food may be a problem as the tongue is important in moving food around the mouth and in swallowing.
When your child starts to talk
Your child's ability to talk is influenced by a variety of factors. Theories may consider a tongue tie may be one of these factors as the movement of the tongue aids in the formation of letters and sounds.
If your child does develop a speech problem they may be referred to a speech and language therapist. If the tongue appears to be causing limited tongue function at this time then the Tongue tie can be cut with the support and expertise of a surgeon or dentist.
Lip Tie Statement
A lip tie diagnosis and division is a very grey area in UK-USA divide alongside a tongue tie, but current research does suggest that isn't necessary. You may find this article helpful…
My understanding is that issues with lip-ties are more dentally related and regular dental visits as normal are suggested. A lingual lip tie is normal-everybody has one-and they tend to recede as one grows anyway-when it comes to weaning. However be sure to remove any food debris from either side of the tie as held against the gum or tooth will cause decay.
There is also new research I read recently that suggested that even if a lip tie was divided unless bone was removed then it would reoccur/reattach anyway. The best profession to get further info on this is the infant’s dentist. The Association of tongue tie practitioners has made a statement on lip-ties which I have included below for you.
It is also worth mentioning that many perceived lip tie problems are actually tongue tie related-and once tongue function reaches optimum motility the symptoms alleviate. Sometimes a lip tie can affect the ‘vacuum draw’ of getting breast into a correct breast feeding position but this does not prevent a successful pain-free breastfeed, can be addressed with correct positioning and attachment techniques, and can be subjective.
Facebook Support Group:
"Infant Tongue Tie UK Support Group for Parents and Health Professionals"
Association of tongue tie practitioners:
International affiliation of tongue tie professionals:
Hogan M, Westcott C, Griffiths M (2005) Randomised controlled trial of division of tongue-tie in infants with feeding problems Journal of paediatrics and child Health 41 issue5-6 p246-250
Geodes D et al (2008) Frenulotomy for breastfeeding infants with ankyloglossia:effect on milk removal and sucking mechanism as imaged by ultrasound Paediatrics vol 122 no1:e188-e194
For speech/language (Carmen Fernando)
https://sarahoakleylactation.co.uk/lip-tie/. (This article is in the ABM magazine)
© DIANA WARREN IBCLC, RGN