Tongue Ties Part 1: A Developmental Issue, Not a Fad!
The tongue is an amazing group of eight muscles, designed to move in every direction (up/down, in/out, side to side) and when it is functioning properly moves in a peristaltic (wave-like) motion during the swallow, and rests in the roof of the mouth at rest. Not everyone is born with the ability to achieve these goals; some people are tongue tied.
Tongue tie (aka ankyloglossia) is when the lingual frenum (the tissue that connects the tongue to the floor of the mouth) is too short, too tight, or attached too far forward on the tongue, preventing the tongue from having full range of motion and function. This condition happens early in a baby’s development, if the tissue fails to properly dissolve/resorb at about 12 weeks in utero. Everyone has tissue that connects the underside of the tongue to the floor of the mouth, but most people’s frenum is attached at least half way or further back on the tongue, well behind the salivary glands in the floor of the mouth, and is very thin and elastic, allowing for full range of motion.
Tongue ties are not a new medical diagnosis, they have been referenced in literature for thousands of years, even the Bible mentions Moses may have had a tongue tie as he was described as “slow of speech and of tongue” Exodus 4:10 (ESV).
The process of releasing a tongue tie (frenectomy or frenotomy) has also been widely practiced and written about. Midwives in the Middle Ages would often keep a long fingernail for just this purpose, as they were not allowed to use surgical instruments but found that a sharp fingernail was effective to slice the thin tissue just after birth, allowing the tongue to move as needed for breastfeeding. Medical doctors have long been aware of tongue ties needing to be treated at birth, as demonstrated in an obstetric textbook from 1609 that stated: “One should gently pass a finger under the tongue to find if they have the band…the surgeon consulted to the business will remove it with a scissors tip without risk.”
Unfortunately, treating tongue ties routinely at birth fell out of practice and babies born in the United States are not generally screened for tongue ties at birth. It is often not until or unless a mother is having significant issues with nursing that a baby is evaluated. Most medical providers are not educated in school about how to properly screen for a tongue tie, so unless they go on to learn these skills after graduation they will be unable to accurately diagnose all but the most severe or obvious ties. This lack of awareness results in many parents being incorrectly told their babies “are fine”, that they “just aren’t good at nursing”, or that the mom and baby “aren’t compatible” and are told that they “should just bottle feed”, all of which can be harmful to the mother/baby breastfeeding dyad, and can have life-long consequences for the child.
A tongue tied baby will often have one or more of the following symptoms:
Difficulty forming a proper latch/seal on the breast (including biting the breast, coming repeatedly on/off the breast, milk leaking from the mouth)
Improper suction and swallow (clicking noises, gagging or choking, milk coming out of the nose)
Falling asleep at the breast, often after just a short nursing session, due to excessive energy used while nursing
Aerophagia (swallowing air) which can cause colic or reflux symptoms (bloating, gas, fussiness, spitting up)
Green, frothy stools due to getting mostly fore-milk (which has more lactose) and not the hind-milk (which has more fat content) that comes at the end of a complete nursing session.
Failure to gain weight
Excessively long nursing sessions (longer than 20 minutes on each breast)
Frequent nursing (more than every 2 hours)
A mother may notice these signs and symptoms that can be used to help identify a tongue tie issue:
Painful or difficult nursing
Breast concerns (engorgement, mastitis)
Nipple concerns (cracked, flattened, bleeding, lipstick-shaped, thrush, needing to use a nipple shield)
Incomplete draining of the breasts
Poor milk supply
If you have concerns regarding your baby’s tongue or are having issues with nursing, find an IBCLC (International Board Certified Lactation Consultant) who is experienced with identifying and supporting babies with tethered oral tissues.
Ideally, every baby would be screened (and treated) for tongue tie at birth, allowing every baby to thrive! The occurrence of tongue ties is estimated at 4-10% of the population, however this may be very low considering how many less obvious (posterior) tongue ties go unnoticed/unidentified until they cause symptoms in childhood, or even adulthood.
More on these issues in part 2 and 3 of our tongue tie blog series… stay tuned!
For more in-depth information on tongue ties check out this fantastic book: “Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More” by Richard Baxter, DMD, MS.