Tongue-tie (ankyloglossia) in infants

Tongue-tie (ankyloglossia) in infants

It has taken me several years to write about this “hot” pediatrics topic. A medical condition that has become very trendy. A trend that has turned into a business.
A business entailing respectable consultants, clinics and hospitals. A topic that comes up almost daily in pediatric clinics, often between mothers and among lactation consultants.
How did a topic, that we would rarely hear about several years ago, turn into a commonly discussed condition in the past few years?
Are there currently lots of adults with long-term tongue-tie effects among us that with missed diagnoses as babies or is the condition simply being over-diagnosed nowadays?

In the following post I will try to both address all the medical questions with regards to tongue-tie and attempt to answer some of the other difficult questions related to this condition.

What is tongue-tie?

The medical term of this word is ‘ankyloglossia’.
This is a phenomenon in which the frenulum that connects the middle part of the tongue to the floor of the mouth, causes a problem with the tongue’s range of motion.
This could be because the frenulum is thicker, shorter or more anterior (towards the front of the mouth), than what it should normally be. Take a look at what the frenulum looks like in the image attached to this post below.

What is posterior tongue-tie?

A posterior tongue-tie is located deeper in the mouth. This is a condition where there is an additional frenulum or ‘cord’ that is found underneath the tongue and it ties the tongue to the floor of the mouth and leads to a functionality problem. This frenulum is usually discovered only on palpation.

How common is this condition?

Depends on what you would define as ‘tongue-tie’. The prevalence is around 3-4%. It is found more in boys.

Are there degrees of severity?

There are several criteria that take into account the anatomy and range of motion of the tongue. Some of them also take symptoms into consideration to give a final assessment of severity of the condition. Nonetheless, in practice, these descriptions and criteria are rarely used.

Do a tongue-ties necessarily lead to functionality problems?

Absolutely not.
There are many adults among us with a slightly shorter, thicker or more anterior frenulum than the norm and they have lived with their “tongue-tie” for many many years without any issues at all. Some of these adults, had they been born today, would have undergone a frenotomy, which you will learn more about below.
What I’m trying to say is that even if your baby has been diagnosed with tongue-tie, it does not necessarily indicate a problem. The more important question would be whether or not he has symptomatic tongue-tie.

What kind of symptoms do babies with tongue-tie present with?

Let’s start by reminding ourselves that there is no clear, medical definition for tongue-tie. The fact that a frenulum looks slightly shorter than usual, or that the baby’s tongue does not pull out as far as you would expect it to, does not necessarily mean that they have symptomatic tongue-tie.
Nonetheless, if symptoms appear, they are usually related to breastfeeding.

What kind of breastfeeding symptoms are related to tongue-tie?

This is mainly pain in the mother’s nipple and difficulties with latching.
Look, I’m sorry, it’s not like I have ever breastfed a child – but to me it does not look like an easy ordeal whatsoever. I have never met a mother who has been able to breastfeed without any problems at all, and without experiencing any pain or difficulties with latching, especially in the beginning.
So again, deciding which babies have tongue-tie with lactation symptoms is not easy.

Can tongue-tie cause difficulties with bottle-feeding?


Can tongue-tie cause difficulties with speech and pronunciation in a child?

There is a huge debate in the medical literature as to whether this condition can cause problems at an older age. We tend to believe that pronunciation difficulties will only occur with children who have severe tongue-tie. I personally think that if this were true, there would be many adults with pronunciation problems due to tongue-tie. I mean, after all, this diagnosis did not exist several years ago.
And I just do not come across such cases.
Additionally, even if there are pronunciation difficulties that could develop in the future, we have seen how these can be treated with a frenotomy at an older age, with excellent results and improved pronunciation.

Can tongue-tie cause other problems?

Some online sources claim that tongue-tie can cause lots of different medical conditions such as diarrhea, recurrent ear infections, attention and deficit disorder (read more about this here), obesity and more.
This is simply nonsense.

How is symptomatic tongue-tie treated?

In situation where the diagnosis is clear-cut, the solution to the tongue-tie is cutting the frenulum.

How is this resection performed?

For infants under the age of 6 months, this is done using a sterile pair of scissors at the doctor’s office. Some providers may elect to use local anesthesia and others will give the infant some sugar water. Either way, the infant can usually be breastfed immediately after the procedure.

Who should receive a frenotomy?

In cases when breastfeeding is accompanied by severe pain, a frenotomy should be performed.
In cases where the baby has difficulties with latching the nipple, is repeatedly unlatching or unable to gain enough weight due to difficulties with feeding, a frenotomy should be considered.
Take a look at this scientific article that addresses the question of whether or not all children with tongue-tie need to be operated on.

When is the right time to perform the procedure?

In cases with clear symptoms, the procedure should be done as soon as possible. Most cases with milder symptoms should be waited out for several days to allow for breastfeeding to settle and to give it a chance to improve without invasive intervention.

What is my personal opinion about all of this?

I think that getting in touch with a good lactation consultant is of great value, but I also believe your pediatrician is able to give valuable advice.
If both your lactation consultant and your pediatrician think a frenotomy should be performed, seek a professional and get it done.
Remember that ‘to a man with a hammer, everything looks like a nail’. And so, I suggest you reach out to a provider that performs these procedures only once you have consulted with another professional and you are certain that you want to go ahead and do it.
To my great disappointment, frenotomies have turned into a business. And unfortunately, the number of children that I see that do not get better after the procedure is much larger than those who do.
In addition, the number of babies that undergo this procedure is just rising from year to year, and there is really no medical explanation to this.
On the other hand, I fully trust your pediatrician, and also the dedicated lactation consultants (those do not walk around with hammers).
Seek their consultation and advice, and I hope you are all able to overcome any breastfeeding difficulties that you may encounter, which are an inevitable part of the process and are not always related to tongue-tie, without the need for unnecessary procedures.
And I also hope you are able to overcome any difficulties when procedures are required as well.
Best of luck!

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