Under the tongue there is a stringy piece of tissue that connects the tongue to the floor of the mouth. Its medical name is the frenulum, and it is much more prominent in babies than in adults. Sometimes babies are born with a frenulum that is too short, or that extends too far forward. In either of these cases, the tongue will not have the mobility it should.
Symptoms of tongue tie may be evident in the first few days of life. If the baby is breastfed, the mother may find it painful to feed. Baby might struggle to make a proper seal, and be heard to suck in air. They may also seem generally unsettled at the breast, struggle to gain weight, or have unusually long or frequent feeds. Unfortunately, a lot of these symptoms could be attributed to a number of different things, and tongue tie is not always easy to diagnose.
Controversy
Although there are diagnostic criteria for ankyloglossia, they do not appear to be widely adopted. A study published in a Canadian medical journal recognised the need for further research into diagnosis and treatment.
Some cases of posterior tongue tie are missed, as the frenulum limits movement but only towards the back of the tongue. This is unlikely to change the shape of the tongue either, making it harder to spot.
Conversely, there is also the possibility for over-diagnosis, particularly as knowledge of the condition becomes more widespread. Breastfeeding issues can occur for a number of reasons, not just tongue tie.
Lip Tie
There is another frenulum between the gums and the inside of the top lip. This too can be restrictive and affect feeding, although it is less commonly discussed. If your baby’s top lip is always curled in when feeding, this could be a reason why.
Treatment
Insufficient movement of the tongue is associated with feeding and speech issues, but also improper development of the teeth. Tongue tie may not be diagnosed when the baby is young, but become more apparent when starting solid foods or beginning to speak.
NHS guidelines recommend massage as part of a conservative treatment plan for tongue tie. The guidelines also note that some cases will sporadically resolve on their own, or can be managed with the help of a lactation consultant.
Beyond conservative measures, standard medical treatment is a simple incision. However, sometimes the first attempt is insufficient or the frenulum regrows, and the procedure needs to be repeated. Although young babies do not feel sensation in the frenulum, the procedure can still be distressing for the baby and parent.
The frenulum is soft tissue, and osteopaths work on releasing soft tissues on a daily basis. If you suspect that your baby has a tongue tie, and would like to try and avoid surgery, you can book an appointment in Naas here.
