Tongue-tie (ankyloglossia) in babies

Tongue-tie or ankyloglossia can affect a baby’s ability to breastfeed or feed from a bottle successfully. It’s a condition that babies are born with that restricts the range of motion of their tongues. And if a baby is born with tongue-tie they can develop another condition that can cause feeding problems too, called a high palate (you may also hear this referred to as a high-arched palate or a high-vaulted palate).

 

What is a tongue-tie?

If you look in your mouth and raise your tongue you’ll see a small strip of skin that connects your tongue to the floor of your mouth – this is called a frenulum. If your baby has tongue tie  it means they will  have a problem with their  development of their frenulum. This is what restricts their ability to breastfeed properly. 
 

What does tongue tie look like?

Tongue tie in babies presents itself as a frenulum that is either: 

• Too short, thick or tight

• Extended too far forwards towards the tip of the tongue and attached close to the lower gum (anterior tongue-tie) 

• Located far back within the mouth underneath the tongue (posterior tongue-tie)

 
All of these problems can cause difficulties with moving your tongue. So for instance, if you have tongue-tie you may not be able to extend or lift the tip of your tongue, stick your tongue out or move your tongue from one side of your mouth to the other (or all three).
 
Where babies are concerned, having restricted tongue movement can make it harder for them to breastfeed successfully. Older children and adults with tongue-tie may also find it affects how they eat, swallow and speak. However, nobody really knows why some babies are born with tongue-tie while others aren’t, though it could be possible that genetics may have something to do with it.
 

Anterior vs posterior tongue tie

Practitioners often divide tongue ties further based on the exact presentation of how the frenulum has developed. 
 

Posterior tongue tie

When the frenulum is farther back behind the tongue it is referred to as a posterior tongue knot (although the exact definition of where can vary). 
 

Anterior tongue tie

Anterior tongue tie refers to a pronounced restricting frenulum that is more visible at the front of the tongue.
 

How common is tongue-tie? 

According to Patient UK it’s thought that up to 11 percent of babies are born with tongue-tie (i). 
 

Tongue-tie symptoms

If a baby has tongue-tie, they may not be able to open their mouth wide enough to latch on to the breast well enough to breastfeed properly. Some of the symptoms to look out in a baby with tongue-tie for include:
 

• Difficulties attaching to the breast

• Difficulties staying attached to the breast for a normal feed

• Spending a long time feeding

• Taking a break during feeding, then feeding again

• Being hungry all the time

• Being unsettled

• Not gaining enough weight

• Making a clicking sound when they feed

• Other problems such as colic, wind, reflux (bringing up a small amount of milk, also called posseting) and hiccups

 
It’s not always possible to spot the signs of tongue-tie simply by looking in a baby’s mouth, but you may notice they have problems lifting their tongue or moving it from side to side or extending their tongue out past their lower front teeth. If the tip of their tongue looks notched or heart-shaped, this may also be a sign of tongue-tie.
 
Meanwhile, symptoms to look out for in a mother who’s breastfeeding a baby with tongue-tie include recurring episodes of mastitis (inflammation of the breast), sore or cracked nipples and low milk supply.
 

Tongue tie diagnosis

According to the NHS, tongue-tie is sometimes diagnosed during a baby’s newborn physical examination (ii). However it’s not always easy to spot, and tongue-tie may not become noticeable until a baby is found to have problems with feeding. Indeed, the National Childbirth Trust  (NCT) says a baby’s tongue can look normal to an untrained eye, yet still cause problems with feeding (iii).
 
A doctor, midwife or health visitor can usually diagnose tongue-tie just by examining your baby, and depending on the outcome they can recommend treatment or advise a wait-and-see approach. 
 
A simple physical examination can also often diagnose a high palate, as in many cases it will be obvious to see the problem just by looking in a baby’s mouth.

 

Tongue tie treatment

If your baby has feeding problems and you suspect it could be caused by tongue-tie or a high palate, speak to your GP or midwife. Many babies with tongue-tie don’t need treatment if their condition isn’t making it difficult for them to feed. As they get older some children who weren’t treated for tongue-tie may find they no longer have any tightness in their tongue movements, as the problem often resolves itself naturally. Some, however, find untreated tongue-tie can cause problems, particularly with speech and eating certain foods. 
 

Tongue tie surgery

If your baby needs treatment for tongue-tie, your doctor, midwife or health visitor will usually recommend a simple surgical procedure called a tongue-tie division (the medical term for this procedure is a frenectomy). According to the NHS this is a quick procedure that involves snipping the frenulum to help the tongue move more easily – which usually improves feeding immediately (ii). 

Tongue-tie division is carried out by a specially trained doctor, nurse or midwife. Lasting for just a few seconds, it’s almost painless says the NHS, since there are very few nerve endings in the area around the floor of the mouth (ii) – though in some cases a local anaesthetic may be given to numb the baby’s tongue (oIder babies with teeth as well as older children and adults having the procedure may, however, need a general anaesthetic).

 

Does tongue tie need to be corrected?

If you decide not to treat tongue-tie in your baby, there are ways of helping them to feed more successfully without surgery, such as changing their feeding position or pacing their feeds if they’re bottle fed – ask your midwife, health visitor or other trained professional such as a breastfeeding counsellor to show you how.
 

For more information about tongue-tie 

If you need more help you can consult an NHS or private tongue-tie practitioner – find one by looking at the directory on the Association of Tongue-tie Practitioners’ website. There’s also plenty of advice available to help you with breastfeeding problems – ask your midwife or health visitor for details, or try calling the National Breastfeeding Helpline on 0300 100 0212. La Leche League (0345 120 2918) and NCT (0300 330 0700) also offer lots of support and advice to breastfeeding mothers both by phone and online.
Meanwhile, find information on a range of children’s health conditions by visiting the children’s health section of our pharmacy health library.

 

References:

1. Available online: https://patient.info/news-and-features/babies-with-tongue-ties-usually-dont-need-surgery

2. Available online: https://www.nhs.uk/conditions/tongue-tie/

3. Available online: https://www.nct.org.uk/baby-toddler/feeding/common-concerns/tongue-tie-babies

 

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