What is tongue tie? Many new parents wonder about this as there is so much talk of it around feeding as it can affect feeding. With so much confusing information out there, it's hard for new parents to know the facts. This article brings calm and clarity to the topic of tongue-tie.
Knowing what to expect as your baby develops can help you feel more confident as a new parent and help dispel breastfeeding myths you may have heard about from other parents. When you have the right information at your fingertips, trusting your instincts becomes easier.
Editor's note
If you think your baby might have tongue tie contact your Health Visitor or look through the NHS website for more information.
We’ll cover what tongue tie is, what causes it, how to identify it, and how it impacts feeding. You'll also learn about treatment options, from changes in feeding position to a minor procedure called a frenulotomy or frenotomy.
With the right information and support, tongue tie can be managed so that your baby is feeding well.
What is tongue tie in infants?
Tongue tie (ankyloglossia) is a condition where the little bit of tissue under the tongue that attaches the tongue to the floor of the mouth (frenulum) is too short, tight, thick or inflexible. This affects the movement of your baby’s tongue and can impact feeding.
Don’t panic if you hunt under your baby’s tongue and find a frenulum. We all start life in the womb with a frenulum under the tongue, which goes all the way to the tongue tip. But that frenulum is usually elastic and thin. As a baby starts to work their tongue in the womb to practice sucking and swallowing, that frenulum tears back bit by bit until only a little is left when a baby is born.
According to the GP Infant Feeding Network, between 0.2 and 10.7% of babies are affected by tongue tie.
What causes tongue tie?
Midwife Pip, a practising midwife and podcaster, told Goodto, “Tongue tie happens where the skin that connects the base of a baby’s tongue to the bottom of their mouth (frenulum) is shorter and tighter than normal. There is no definitive reason for tongue tie, but it is thought to be genetic.”
However, the frenulum is only problematic when it hampers normal tongue action. This can happen in around 1 in 10 babies.
Midwife Pip is a practicing Midwife Sister, Podcaster, Researcher and Mum. Currently working as a Delivery Suite Sister, she has a wealth of experience supporting thousands of women and parents to be through all aspects of pregnancy, birth and postpartum.
What does tongue tie look like?
Parents may notice their baby’s tongue looks visibly held back, creating a little heart-shaped tip. Sometimes, the tongue looks normal but doesn’t function as well as it should during breastfeeding.
“It can be difficult to identify a tongue tie, and this is why seeing a trained tongue tie practitioner is important,” says Midwife Pip. “The tongue may look heart-shaped or misshapen when your baby tries to lift their tongue or move it forwards, and their ability to move their tongue is usually restricted.”
What are the four signs of tongue tie in a baby?
“Because there are varying degrees of tongue tie, there will be varying degrees of signs and symptoms,” says Midwife Pip. “A baby with a tongue tie will have difficulty lifting their tongue and moving it fully, especially sticking their tongue all the way out. When they do move it forwards, it may look heart-shaped.”
There are four signs of tongue tie to watch out for in feeding babies:
- Difficulty latching on to the breast or bottle teat
- Very long feeds with short breaks and an unsettled baby
- Slow weight gain
- A clicking noise when feeding
How do I know if my baby has a tongue tie?
If you think your baby may have a tongue tie or you’re having any issues with breastfeeding or bottle feeding your baby, it’s important to ask your GP, midwife or health visitor for advice. They can refer you to a clinic or hospital with an infant feeding team.
These specialists can tell you if your baby’s feeding challenges are caused by tongue tie. Don’t rely on your own eyes or those of well-meaning friends and relatives.
Will my baby’s tongue tie go away?
As kids grow, tongue tie often sorts itself out. The mouth changes shape, so any tightness tends to disappear without treatment. But for some children, tongue tie leads to trouble talking clearly or managing certain foods.
“As your baby grows, their tongue tie may not cause any issues, and the restriction may resolve as their mouth develops, “ says Midwife Pip. “However, it can cause speech and eating problems if left untreated.”
Even for bigger kids and grown-ups, tongue tie division is possible - it usually happens under general anaesthetic. If your little one seems affected, chat to your GP.
How do you treat tongue tie?
While up to 10% of babies have feeding problems due to a tongue tie, with good support from a knowledgeable and trained professional, only 2.5% of babies will continue to have problems. The vast majority of baby feeding issues are unrelated to tongue tie. Even when the issue stems from the frenulum, around three-quarters of babies will learn to feed well, with the right help.
If a specialist diagnoses tongue tie, simple changes like how you hold your baby during feeds or using a different bottle teat may be all that's needed. Nipple shields can also help your baby latch better, but they should be used under the guidance of a feeding specialist.
For the 2.5% of babies who struggle despite support, your baby may be offered a frenulotomy. This is a quick procedure to release the frenulum. Most hospitals offer it and you can also have it done privately. Midwife Pip describes the procedure: “The short, tight skin connecting the bottom of the tongue to the bottom of the mouth is snipped to provide better movement of the tongue.”
In a young baby, frenulotomy requires no anaesthetic, takes just seconds, and is low-risk. However, there is a small risk of infection and bleeding, although heavy bleeding is rare due to lack of blood flow to the frenulum.
After a frenulotomy, most mums notice some improvement immediately. But it can take weeks or months for the tongue to build full strength and coordination, as it hasn't been able to exercise properly since conception.
Remember that if you are experiencing feeding problems, breast or bottle, and want your baby assessed for tongue tie, speak to a trained and experienced infant feeding specialist and continue to get support until you feel happy and confident.
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