When a baby is born, the tongue is typically soft and mobile. However, in some cases, the baby may be born with a condition known as tongue tie, or ankyloglossia. This condition, which restricts the movement of the tongue, can cause difficulty with a wide range of activities, including breastfeeding and speaking. For parents and healthcare providers, recognising and treatment of tongue tie in children can be challenging. This comprehensive treatment guide provides an overview of the condition, including the various symptoms, causes, and treatments available. It also offers advice on how to support children who have been diagnosed with the condition, so that their quality of life may be improved.
Tongue-tie (ankyloglossia) is a condition present at birth that restricts the tongue’s range of motion. With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth, so it may interfere with breastfeeding.
Who is this article for?
This article is for parents who are worried that their child has tongue-tie, feeding difficulty, speech concerns, restricted tongue movement, mouth breathing, or difficulty cleaning the mouth. It is especially useful for parents of infants with latching difficulty and older children who struggle with certain speech sounds, tongue movement, or oral habits. Tongue-tie treatment should be based on function, not only appearance.
How tongue-tie affects children differently by age
In infants, tongue-tie may be noticed because of breastfeeding or bottle-feeding difficulty. In older children, it may be noticed during speech, swallowing, licking, oral hygiene, or dental development. Some children with tongue-tie have no major functional problem and may not need surgery. Others may need evaluation by a dentist, paediatrician, lactation consultant, speech therapist, or oral surgeon depending on age and symptoms.
When treatment may be considered
Treatment may be considered if tongue-tie affects feeding, speech, swallowing, oral hygiene, or tongue movement. Frenotomy can be a quick procedure in infants, but not every child with tongue-tie automatically needs surgery. Mayo Clinic Health System notes that tongue-tie can affect up to 10% of newborns, while recent paediatric guidance has raised concerns about unnecessary procedures in some infants.
What is a tongue tie in children?
Tongue tie is a condition that restricts the mobility of the tongue, which can cause problems with feeding, speech, and oral hygiene. While it is commonly associated with breastfeeding, it can also affect infants who are being bottle-fed. The baby’s tongue is anchored to the floor of the mouth by a piece of tissue called the lingual frenulum. In the case of a tongue tie, this frenulum is too short, which restricts the movement of the tongue. There are three degrees of it:
✦ A mild one is when the frenulum is tight, but there’s still some movement in the tongue. Treatment is recommended when breastfeeding is causing pain and/or difficulties.
✱ A moderate one occurs when the frenulum completely restricts the movement of the tongue. Treatment is recommended when an infant is feeding poorly or has an increased risk of dehydration.
✦ A severe tongue tie is when the frenulum is so short that it pulls the tongue into a bow-like shape. Treatment is recommended when an infant is not able to feed adequately, even after other interventions.
Causes of tongue tie in children
The cause of tongue ties is unknown, but research suggests that several factors might be involved. These include genetics, ethnicity, the mother’s health, and the baby’s position in the womb. If you are born with it, is likely to remain throughout your life.
As such, babies who are born with a tongue tie may require treatment to help them feed. If the tie is severe, it may not be possible to correct it, in which case the baby may need to be fed through a feeding tube.
Symptoms of tongue tie in children
Problems with breastfeeding. If a baby has a mild or moderate tongue tie, breastfeeding may be painful, or the baby may be unable to get enough milk. When baby has a severe tongue tie, it may not be able to suck at all. If the infant is not getting enough milk, they may be at risk of dehydration and be sent to a neonatal intensive care unit (NICU).
Problems with bottle feeding. If a baby has a mild frenulum, they may be able to feed from a bottle, but the milk may leak out of the corner of their mouth. If the baby has a moderate or severe tongue tie, it may not be able to suck from a bottle.
- Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side.
- Trouble sticking out the tongue past the lower front teeth.
- A tongue that appears notched or heart-shaped when stuck out.
At what age can tongue-tie be corrected?
Tongue-tie occurs when a string of tissue under the tongue limits tongue movement to the point where it affects functions such as feeding and speaking. Tongue-tie can improve on its own by the age of two or three years. Untreated tongue-tie may not cause any problems as a child gets older, and any tightness may resolve naturally as the mouth develops. However, tongue-tie can sometimes cause problems such as speech difficulties and difficulty eating certain foods.
Infant’s Issues
- Poor weight gain
- Reflux or spitting up often
- Milk leaking out of the mouth
- Frustration with eating
- Prolonged nursing or feeding sessions
Mother’s Issues
- Painful nursing
- Creased, flattened, blanched nipples
- Blistered or cut nipples
- Poor breast Drainage
- Plugged ducts or mastitis
Treatment for tongue tie
If a tongue tie is diagnosed, treatment is usually recommended. Parents can look for early signs of tongue tie, such as a baby whose tongue doesn’t extend past the gums. If the baby is between 3 and 6 months of age, the doctor may suggest a frenotomy, which involves cutting the tie. Alternatively, a paediatric dentist or oral surgeon may be able to perform a laser frenotomy. A baby with a tongue tie who is breastfed should be monitored closely to ensure that they are thriving. If they are not, it is important to see a doctor as soon as possible.
Conclusion
Frenulum can cause many different difficulties, including feeding issues and pain when breastfeeding. If you notice any of these symptoms, or your baby is younger than 3 months old, you should speak with your doctor about your concerns. Early intervention is key, and your doctor may recommend a treatment such as clipping or a frenotomy.
FAQs
Does every child with tongue-tie need surgery?
No. Treatment depends on whether tongue-tie is causing functional problems such as feeding difficulty, speech concerns, or restricted movement. Some children only need observation.
Can tongue-tie affect speech?
It can affect speech in some children, especially certain tongue-tip sounds, but not all speech problems are due to tongue-tie. A speech therapist and dentist may need to evaluate the child together.
Suggested Article:
- Do you need to Brush your Tongue
- What does early tongue cancer look like?
- What causes tongue cancer?
Medical Disclaimer
This article is for patient education only. Dental treatment should be planned after clinical examination, medical history review, and X-rays or scans where required. Treatment suitability, cost, timeline, healing, and results vary from patient to patient.
