Technically known as “ankyloglossia”, tongue tie is a condition in infants that leads to limited mobility of the tongue. This is problematic in young babies if it affects their ability to feed.
The cause of tongue tie is a short or tight frenulum. This is the piece of tissue under the tongue that connects the tongue to the floor of the mouth. Sometimes it connects too far forward, restricting the tip of the tongue more than it should.
Symptoms of Tongue Tie
Symptoms fall on a spectrum
- Breastfeeding is painful for the mother
- Baby is slow to gain weight despite frequent or long feeds
- Feeding is noisy and baby might take on a lot of air
- Bottle feeding can be difficult – the motion of sucking results in the bottle moving like a piston because the baby’s tongue cannot move up and down to create a seal to allow proper suction – this usually results in milk spillage from the mouth during the feed
- There may be symptoms of reflux as a result of swallowing air
- Milk remains on the tongue after a feed
- Baby cannot stick their tongue out and may have difficulty moving it from side to side
- Baby’s tongue does not raise fully when they cry, and appears heart shaped instead
- Baby is very unsettled if laid flat after a feed
When problems like this affect baby’s positioning, there can be a knock-on effect on milestones. Many physical milestones require plenty of floor time. A baby who needs to be fed frequently and held for long periods after may be at a disadvantage.
Similar problems can arise in the frenulum that attaches to the lip and gum. Whether breastfeeding or bottle feeding, babies should have their top lip flared out when latched on. If the lip consistently curls under, there may be a restriction in lip movement. Although lip ties are generally less problematic, they can still cause some of the above symptoms.
Managing Tongue Tie
The NHS recommends conservative treatment as a first line of therapy. Surgery is the more invasive solution, in which the frenulum is snipped. In young babies this can be done quickly and relatively easily as there is no sensation in the frenulum. However, after about three months of age, nerves begin to grow into it. This means the surgery has to be performed under general anaesthetic.
A paediatric osteopath will have a number of techniques to help massage and stretch the frenulum. You can expect them to work directly within baby’s mouth, and they may give you exercises to continue with at home. You will be given a rough prognosis, which will take into account the severity of the case.
This is a very good video guide to post-release exercises, by Bobby Ghaheri MD