Tongue ties in babies - early detection is crucial

Tongue ties are common in babies and early detection is crucial.

Warning: This post contains illustrations of breast-feeding. 

Most new parents have no idea what tongue-tie is. Known as ankyloglossia, it is where the tongue has an extra bit of skin and is unable to touch the roof of the mouth during rest or swallowing. It occurs in 5 % of the population, is more common in males than females, and can run in families. 

There are degrees of severity, so some babies are able to attach to the breast and suck well despite a tongue-tie . However, many will have breastfeeding problems (sometimes from birth, sometimes from 2 or 3 weeks) due to  poor latch. Here are some of the signs that make early detection cruicial:

• nipple damage
• low weight gain or malnutrition in the baby
• recurrent blocked ducts or mastitis in the mother due to ineffective milk removal
• clicking sound during feeding
• colic-type symptoms due to increased air intake during sucking
  

The following picture illustrates a normal suck where the baby's tongue massages the nipple in a circular fashion.

​In a baby with tongue-tie (right), the tongue is anchored down by the extra skin and can't form a tight seal against the nipple. It also can't perform the smooth, circular action to extract breast milk. 

It may contribute to an abnormal tongue-resting posture (low and forward), and an abnormal swallowing pattern (tongue thrust). The entire body will then begin to accommodate to this incorrect tongue-resting posture, contributing to changes in the growth of the face, forward head posture, mouth breathing and sleep apnoea.

If untreated as a baby, it can go on to alter speech. Affected adults and children will often try to speak with a small mouth opening, slowly or softly so that they can pronounce specific consonants.

​According to the Australian Breastfeeding Association, your baby may have a tongue-tie if:

• the baby cannot poke his tongue out beyond his gum or lips
• his tongue cannot move sideways
• the tip of his tongue may be notched or heart-shaped when he cries
• he may readily gag
• the tip may look flat, square or cup-shaped instead of pointed
  

As osteopaths, we can identify any neck or facial asymmetry in babies, treat any symptoms of colic or gastrointestinal discomfort and recommend a referral to a lactation consultant  if we suspect a tongue-tie.
Once diagnosed, the tongue-tie is snipped without anaesthetic in a quick procedure.  Breastfeeding may improve immediately or it may take 2 weeks for the baby to relearn feeding technique.