Tongue Tied

Tongue-tie is known as ankyloglossia, a condition present at birth affecting or restricting movements of the tongue tip. A child or baby with a tongue tie will have a thick, tight, and short band of tissue (lingual frenulum) from the tip of the tongue to the floor or bottom of the mouth. Ankyloglossia has an incidence of around 4 to 16% incidence with more cases of boys than girls.

In my experience, not all children with tongue-tie are symptomatic or have difficulties. The more symptomatic group has difficulty in breastfeeding while the lesser symptomatic ones show no signs of a tongue tie. Children or babies with difficulty in breastfeeding require medical attention as natural breastfeeding plays an important role in the development of muscles around the mouth, swallowing, and breathing. According to scientific studies, muscular efforts made by babies during breastfeeding are key preparatory exercises for future chewing functions. Multiple studies done across the world have shown immediate improvement in breastfeeding after tongue tie release (frenulectomy/frenotomy) in the majority of cases.

Tongue-tie may be identified by a Pediatrician during the general examination of the newborn but it can be difficult to spot at all times. The mother will be able to identify the issue by keeping certain points or questions in mind. Five key questions to remember are

1. Does my baby feed for a long time at a stretch and feed again after a short break?

2. Is my baby restless and hungry throughout the day?

3. Is there adequate weight gain as expected in a normal baby?

4. Does my child make a clicking sound while feeding?

5. Am I having pain / sore or cracked nipples due to breastfeeding?

Another common problem associated with tongue-tie is difficulty in making certain sounds as the child grows up. Ankyloglossia does not affect the child's from speech development. But the child may have difficulty in making sounds like T, D, Z, TH, R, and N hence affecting phonetics or pronunciations of words. Generally, these sounds get affected as it requires a full range of movement of the tongue to produce this sound. A sound is created by a combination of breathing techniques, constriction of airflow along with movements of the tongue. Hence a tongue-tie can result in a slight, moderate, or highly deviate from the proper sound. Many such cases can be treated with help of a Speech pathologist who can provide exercises to improve the tongue movement. In case adequate improvement is not achieved, a frenotomy or frenuloplasty can be done.

In my practice, children with difficulty in articulation of words may improve with the help of a Speech Pathologist. I assess the degree of ankyloglossia based on protrusion and elevation of the tongue. If the child can protrude his/her tongue up to the outer margins of the upper or lower lip, speech therapy is adequate in my experience. I perform frenotomy for older children as outpatient procedure as they tend to cooperate better without any sedation. In younger children, the procedure is done under sedation to ensure optimum outcomes.

Reference

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2. Van Der Laan T. A importância da amamentação no desenvolvimento facial infantil. Pró-fono R Atual Cient. 1995;7:3–5.

3. Sethi N, Smith D, Kortequee S, Ward VM, Clarke S. Benefits of frenulotomy in infants with ankyloglossia. Int J Pediatr Otorhinolaryngol. 2013;77(5):762-765. doi:10.1016/j.ijporl.2013.02.005

4. Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008;122(1):e188-e194. doi:10.1542/peds.2007-2553

5. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg. 2002;127(6):539-545. doi:10.1067/mhn.2002.129731

6. Ostapiuk B. Poglady na temat ruchomości jfizyka w ankyloglosji a potrzeby artykulacyjne [Tongue mobility in ankyloglossia with regard to articulation]. Ann Acad Med Stetin. 2006;52 Suppl 3:37-47.