To do its job well, your tongue needs to be able reach almost every part of your mouth. That full range of motion lets you make different sounds when you speak. It also helps you swallow and sweep away bits of food to keep your mouth clean.
But for babies with tongue-tie, there’s a problem with something called the lingual frenulum. That’s the small stretch of tissue that connects the underside of your tongue to the bottom of your mouth. It might be too short and tight, or attached way up near the tip of the tongue.
Either way, it ties the tongue in place. For some, it’s not much of an issue. For others, it can lead to problems breastfeeding. Later on, it can affect eating and speaking.
Doctors don’t always check for it, and it’s not always easy to notice. But even if your child’s pediatrician doesn’t find it until later, it can be treated.
Usually, the lingual frenulum separates from the tongue before your baby is born. But sometimes it doesn’t. Doctors aren’t sure why. It may run in families. We do know that boys are 3 times more likely to get it than girls.
- Can’t latch well
- Tends to chew more than suck
- Doesn’t gain weight the way you’d expect
- Feeds for a long time, takes a short break, then feeds for another long stretch
- Is fussy when trying to feed
- Makes a clicking sound while feeding
- Seems hungry all the time
Along with symptoms, you may hurt during and after breastfeeding. You may also have sore or cracked nipples. But tongue-tie isn’t the only reason there may be breastfeeding problems. So if you’re having them, talk to your doctor.
You might also notice your baby’s tongue:
- Can’t move far from side to side
- Can’t reach the upper gums or roof of the mouth
- Can’t stick out past the gums
- Has a V shape or heart shape at its tip when it’s sticking out
A physical exam is all it takes to see what’s going on. The doctor will:
- Ask how feeding is going
- Check your child’s tongue, mouth, and teeth
- Use a tongue depressor, which is like a big popsicle stick, to look under your child’s tongue and check the range of motion
The doctor may ask older kids to move their tongue around and make certain sounds, like of an r or l.
Does It Need to Be Treated?
Not all doctors agree on this. Some say to take care of it right away to ward off any issues. Others think it’s better to wait. That’s because it might not cause any problems or may loosen up over time.
There’s no way to know for sure what’ll happen.
If it's not treated, it can also lead to:
- Dental problems like tooth decay, swollen and irritated gums, and a gap between the lower two front teeth
- Gagging or choking on foods as your child starts to eat solids
- A hard time with basic things, like licking an ice cream cone and kissing
- Trouble saying d, l, n, r, s, t, th, and z sounds. Rolling an r can be especially hard.
Talk it through with your doctor to learn what’s best for you and your baby.
There are two ways to take care of tongue-tie:
Frenotomy: This basic procedure happens in a doctor’s office. Sometimes you don't even need numbing drugs.
The doctor takes a pair of specially cleaned scissors and clips the frenulum, which doesn’t have many nerves or blood vessels. That means there’s not much pain. And if there’s any blood at all, it’s a drop or two at most.
Your baby can breastfeed right away, which can be soothing and healing.
Frenuloplasty. When the frenulum is too thick for a quick snip, your pediatrician will choose this option.
The doctor will:
- Give your child drugs so they sleep through the whole thing
- Use special tools to cut the frenulum
- Put in a few stitches that dissolve on their own as the wound heals
Some hospitals may use a laser instead. In that case, your child won’t need stitches.
Are the Treatments Safe?
Both are usually very successful and prevent any speech, dental, or eating problems. It’s rare for either one to cause any issues.
As with any medical procedure though, there are risks, such as:
- Damage to the tongue or the glands that make saliva
A frenuloplasty can also lead to scarring. And your child could have a reaction to the drugs used to help him sleep.