Tongue ties are not something you generally speak about, so most people don’t learn about tongue ties until they get a baby with a tongue tie. The normal thing to do at this point, is to google tongue ties and search for it on social media, such as Facebook.
Unfortunately, tongue ties as a medical condition is very new, so not all ENT’s (ear, nose and throat doctors) have enough knowledge about it. For this reason, there is a lot of untrue or inaccurate information out there, so to get you started in the right direction, we have assembled a beginners guide to tongue ties which will lead you through the basics of what you need to know.
If we put all relevant information into the article, it would get too long, so a lot of the information is available through links below instead, be sure to check them out for even more information.
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What is a tongue tie?
A tongue tie (ankyloglossia) is a condition 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.
Tongue ties can give a range of issues and often need to be treated.
There are many terms related to tongue ties, to be sure you understand the most important ones, read our glossary here.
What can an untreated tongue tie cause?
An untreated tongue tie can cause a range of issues. Early on, it can make breastfeeding difficult and painful. It can also lead to reflux, constipation and sleep issues. If a tongue tie is untreated, it can be impossible for the tongue to serve its purpose, which is to help shape the skull. This might lead to high palate, digestive issues and later in life stress and other similar issues.
For more examples of tongue tie related issues, click here.
What are the symptoms of a tongue tie?
Because the tongue has many functions, and an untreated tongue tie has many implications, the symptoms of a tongue tie are also many. The most obvious symptom is if the front of the tongue is tied to the bottom of the mouth to a degree where it is clearly visible. Apart from this, the most obvious symptom is difficulty breastfeeding. A tongue tie makes it hard for the baby to latch, leading to other conditions, such as reflux.
A tongue tie might also lead to difficulty speaking or delayed speech development and tightness in muscles and joints in the body.
For more information on symptoms, click here.
Can tongue tied babies use a pacifier?
A tongue tied baby will no doubt struggle with a pacifier as it is a lot harder to generate the suction required to use a pacifier with a tongue tie. Similarly, a baby that has just undergone a tongue tie revision will also struggle to use a pacifier, as the newfound mobility in the tongue required practise to master.
It is however not impossible to get a tongue tied baby or a newly treated baby to use a pacifier. For our recommended pacifier for babies both before and after release, click here.
How early can tongue ties be diagnosed?
Tongue ties are present from birth, and as such can be diagnosed from birth. Usually if the tongue tie is visible, the midwife will let you know that she recommends you get it checked out. Even if your midwife didn’t tell you, it does not mean that there is no tongue tie. Many ENT’s don’t know much about tongue ties, so chances are that your midwife don’t know much about them either.
The best way for you to get a feeling if your baby has a tongue tie, is to evaluate the symptoms. Symptoms are very indicative and if you are not trained in how to assess for tongue ties, you will not be able to make the distinction yourself.
How are tongue ties diagnosed?
If the reason you expect that your baby has a tongue tie is solely related to breastfeeding, you should visit your local IBCLC first. She will evaluate your baby’s breastfeeding in general and might come across issues that are not tongue tie related.
To learn more about IBCLC and how not all breastfeeding issues are tongue tie related, click here.
If the IBCLC suspect that there might be a tongue tie, you should schedule a session with a local practitioner. At this session, the practitioner will examine your baby and, if relevant, diagnose the tongue tie. Tongue ties are a very common condition, it occurs in about 5% of the population, however it is not widely understood. So, if your practitioner diagnoses, or refutes, a tongue tie without physically stretching your babies’ tongue, he is not sufficiently knowledgeable about tongue ties, and you should get a second opinion.
To see how to properly diagnose a tongue tie, click here.
How do you treat a tongue tie and what is the best way?
There are two ways to treat a tongue tie. If it is not too tight and the symptoms are mild, it is sometimes possible to out-train the symptoms. For babies you can stick sweet substances on the lips, palate or teeth, to stimulate the baby to lick this off. For children above the age of 4, you can use OMFT exercises.
For more information on OMFT, click here.
The other way to treat a tongue tie, is through surgery (releasing the tongue tie). A release can be performed either with scissor or with an O2 laser and is called a frenotomy. A frenotomy is simply put cutting the frenulum that runs underneath the tongue. It is a procedure that can be performed both with scissors and laser and that is performed under local anesthesia.
Both types of procedures are typically very quick, ranging from 1 to 5 minutes, with laser surgery being the fastest, as laser surgery does not require stitching.
In both cases, discomfort is minimal, and usually does not cause pain for more than a very short time. Babies can breast-feed immediately after the procedure.
We highly recommend laser for the procedure, as this gives much better wounds, which are much easier to manage afterwards.
For more information on the tongue tie treatment, click here.
What do you need to be aware of before and after the procedure?
Getting a tongue tie release, is only one part of the treatment. The release needs to be accompanied with both bodywork and aftercare, and you should be paying regular visits to your IBCLC.
It is not possible to overstress the importance of this, without proper aftercare and bodywork, the tongue tie will reattach, and your baby will be in pain or discomfort from muscle tensions.
For more information on reattachment, click here.
Aftercare are exercises you need to do with your baby after the release. The exercises must be performed 6 times a day for the first 3 weeks, and 4 times a day from week 4 to 6. The purpose of the exercises is to keep the wound from reattaching and to increase mobility in the tongue. This can be stressful for some parents, as the baby often resists this. You should watch the video linked below, to get a feel for what you are getting into.
For more information on aftercare, and a video of how to do it, click here.
Bodywork is done by a professional, such as an occupational, physical or speech therapist, chiropractor, osteopath, nurse, massage therapist or other. The purpose is to relieve the tension that has built in the baby from using a restricted tongue, from the treatment and from the ongoing aftercare.
For more information on bodywork, click here.
How long should you do aftercare and bodywork, and when are you “done”?
The entire process from the release and until aftercare and bodywork is done, is about 6 weeks. It is important though, that you don’t abruptly stop aftercare and bodywork from one day to the other. You need to ease out of it, while at the same time observing how the wound and body reacts. Neither the wound, nor the body should become tighter, in that case you need to ease back in, before easing out again.
For a detailed timeline of the entire process including aftercare, bodywork and IBCLC, click here.
We hope that this article gave you some insight into tongue ties. Feel free to search our website for more information, or follow us on Facebook for even more information on tongue ties.