Tongue-tie (Ankyloglossia)

The tongue is a muscular organ that helps us speak and also swallow the food. With tongue-tie, an remarkably short, tight or thick band of tissue ties the bottom of the tip of your tongue to the floor of the mouth. Tongue-tie may also affect the way a child speaks, eats and swallows.

It can affect speech and food intake as babies  grow.

What is Tongue-tie Ankyloglossia?

A short band of tissue called the lingual frenulum attaches the bottom of the tongue’s tip to the floor of the mouth cavity. This causes issues when the infant is breastfeeding, as the baby is unable to make sucking movements. If not corrected, this further affects the child’s eating, speaking and swallowing.

Symptoms of Tongue-tie Ankyloglossia

The symptoms are usually seen when problems arise during breastfeeding. You may notice that the child:

• Does not latch on to the breast
• Is unable to suck
• Takes longer than normal for feeding with more breaks in between
• Loses weight
• Becomes fussy when hungry
• Prefers to chew more rather than suck
• Makes clicking sounds during breastfeeding
• Is unable to stick out the tongue or move it from side to side
• Is unable to lift the tongue and touch the front teeth or gums
• The shape of the child’s tongue is V, or heart-shaped

Causes of Tongue-tie Ankyloglossia

Generally, the tissue that connects the tip of the tongue to the floor of the mouth cavity separates during childbirth. However, this tissue separation does not happen in some cases.

When to See a Doctor?

If you spot the symptoms associated with tongue-tie ankyloglossia, such as:

• You notice trouble during breastfeeding.
• Your child complains that the tongue interferes with speaking or eating.
• Your child constantly makes clicking sounds.
• Your child has a slurred speech.

A speech-language pathologist can help you distinguish if the slurring in speech is due to tongue-tie ankyloglossia or because of some other reason. Usually, when you go to a doctor with these symptoms, the doctor will perform a physical exam using instruments, such as a tongue depressor, to view the area below your child’s tongue and check the tongue’s motion. In an older child of 2 years or more, the doctor might ask them to move the tongue around the mouth cavity and make certain sounds, such as r or l. In the case of infants, the doctor will ask questions about breastfeeding to the mother.

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Treatment of Tongue-tie Ankyloglossia

When the child is born, a thorough physical examination of the newborn is performed before discharging the mother and the child. The doctors make sure that the child is properly breastfed and is sucking milk properly. Doctors might employ the wait-and-see approach. This is because the tissue that causes tongue-tie ankyloglossia, the lingual frenulum, loosens over time as the infant sucks on milk, resolving all related issues. A speech therapist or lactation consultant’s help might be taken to resolve the issues arising from tongue-tie ankyloglossia in some cases.

In some cases, surgery might be the option. There are two surgical procedures. They are:

1. Frenotomy- This procedure is very simple and does not even require anesthesia. The doctor will take a pair of sterilized scissors and clip the frenulum tissue. As this tissue is very less vascularized, it does not pain or bleeds much. The procedure is very effective and heals quite quickly. In fact, the infant can breastfeed right away. The chances of the surgical area getting infected are very rare. Also, there is a very slight possibility of a scar forming in the surgical area.
2. Frenuloplasty- If the frenulum tissue grows very thick when the child is growing up, the doctor will have to put the child under anesthesia, use special tools to cut the frenulum, and stitch the area for the wound to heal. It is an extensive procedure. Post-surgery, the child is asked to perform tongue exercises. With time, certain advancements have taken place in frenuloplasty, where doctors use lasers. Thus, the need for stitches is eliminated.

Complications Associated with Tongue-tie Ankyloglossia

Often, the issues arising from tongue-tie ankyloglossia go away on their own as the frenulum tissue loses its elasticity and spreads further apart, thus helping in the free movement of the tongue. If it does not, it can lead to certain complications, such as:

• Choking on food.
• Gagging.
• Difficulty in licking movements
• Irritated gums.
• Gap between teeth.
• Tooth decay.
• Trouble pronouncing certain words or alphabets, especially rolling ‘r’.

Conclusion

Tongue-tie ankyloglossia is very common. It is important for the mother to pay attention to the child’s breastfeeding routine. The best way is to talk with your doctor so that you can learn what is best for the baby and you.

Frequently Asked Questions (FAQs)

• My child is 4 years old and has trouble swallowing food. Is it tongue-tie ankyloglossia?

The trouble with swallowing can be due to many reasons. If your child is unable to stick his or her tongue out, it can be ankyloglossia. Either way, talk to your pediatrician. 

• There is a gap developing in the front teeth of my child. Also, he has painful gums with tooth decay. Is it tongue-tie ankyloglossia?

Tooth decay or gap development is a side effect of tongue-tie ankyloglossia if left untreated. Tooth decay and gap formation can also be due to many other medical conditions. You should observe the tongue’s movement in the oral cavity. It is advisable to consult your pediatrician.

• My infant is not taking breast milk. She does not suck the milk. Is it tongue-tie ankyloglossia?

This might be a case of tongue-tie ankyloglossia, where the child is unable to suck milk because of restricted tongue movement. Consult your healthcare provider or a pediatrician who will diagnose and treat the problem.