Tongue-Tie in Newborns

Tongue-tie, medically known as ankyloglossia, occurs when the band of tissue connecting the underside of the tongue to the floor of the mouth, called the lingual frenulum, is unusually short, thick, or tight.

The condition is present from birth. Some babies with tongue-tie experience no noticeable problems, while others have restricted tongue movement that interferes with breastfeeding.

Tongue-tie has been reported in approximately 4-11% of newborns and appears to occur more often in boys than girls. However, not every baby with tongue-tie develops feeding or functional difficulties.

How to Recognise Tongue-Tie in a Newborn

Possible signs include:

๐ The baby cannot extend the tongue beyond the lips or upper gums.

๐ The baby cannot lift the tip of the tongue towards the roof of the mouth.

๐ The tongue tip appears notched or heart-shaped when extended.

๐ The baby has difficulty moving the tongue from side to side.

๐ The baby cannot latch onto the breast properly.

๐ A clicking sound can be heard while the baby is breastfeeding.

๐ The baby repeatedly loses attachment to the breast during feeding.

๐ Feeding sessions take an unusually long time.

๐ The baby appears hungry again shortly after feeding.

๐ The baby gains weight slowly or does not gain sufficient weight.

Tongue-tie may also affect the mother during breastfeeding. Possible signs include:

๐ Persistent nipple pain during or after feeding

๐ Cracked, bruised, or damaged nipples

๐ Flattened, compressed, or ridged nipples after feeding

๐ Breast engorgement because the baby cannot remove milk effectively

๐ Recurrent blocked milk ducts or mastitis

These signs do not always confirm tongue-tie. Breastfeeding difficulties can have several causes, so assessment by a paediatrician, breastfeeding specialist, or other qualified healthcare professional is important.

What Causes Tongue-Tie?

During normal development, the tissue connecting the tongue to the floor of the mouth gradually separates, allowing the tongue to move freely.

In babies with tongue-tie, part of this tissue remains unusually short, thick, or tightly attached. This restricts the tongue’s range of movement.

The exact cause is not fully understood. Genetic factors may play a role because tongue-tie sometimes occurs in several members of the same family.

How Does Tongue-Tie Affect Breastfeeding?

Effective breastfeeding requires the baby to open the mouth widely, position the tongue beneath the nipple, and create a secure latch.

Restricted tongue movement may make it difficult for the baby to:

๐ Maintain a deep latch

๐ Compress the breast effectively

๐ Remove enough milk

๐ Coordinate sucking and swallowing

๐ Feed without becoming tired

As a result, the baby may feed frequently but receive insufficient milk. The mother may also experience persistent pain and nipple damage.

Does Every Baby with Tongue-Tie Need Treatment?

No. Treatment is generally unnecessary when the baby:

๐ Feeds effectively

๐ Gains weight appropriately

๐ Has no significant restriction in tongue function

๐ Causes no persistent breastfeeding pain for the mother

Observation and breastfeeding support may be sufficient in babies without functional problems.

Treatment may be considered when tongue-tie clearly interferes with feeding despite appropriate positioning and breastfeeding assistance.

Treatment for Tongue-Tie

Breastfeeding Assessment and Support

Before considering a procedure, a healthcare professional may assess:

๐ The baby’s latch

๐ Feeding position

๐ Sucking and swallowing

๐ Milk transfer

๐ The baby’s weight gain

๐ The mother’s nipple pain or damage

Adjusting the feeding position and receiving support from a lactation specialist may improve breastfeeding in some cases.

Frenotomy

A frenotomy, sometimes called a tongue-tie release, is a procedure in which the tight lingual frenulum is divided.

During the procedure, the doctor uses sterile instruments to make a small cut in the restrictive tissue beneath the tongue. The procedure is usually quick and allows the tongue to move more freely.

In young babies, the frenulum contains relatively few nerve endings and blood vessels. Pain control varies according to the baby’s age, the technique used, and the healthcare provider’s protocol.

Breastfeeding may be encouraged immediately after the procedure because it can help comfort the baby and assess whether feeding improves.

A small amount of bleeding may occur, but significant bleeding is uncommon. The procedure should be performed by an appropriately trained healthcare professional.

Possible Risks of Treatment

Although frenotomy is generally considered a minor procedure, possible complications include:

๐ Bleeding

๐ Infection

๐ Pain or discomfort

๐ Injury to nearby structures

๐ Scar formation

๐ Reattachment of the frenulum

๐ Feeding difficulties that continue despite treatment

This is why the decision should be based on a functional assessment rather than the appearance of the frenulum alone.

Care After a Frenotomy

Parents should follow the doctor’s instructions carefully.

General recommendations may include:

๐ Breastfeeding or feeding the baby after the procedure

๐ Monitoring for continued bleeding

๐ Watching for fever, swelling, or signs of infection

๐ Attending follow-up appointments

๐ Receiving continued breastfeeding support if feeding remains difficult

Parents should seek medical attention if the baby experiences persistent bleeding, breathing difficulty, severe swelling, fever, unusual drowsiness, or refusal to feed.

Tongue-Tie and Speech Development

Severe restriction of tongue movement may affect the pronunciation of certain sounds in some older children. However, not every child with tongue-tie develops speech difficulties.

Tongue-tie treatment in a newborn should primarily be considered when there is clear difficulty with feeding or tongue function. It should not be performed solely on the assumption that it will prevent all future speech problems.

Summary

Tongue-tie is a congenital condition in which the tissue beneath the tongue restricts its movement. Some newborns have no symptoms, while others experience difficulty latching, ineffective breastfeeding, slow weight gain, or maternal nipple pain.

When tongue-tie significantly affects feeding, a frenotomy may help improve tongue movement and breastfeeding. Early assessment by a doctor and breastfeeding specialist can help determine whether treatment is necessary and support appropriate growth and development.

 

Reference:

Bangphai Hospital Tongue-Tie in Newborns

ArokaGO Providers Bangphai Hospital