Here in the world of breastfeeding, “tongue tie” or Ankyloglossia has recently earned a lot of buzz and we are here to simplify it and break it down. Let’s talk about signs of a tongue tie, why parents hear conflicting things from their care team, and what to do if you think your baby has one.
What is a tongue tie?
A tongue tie is a fold of mucosa and sometimes fascia (soft tissue) that is visible on elevation of the tongue and that restricts its function.
Signs That a Baby May Have a Tongue Tie (Ankyloglossia)
Check the nipple/breast
- Lipstick Shaped Nipple after feeding
- Nipple pain while nursing
- Damaged nipples
- Recurrent mastitis/inflammation/engorgement
Check the tongue/mouth
- Heart shaped tongue
- White coating of milk on tongue
- Impacted tongue function (cupping, rhythmic suck abilities or range of motion)
- Baby can not lift tongue when crying (or can barely lift it)
- Baby can not extend tongue beyond lower gum ridge line and hold it there for the entire feed (tongue retracts always of periodically)
- Lip blisters
- Open mouth breathing/sleeping
- High palate or abnormal palate shape
Check the latch
- Inability to stay latched
- Clicking, sputtering, coughing, leaking on bottle or breast
- Inability to extract milk effectively from the breast
Check the state of the baby
- Fussy baby
- Always hungry baby
- Infant Reflux
"I Notice Some Of Those Signs But My Care Team Is Telling Me Conflicting Things..."
This is a difficult topic for some practitioners. Why? There are 4 main reasons:
1) Because no one wants to perform unnecessary surgery to a baby’s mouth if they don’t have to
2) There is no single diagnostic tool that all practitioners can use to diagnose a tongue tie
3) Body tension can affect the presentation of the symptoms and function and so one of the first steps is sometimes to pursue manual therapy and watch prior to surgery.
4) A tongue tie is a functional diagnosis. The presence of the frenulum under the tongue is not the way to diagnose it, there must be a functional assessment performed beyond looking. Many practitioners are actually not trained to do a functional exam of the infant tongue and so they have a hard time determining a differential diagnosis.
"So I think my baby has a tongue tie, what to do next…"
Contact a qualified IBCLC to do a functional assessment first and then discuss next steps with your care team. The treatment usually involves:
- Interim custom feeding plan
- Confirming diagnosis
- Seeking body work/manual therapy
- An outpatient surgery called a frenectomy where the oral mucosa or fascia is cut with scissors or a laser by a specially trained dentist, ENT, midwife or pediatrician
