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Tongue Tie Diagnosis: How to Determine Tongue Ties in Babies? Written By: Dr. Ankita Shah, August 2021

Tongue Tie

Tongue-tie (ankyloglossia) is a condition present at birth. It is a string of tissue that restricts the tongue's range of motion. This tissue is known as the frenulum. The floor of the mouth is connected to the underside of the tongue, and the frenulum can limit various tongue movements that are essential for breastfeeding, sucking, swallowing, eating, drinking, chewing, breathing, speech, jaw growth, posture, and digestion.

1) Symptoms and Causes of Tongue Ties in Babies:

While there are many theories behind the causes of infant tongue-tie, there is no concrete reason. Some say it's hereditary, while others believe that it could be because of the defect in cellular apoptosis.

For breastfeeding infants, the right tongue function is important for feeding and correct jaw development. Failure to diagnose tongue & lip ties can result in breastfeeding problems, and it could make mothers turn to supplement bottles under the notion that they can't produce sufficient milk.

To rule out lactation concerns, breastfeeding mothers should visit a paediatric dentist, lactation consultant, or paediatrician.

The following are some of the tongue tied symptoms in babies:

Prolonged latching / long feeding hours

Unsettled after feeding

Short sleep duration

Poor/shallow latch

Chewing on nipples

Reflux symptoms

Colic symptoms / Gassiness

Falls asleep during feeds

2) Steps to Determine if the Baby Has a Tongue Tie:

The Lactation Consultant working for your baby gives me background knowledge on your sessions with her. This helps me gauge the baby’s nursing progress before my initial consultation.

If breastfeeding issues including inadequate latch, poor breast draining, painful nipples, fussiness at the breast and other possible issues have not improved and a lactation consultant is concerned about a possible tongue tie and/or a lip tie, she will ask the mother to get a complete functional tongue tie assessment for the baby.

Tongue Tie Diagnosis

Proper Lighting: By using proper lighting and magnification, I can freely examine the baby’s mouth with both hands. Like many problems in life, "When The Vision Is Clear, Strategy Is Easy."

Adequate Positioning: Positioning of the infant and myself is extremely important during the examination. The parent and I face each other with our knees touching. This creates a sort of “table” for the baby to lay on. I primarily have the baby’s head towards me, laying on his/her back.

Gentle Examination: Our goal is to assess the level of tension in the infant’s lingual frenulum when the tongue moves up and down, in and out, and right to left. I perform some exercises to measure the tongue’s range of motion and overall mobility. While doing so, I gauge the baby’s reactions to discomfort. I also assess the lip frenum, which will turn white where it attaches to the upper jaw and create a dip in the upper lip if it is too tight.

THESE ARE ALL TONGUE TIES!

Tongue Ties1
Tongue Ties2
Tongue Ties3
Tongue Ties4

3) Complications if Infant Tongue Tie is Not Treated:

The following are the complications faced if tongue tie is not treated.

Selective in chewing solid foods

Speech defects

Improper jaw growth

Crooked teeth

Thumb/finger sucking

Mouth breathing

Forward neck and shoulder posture

Long term bed-wetting

Hyperactivity / Lack of attention (ADD, ADHD)

Snoring or Noisy breathing

Frequent nasal allergies and throat infections

Teeth grinding

Picky eating or slow eating

4) Tongue Tied Baby Treatments:

Depending on the severity of the tongue tie condition, a tongue tie specialist will advise on the probable treatment.

In extreme cases, frenotomy is recommended, which can be performed through laser technique or by using a scissor. The laser technique is a safer, quicker, simpler, and painless procedure compared to the scissor technique and generally requires no anaesthesia.

Oral Myofunctional Therapy is provided to improve the tongue function and avoid any relapses.

Craniosacral Therapy may be used for some infants as a supplement when some asymmetry in the head shape or problems with neck stabilisation has been observed.

What Happens During a Tongue Tie Revision (Frenotomy)?

We ensure that there is zero to minimal discomfort experienced by the child during the procedure. An effective topical anaesthetic gel is applied on the frenulum before the treatment, which lasts for approximately 30 minutes. Next, we move to examine the lingual frenulum and then use the chosen technique to free the frenulum. The procedure is quick, and there is minimal discomfort as there are few nerve endings or blood vessels in the lingual frenulum. The wound will appear in a "diamond form."

While the procedure can be performed with a laser or scissor, benefits of revising infant tongue tie with a laser include:

Precision tongue tie release

Minimal discomfort

Minimum bleeding during/after the procedure

Faster healing

5) Aftercare Instructions Post Frenulotomy:

There is a healing period your infant will undergo after the procedure until the full benefits are realised.

Breastfeeding is encouraged immediately following the procedure.

We teach mothers proper active wound management plus daily stretching exercises to facilitate healing.

Post-treatment follow up is just as important as pre-treatment care. We send a detailed report of my assessment and/or procedure to the lactation consultant and stay up-to-date with the baby's progress.

6) Procedure Tongue Tie Exercises:

The tongue now has more opportunities to move, but this does not take place automatically. The resting tongue can relapse to its old position and may ‘reattach’ during the healing process if post-surgery tongue tie exercises are not performed diligently.

Post-surgery exercises should be carried out for at least two weeks after the procedure.

Exercise a minimum of thrice a day, even at night if the baby is awake and relaxed.

Gently lift the tongue once or twice with both index fingers. Keep in mind that an actual stretch has to occur. By separating the upper half of the diamond on the tongue from the bottom of the mouth, you can lift the tongue with your two index fingers as you stand behind the baby.

Diagnosing Tongue Ties - Caution About ‘Do-it-Yourself’ Diagnosis

While it may be tempting to attempt infant tongue tie examination on your own, I highly recommend that you allow a trained professional to perform it. Why? Experience is necessary to determine what level of tension warrants a lingual frenectomy and what does not. Diagnosis of a tongue tie is not simply based upon appearance - it is largely based upon symptoms experienced by mom and baby as well as tongue function.

I conduct a thorough examination of the baby’s mouth to determine if the lingual frenulum is causing interference in the movements that are important for proper latch and tongue function. While it is certain that not all tongue ties need to be released, it is the experience I have in evaluating infants that helps me make an informed decision.

Do not worry. The resulting benefits I have witnessed in improved breastfeeding makes the entire procedure well-worth it.

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