Somewhere between 4%-11% of all infants born will present symptoms of a condition called “infant tongue-tie.” This particular condition is usually benign–it may even go unnoticed in some cases. But severe infant tongue-tie can interfere with breastfeeding, and eventually, speech, and requires treatment. It can sometimes be challenging for parents to know when treatment is necessary and when the issue could resolve itself on its own.
Making an informed decision isn’t always cut and dry, and often depends on parental preference. That’s why it’s important to have accurate information and to talk with your pediatrician and/or pediatric dentist about assessment and your options.
What is Infant Tongue-Tie?
Known medically as ankyloglossia, infant tongue-tie is a condition in which the tip of the tongue is tethered to the bottom of the mouth. This usually occurs due to a small strand of tissue that tethers the tongue to the bottom of the mouth. Infant tongue-tie is usually spotted during your initial infant exam, but it can sometimes be subtle and difficult to spot.
This tiny piece of connective tissue, called the lingual frenulum, typically separates before birth. In cases of infant tongue-tie, this simply has not happened yet. The result is a tongue that the infant may find difficult or impossible to move. The degree to which tongue-tie will impact your child’s health will depend on the severity of the symptoms.
How Will Infant Tongue-Tie Impact My Child?
The mildest cases of infant tongue-tie may have no functional impact on your child other than a tongue with slightly less mobility than it might have otherwise. Even in moderate cases of infant tongue-tie, few adverse effects are observed by parents or medical professionals. It’s entirely possible that children with mild to moderate tongue-tie will express symptoms well into adulthood without any adverse effects.
Particularly severe cases of tongue-tie, however, may have more pronounced impacts on your child’s health. Tongue-tie can, in some cases, interfere with your infant’s ability to breastfeed. Normally, your infant will place the tongue over the lower lip when feeding; when tongue-tie prevents this, the infant may begin chewing instead of sucking, causing significant discomfort for the mother. In such cases, the infant may not get sufficient breast milk and, as a result, experience difficulty thriving.
When severe tongue-tie persists through the developmental years, the condition may impact your child’s ability to speak. In these cases, a speech pathologist may recommend either treating the tongue-tie or speech therapy to compensate for any issues that might develop.
Do I Need to Treat Tongue-Tie?
Most cases of tongue-tie do not need to be treated. However, severe cases of tongue-tie may require surgical intervention. In general, there are two approaches to tongue-tie treatment, both of which are quite effective:
- Frenotomy: This is a very simple surgical procedure in which the lingual frenulum is cut using a sterile pair of surgical scissors. Typically, frenotomy is used in cases where the connection between the tongue and the mouth is tenuous and the lingual frenulum is quite delicate. This procedure usually does not require anesthetic, as there are very few nerve endings in the lingual frenulum. Once the tissue is severed, the mobility of the tongue returns to normal.
- Frenuloplasty: When the lingual frenulum is more robust, a more significant surgical procedure may be required to ensure future mobility of the tongue. This procedure is called frenuloplasty and involves general anesthesia and the use of more surgical tools and techniques. Essentially, when the lingual frenulum is larger, its removal can require more significant repairwork around the incision site.
Both frenotomy and frenuloplasty have very low occurrences of complications or side effects. In some rare cases, bleeding or infection may occur. Once the procedure is complete, a series of tongue exercises will be recommended in order to ensure the tongue maintains the greatest dexterity possible.
In cases where tongue-tie has not been corrected and a speech pathologist recommends treatment, parents will have to choose between a surgical approach and speech therapy, depending on what is most appropriate for their child.
Deciding When to Treat
When tongue-tie is severe enough to interfere with your infant’s breastfeeding, patients have a relatively straightforward choice in terms of treatment. But in mild and moderate cases, the decision to treat can be a little more challenging.
On the one hand, complications and side effects from treatments are incredibly rare. But many parents choose to avoid even those remote risks. Other parents may take a “if it’s not broke, don’t fix it” approach, opting to embrace and emphasize that which makes their newborn unique (so long as it’s not causing other problems).
There are also adults who, later in life, opt to treat mild and moderate tongue-tie for aesthetic or comfort purposes. But there are others who are glad that they were offered the opportunity to keep what they view as a token of their individuality.
Parents whose newborns have mild to moderate tongue-tie will need to weigh the pros and cons of their choices as best as possible. In such mild and moderate cases, there is rarely a “right” answer–but there is also rarely a significant downside to either choice.
However, treatment is recommended in cases where:
- Your infant has difficulty feeding.
- Feeding becomes painful or uncomfortable for the mother.
- Your infant will feed for short periods at a time or take many breaks while feeding.
- Your infant makes “clicking” sounds as they feed (and your infant is positioned properly).
- Your infant seems fussy or unsettled constantly; or, put more simply, your infant seems hungry all the time.
- Your infant is not gaining weight as quickly as they should.
- A speech pathologist determines the tongue-tie could compromise your infant’s lingual development.
- As an adult, you find your tongue-tie uncomfortable and wish to have it treated.
Some of these warning signs in and of themselves might warrant a trip to a medical professional. Often, a combination of these warning signs might be what you want to look out for.
In those cases where your infant has been having trouble feeding, it’s sometimes a big relief to finally know what’s wrong! In the case of an infant with tongue-tie, it’s nothing that you, as the parent, are doing–it’s the complication caused by the lingual frenulum that’s causing poor feeding.
Is Tongue-Tie Common?
Generally speaking, tongue-tie is a common condition. So if your infant is one of those diagnosed with tongue-tie, it’s important to remember that frame of reference. For most, tongue-tie is a relatively straightforward condition. In all but the most severe cases, treatment will depend almost entirely on your own preferences as parents.