What is a tongue tie?
In all of us, the tongue is attached to the floor of the mouth, about half way back. In some cases, a thin membrane extends further forwards in the mouth, sometimes up to the lower gum. This is called a tongue tie, also known as ankyloglossia (literally "stiff tongue"). The extent and consequences of a tongue tie vary between cases. It is a very common finding in the population, and around one in twenty babies are born with some degree of tongue tie. Boys are more often affected than girls, and tongue ties often run in families. Right from the start, it is important for parents to be aware that a tongue tie is common, will often cause no problems, and only some cases need treatment.
What problems can a tongue tie cause?
A tongue tie will often cause no problems at all. In fact, in ENT practice we often notice tongue ties in older children and adults when examining their mouths and throats, which have caused them no problems at all and may never have even been noticed before.
Feeding problems may sometimes be caused by a tongue tie. This is usually noticed in newborns who may have trouble latching on when breast feeding, and may therefore find feeding difficult, as they are unable to obtain a good seal around the nipple and breast. The tongue usually slips forwards during breast feeding to protect the lower gum, reducing nipple trauma. A tongue tie may hinder this, making breast feeding inefficient and uncomfortable. Bottle feeding may also be affected, but usually to a lesser degree.
Speech problems are often attributed to tongue ties. In reality, speech development is a very complex process, requiring good hearing, appropriate parental support and normal general development, among other things. However, in some cases, reduced mobility of the tongue as a result of a tongue tie may create difficulties with pronunciation of words, but it is often difficult to be sure whether the tongue tie is responsible for such problems or not.
Does a tongue tie require treatment?
All cases should be assessed on an individual basis by a doctor or allied health professional (eg a midwife) who has experience in this area.
Babies with feeding problems There is evidence to suggest that in newborns with tongue ties and breast feeding problems, prompt division of the tongue tie allows a quicker and more reliable return to normal feeding than if the tongue tie is left alone. In reality, dividing a tongue tie in a newborn is very straightforward and causes minimal distress to the baby- so it should be considered without too much delay if feeding is a problem.
Young children with speech problems As discussed above, it may be difficult to be sure whether a tongue tie is responsible for speech difficulties. Again, this is worth discussing with experienced professionals. Dividing a tongue tie in young children is typically less straightforward than in babies, requiring an anaesthetic. Additionally, the procedure may or may not help with speech. Parents should be aware of these possible limitations when making decisions about treatment.
How is a tongue tie divided?
In newborns the procedure is very straightforward, and is usually possible right away without any anaesthetic, in the clinic. Babies spend much of the time asleep. By tickling the chin, it is often possible to produce a feeding reflex which opens the mouth and exposes the tongue tie. This is easily cut with a pair of blunt-ended scissors. In many cases, the babies will not even wake up, demonstrating that the procedure is not distressing for them. Babies who are awake also tolerate the procedure well, although they may startle slightly. A tiny amount of bleeding is common, as with any small injury to the lining of the mouth, but this usually stops quickly. It is good if babies are slightly hungry at the time, as feeding straight afterwards will help settle them down quickly, and also helps stop any bleeding. Parents often worry about procedures on small babies without anaesthetic. In reality, this is very safe on the whole and causes minimal distress- usually less than having immunisation injections, for example.
In toddlers and older children tongue ties are typically thicker and more sensitive than in newborns. Bleeding may also be a little heavier. For these reasons, tongue tie division in these cases is usually done in an operating theatre with a short general anaesthetic. As well as dividing the tongue tie, any bleeding points can then be cauterised with electrical forceps. Children can start to feed straight away, and can go home on the same day.
What are the risks?
Bleeding is the most important risk of the procedure. Heavy bleeding in newborns is very uncommon after tongue tie division, as the tongue ties tend to be thin membranes. In older children, with thicker tongue ties, bleeding can occur, but is easily dealt with in the operating room.
A small mouth ulcer will occur at the site of the tongue tie division, which will heal over within a few days.
Persistent symptoms in the form of feeding difficulties in newborns, or speech difficulties in older children, may occur despite tongue tie division. This is because feeding and speech depend on many factors, of which tongue mobility is just one. As such, it is hoped that dividing a tongue tie will help in these circumstances, but this cannot be guaranteed.
Aftercare following tongue tie division
Babies and children should be fed normally, and do not usually require painkillers. Parents should continue to work closely with health professionals (eg midwives in the case of babies) to ensure that symptoms improve.