The diagnosis and treatment of tongue tie

Tongue tie can cause a range of issues in infants and adults but treatment is effective and straightforward

A tongue tie (ankyloglossia) is a condition in which the band of tissue (called the frenulum) underneath the tongue is shorter or tighter than usual such that it affects the tongue’s normal function. This can lead to a variety of issues, including difficulty with breastfeeding or bottle feeding in infants. In older children and adults, it can cause problems with speech, sleep, facial development, eating and drinking, nervous system regulation and even posture.

Symptoms of tongue tie

Tongue ties are most commonly considered in infants as the condition can cause issues with feeding, or slow weight gain. However, tongue ties can also be identified in toddlers, older children and adults. Common symptoms include:

Difficulty with feeding for infants:

• An infant may have trouble breastfeeding or drinking from a bottle. This can result in short, frequent or prolonged feeds.
• They may become frustrated during feeding or make clicking noises.
• They may regularly have colic and reflux symptoms.

Speech delays or issues:

• A toddler with tongue tie may have delayed speech or difficulty saying certain sounds.
• An older child or adult may have learnt to compensate their speech sounds but this makes talking more effortful and they may still trip over words or have a lingering lisp, for example.

Limited tongue movement:

• A toddler with tongue tie might not be able to stick their tongue out past their bottom teeth or move it from side to side.
• A heart-shaped tip when they try to stick out their tongue can be common in children with tongue tie.

Eating/drinking:

• Sometimes, a tongue tie can result in picky eating because chewing is compromised and swallowing sticky foods can be difficult.

Drooling:

• Excessive drooling, especially after a toddler reaches the age where it typically decreases.

If left untreated, a tongue tie can cause further problems into the teenage years and adulthood, such as sleep issues. If the base of the tongue is dropping back into the airway, facial development can be impacted because the tongue does not create the force on the upper jaw to encourage it to grow wider and forwards. A tongue tie can even affect posture due to either tension within the body or craning the head forward to open the airway.

So how does a tongue tie occur?

In normal oral function, if you are not talking or eating, your tongue should be fully in contact with your palate. When your tongue is in that position, you will breathe through your nose. This means the air we breathe is filtered, warmed and humidified and prepared for our lungs.

If we have a low tongue position and the mouth is open, mouth breathing becomes the path of least resistance. You then bypass the nasal system and if you are not using the nasal passages, you are not going to keep them clear.

A common misconception is that people breathe through the mouth because the nose is blocked. It is actually the other way around in the case of a tongue tie and the tongue’s position has a big bearing on how we breathe.

How to treat a tongue tie

If a parent suspects their infant or toddler has tongue tie, they should consult with a clinician who has specialist training in the assessment of tongue tie. This assessment should include a comprehensive evaluation of tongue function including feeding, eating and drinking.

Sometimes therapy to promote normal function is all that is required. However, if the tongue tie is causing significant issues, a simple procedure to release the frenulum (frenectomy or frenuloplasty) can be performed in conjunction with therapy to improve function.

A frenectomy (see images 1a and b) is a procedure that involves releasing the frenulum to free up tension. This allows the tongue to move with a greater range of movement. Frenectomy is a relatively simple and quick procedure. A numbing gel (topical anaesthetic) ensures this is pain-free.

Frenuloplasty (see images 2a-d) is a procedure that involves releasing the tongue frenulum and placing  absorbable stitches and glue to help control the healing. Local anaesthetic is used to ensure this is pain free. Children and older infants would have the procedure under conscious sedation, so they are relaxed, but still have normal tone in their tongue. Adolescents and adults do not need sedation just the local anaesthetic.

National Tongue Tie Centre

Based in Tipperary, the National Tongue Tie Centre is one of the only centres in Ireland that specialises in tongue tie and oral dysfunction. Headed up by Consultant Paediatrician, Dr Justin Roche and Chartered Physiotherapist, Kate Roche, the Centre treats hundreds of infants, children and adults, every year.

One such patient is baby Phoebe.

At 12 weeks, Phoebe (now nine months), was having huge difficulty breastfeeding. Phoebe’s mother had noticed a clicking noise while Phoebe was trying and the whole experience had become difficult, painful and stressful for both mother and baby. It was recommended to attend the National Tongue Tie Centre for treatment.

Phoebe’s mother said: “Following the quick treatment, the difference was immediate. Feeding became a much smoother experience.” Phoebe’s mother now bottle-feeds her daughter without difficulty, and their bond has grown stronger every day. “What was once a stressful and frustrating experience has turned into a time of connection and ease for both of us. Phoebe is now thriving and the stress of feeding is gone.”

Kate Roche, Clinical Director at the National Tongue Tie Centre, said: “For many mothers, painful feeds and feeding difficulties can make the experience overwhelming. Whether you breastfeed, bottle feed or combination feed, every journey is unique, but when challenges arise, a tongue tie could be the hidden culprit of a lot of discomfort. If left untreated, a tongue tie can then go on to cause further problems for toddlers and children with speech and sleep, for example. However, the good news is that a tongue tie is something that can be immediately and easily treated once identified so it is important to raise awareness of it so it can be diagnosed and treated as soon as possible.”

Educational courses

The National Tongue Tie Centre is running courses for healthcare professionals on tongue tie.

The Tongue Tie Toolbox is an educational platform designed to equip healthcare professionals with the skills and knowledge to support patients who have oral dysfunctions. The platform is the culmination of 20-plus years of expertise in tongue tie treatment.

The Toolbox comprises comprehensive courses tailored to healthcare professionals; information on early identification and treatment techniques; a growing library of surgical insights and therapy modules, and a community-driven learning experience with live monthly discussions. The first course, ‘Functional feeding and therapeutic techniques for infants up to six months’ is now live.

For further information or to register, visit: www.tonguetietoolbox.com/