This is an article I've been wanting to write for
some time and now with the help of my Assistant Nicole, we've finally got it
ready to go.
Over the past 18 months, we have been seeing an
epidemic in tongue-tied babies. Every client who has a baby born in their
family, I've been pushing them to get the doctors and nurses to check the baby
isn't tongue-tied. The reason I'm making such a big deal about this, is
because it is a big deal. If a baby leaves the hospital tongue tied and
the mother doesn't know, she will be struggling to breast feed her baby, the
baby will be colicky, constantly hungry and not be putting on weight. All
very disconcerting for a new mum and it makes them feel useless and helpless.
I've been that mum. Not for this reason but for
many other reasons I struggled as a first time mum and my support network
wasn't great and I ended up with post-natal depression. This is a
situation I would do anything to help others avoid.
Added to this problem is that most Doctors and Nurses
in the maternity wards don't appear to know how to pick up tongue tie
issues. The mum will do either one of two things - battle on and
eventually put the baby on a bottle (either expressed breast milk or formula)
or consult a lactation specialist which in my experience are quite good at identifying
tongue tie and then guiding the mother to having the issue resolved.
It's not just the feeding issue that we have to worry
about with tongue tie. As the child grows they can have issues with
speech because they can't get full range of motion with their tongue.
Some can't eat properly. Clicky and painful jaw. Migraines.
Then the effects of these things on self confidence and socially interacting,
which then leads to emotional trauma and possible depression.
We can't fix this issue with remedies after the baby
is born but we are noticing that babies born from our existing clients that had
plans prior to and during the pregnancy aren't having this issue so it might be
an inherited/genetic fault. We can help with recovery from having the
issue surgically fixed.
Snipping a tight frenulum (the thin membrane under
the tongue, causing the issue) in young babies is a simple procedure that takes
only a second or two. No anaesthetic is needed. The baby usually breastfeeds
straight after the procedure. This has to be done with the baby is very
young which is why I push for identification as soon as possible. In our
local hospital (Inverell) we have an excellent doctor that is also a surgeon
and he checks every baby he delivers the day after delivery and will snip the
frenulum without drama.
Below is information taken directly from the internet
about this issue. I hope this article is of use to you and can help you
or someone you know.
Tongue-Tie
Tongue-tie also known as ‘Ankyloglossia’ or ‘anchored
tongue’ – is a common but often overlooked condition and occurs when the thin
piece of skin under the baby's tongue (the lingual frenulum) restricts the
movement of the tongue. In some cases the tongue is not free or mobile enough
for the baby to attach properly to the breast. Tongue-tie occurs in about 5% of
people. It is three times more common in males than females and can run in
families.
The frenum is tissue left over from the time the
foetus was developing in the mother’s womb and which would normally reduce to
insignificance before birth. In the first 3 months of life, the face becomes
differentiated into its various parts, and the frenum is what is left of the
tissues that should have disappeared as the oral areas are formed. Such
vestigial structures are not uncommon, and ‘webbing’, as it is sometimes
called, can occur between upper or lower lips and gums, cheeks and gums as well
as in tongue tie.
Genetic factors
Tongue tie often runs in families. Some relatives may
only have mild effects or no apparent symptoms while others show a severe
impact on structure and function. As this strong familial tendency exists,
parents may also notice a similarity to other relatives with tongue tie,
especially in the older child. The similarities observed may include postures
of lips and tongue, habits of speech, and shapes of the nose and face.
Tongue tie sometimes occurs together with other
congenital conditions which affect the structure of the mouth, such as cleft
lip or palate. It can also occur together with conditions such as severe
hearing loss or cerebral palsy.
Appearance
All tongue ties do not look alike – adding to the
difficulty of spotting them. They can be thin and membranous, thick and white,
short, long or wide, extending from the margin of the tongue all the way to the
lower front teeth, or so short and tight that they make a web connecting the
tongue to the floor of the mouth.
When they extend to the margin of the tongue, they
cause a heart-shaped look at the front of the tongue and no tongue tip can be
seen. When they extend across the floor of the mouth they cause pain when the
tongue is elevated. They can cause separation or inward tilting of the
incisors.
A baby with a tongue tie will look different from an
older child with the same condition.
Diagnosis
In making a diagnosis of tongue tie, the two
traditional criteria have been acute malnourishment or misarticulation of
tongue tip sounds such as ‘t’, ‘d’, and ‘n’.
However, there are several other factors which can be
attributed to the limitations of lingual ability that accompany a tongue tie
and these should be considered in any assessment of whether a tongue tie exists
and whether surgical intervention is warranted. The other factors include:
- Appearance of the tongue
and its movements.
- Maternal factors
including pain, nipple injury, blocked ducts or mastitis during
breastfeeding.
- Infant factors including
low weight, vomiting and gagging.
- Lack of lingual mobility
which affects speed and accuracy of tongue movements.
- Eating difficulties
caused by poor coordination of oral musculature.
- Dribbling – which is
prolonged.
- Dental problems which are
severe and wide ranging.
- Speech which is unclear
due to several aspects, especially coordination.
If it is deemed that a tongue-tie is interfering with
breastfeeding, then release (snipping) of the tight frenulum can improve the
baby's ability to breastfeed.
Snipping a tight frenulum in young babies is a simple
procedure that takes only a second or two. No anaesthetic is needed. The baby
usually breastfeeds straight after the procedure.
Surgical Options
There are four options available in the choice of
interventions in cases of tongue tie:
- Snipping the frenum
(sometimes referred to as ‘frenotomy’) of neonates.Surgical revision
of the frenum (sometimes referred to as ‘frenulectomy’, or
‘frenuloplasty’) under a general anaesthetic at or after 6 months of age
- Revision of the frenum by
laser without a general anaesthetic.
- Revision by
electrocautery using a local anaesthetic.
All these methods are equally successful when used in
appropriate circumstances.
Consequences of untreated tongue-tie
The consequences of an untreated tongue tie can be
many and varied, depending largely on the age of the subject and the severity
of the condition. The demands made on us increase as we grow older, and our
environment becomes less forgiving of mistakes. Delay in treatment, therefore,
can have very negative consequences.
For Infants
Inability to breastfeed successfully in the presence
of a tongue tie can cause a variety of challenges for the infant, the mother
and the family. For the baby, these may include:
- Impact on milk supply
- Termination of
breastfeeding
- The baby failing to
thrive
- Poor bonding between baby
and mother
- Sleep deprivation
- Problems with introducing
solids
The maternal experience of breastfeeding a
tongue-tied baby may include:
- Pain
- Nipple damage, bleeding,
blanching or distortion of the nipples
- Mastitis, nipple thrush
or blocked ducts
- Severe pain with latch or
losing latch
- Sleep deprivation caused
by the baby being unsettled
- Depression or a sense of
failure
For Children
Children with a tongue tie have to contend with
difficulties which may only be discovered as they grow older. These can
include:
- Inability to chew age
appropriate solid foods
- Gagging, choking or
vomiting foods
- Persisting food fads
- Difficulties related to
dental hygiene
- Persistence of dribbling
- Delayed development of
speech
- Deterioration in speech
- Behaviour problems
- Dental problems starting
to appear
- Loss of self confidence
because they feel and sound ‘different’
- Strong, incorrect habits
of compensation being acquired
For Adults
What adults have to contend with is very much the
result of old habits of compensation for inadequate tongue mobility. The areas
of difficulty spread to include social and domestic situations, self-esteem,
the work environment, and dental health. Thus it is seen that the
consequences of unrepaired tongue tie do not reduce with time – instead, more difficulties
are experienced as time passes.
The specific challenges an adult with a tongue tie
may face include:
- Inability to open the
mouth widely affects speech and eating habits.
- Always having to watch
their speech
- Inability to speak
clearly when talking fast/loud/soft
- Difficulty talking after
even moderate amounts of alcohol
- Clicky jaws
- Pain in the jaws
- Migraine
- Protrusion of the lower
jaws, inferior prognathism.
- Multiple effects in work
situations.
- Effects on social
situations, eating out, kissing, relationships
- Dental health, a tendency
to have inflamed gums, and increased need for fillings and extractions
- Sensitivity about
personal appearance
- Emotional factors
resulting in rising levels of stress
- Tongue tie in the elderly
often makes it difficult to keep a denture in place.
