Does My Baby Have a Tongue Tie?

Thank you for sending us your tongue tie pictures so other parents can see what they look like – one picture is worth a thousand words!

Is My Baby Tongued Tied: examples of a tongue tied baby
Have you ever heard of a tongue tie? I’m not talking about when you get all confused end up sounding like a total asshole. I mean the physical connection between your tongue and the bottom of your mouth.

It was something I had heard of but never given much thought, until my son was born with one and I needed a crash course in how to deal.

So, what is it and why should you care?

 

What is a tongue tie?

Tongue tie, also known as Akyloglossia, is a common congenital oral anomaly affecting the movement of the tongue. When the tongue is tied, the frenulum that connects the tongue to the floor of the mouth is unusually short and thick.

The frenul-whatnow?

The frenulum is a thin band of tissue that restricts motion.

The one under your tongue forms in utero to guide the forward growth of the tongue.

There is a similar band of tissue between your top gums and the inside of your upper lip.

Your genitals also have a frenulum but we’re not going to cover that here today and I definitely don’t recommend Googling such things while you’re at work.

Go wash your hands and take a second to feel around in your mouth to see what I’m talking about.

As the mouth continues to develop, the frenulum will retract away from the front of the tongue. When that retraction fails to happen, or the tissue remains tight, you get a tongue tie.

 

Classification of tongue ties

The type of tie depends on where the frenulum connects to the tongue.

 

Classical (anterior) lingual frenulum:

anterior tongue tie

This is the most commonly noticed tongue tie, as the connecting membrane extends towards the front of the tongue and is easily visible when the tongue is lifted. Often, when an infant with an anterior tie sticks out her tongue it has a heart-like or forked appearance.

 

Posterior lingual frenulum:

posterior tongue tie

These ties are often missed, as the membrane connection is submucosal and therefore difficult to spot. In posterior ties, the frenulum is farther back on the tongue but still very tight. The front and sides of the tongue can move freely, but the center is anchored and unable to adequately lift or move forward. Sometimes these ties have to be felt for.


Lip tie:

lip tie

The tongue tie’s upstairs neighbor, the lip tie, occurs when the frenulum between gum and upper lip is tethered too tightly. This has less to do with frenulum placement but rather the tightness. Even if the frenulum is tethered to the gumline, if the lips have adequate movement, it is not an issue.

 

Why does it matter?

In infancy, tongue and lip ties are potential causes of breastfeeding issues, such as:

  • Shallow latch
  • Prone to falling off the breast
  • “Clicking noises” indicating loss of suction and intake of air
  • Nipple and breast pain (including plugged ducts and the dreaded Mastitis)
  • Low weight gain

Even if you are not breastfeeding, tongue and lip ties have been linked to problems throughout life, including:

  • Speech problems
  • Tooth decay
  • Swallowing difficulty
  • Orthodontic issues
  • Inability to lick lips
  • Difficulties kissing

 

Diagnosis

Some ties are noticeable at birth and many OBGYNs and midwives will clip them in the delivery room.

Here is a great step-by-step guide to checking for tongue and lip ties at home.

Older infants will need to be looked at by a provider well versed in tongue and lip ties. This could be a pediatrician, pediatric dentist, midwife, OBGYN, or International Board Certified Lactation Consultant (IBCLC). Not all providers are equally skilled at diagnosing ties. Ask around and find someone who comes highly recommended.

Tongue tied baby examples and treatment options

Controversy

You know there’s always a controversy about anything relating to babies. Practitioners have varying opinions on the existence and treatment of ties. Some do not believe posterior ties exist or that lip ties can interfere with breastfeeding. Others acknowledge the ties themselves but argue with the stated complications they can cause. There are also different methods for treatment, specifically relating to how much tissue to cut when releasing the tie.

Here is one alternative viewpoint, to help you make an informed decision.

Various providers in the hospital setting dismissed my concern about a tongue tie because he could stick his tongue out of his mouth, despite the obvious forked appearance when crying. When I finally saw an IBCLC she immediately suspected a tongue and lip tie and referred us to an ENT who clipped it. The improvement in our breastfeeding relationship from that point was immediate and steady. More than two years later we are still successfully breastfeeding.

 

So, should I seek out a specialist?

During my search for information, I was continuously referred to the website of Dr. Bobby Ghaheri in Portland, Oregon. Much of his practice is dedicated to educating parents about tongue ties, both in person and via his website. I reached out and asked him if the type of provider matters.

“This is the hard part. We’d like to think that oral surgeons or ENTs or pediatric dentists are “specialized” and that it somehow makes them good at everything in the mouth. That’s very wrong. The issue is going to any ENT or any oral surgeon or any pediatric dentist – it’s finding the doctor in your locale who is familiar with ties. In some communities, that’s a pediatrician who knows how to do a full release. Or a NP or a PA etc. It’s more about the provider’s individual skills rather than a broad category of provider that’s important.”

For more information, see his list of helpful questions to ask potential providers.

Educate yourself

I also asked Dr. Ghaheri to tell me the number one thing he wished parents knew about tongue ties.

“The #1 thing I want parents to know is that it is quite possible that they will end up knowing more about tongue tie than their providers, whether it be pediatrician, family doctor, lactation consultant, dentist or ENT. The research on the impact of tongue tie on breastfeeding is relatively new and hasn’t entered most training programs. Most doctors don’t take the time to learn about it, so the support system (if you can call it that) is cobbled together by some people “in the know”. Basically, my advice is to keep looking for support until you get your questions answered, which may require seeing several people. Our definitions of tongue tie are changing based on new research, but doctors haven’t caught up yet.”

 

Treatment

The procedure to treat a tongue tie is called a frenuloplasty. The provider will use medical scissors, a scalpel, or a laser to sever the connective tissue and release the tie.

It only takes a few seconds and many babies cry more from being restrained than they do about the frenuloplasty itself.

After the procedure

  • There will likely be some blood — remember that when mixed with saliva, blood looks far more copious than it is.
  • You can generally try to breastfeed immediately.
  • Your baby’s mouth may be sore for a day or so. You can treat this with whatever over the counter painkiller your provider suggests.
  • To prevent to two sides of the open wound from reattaching, you will need to do frenulum stretching exercises many times a day for the first few days. This generally involves lifting the tongue or upper lip to keep the wounds separate. Your provider will give you exact instructions and you can find videos of the process online.
  • You may find immediate improvement of breastfeeding difficulties or you may need to work with a lactation consultant to help you train your baby how to use her newly mobile tongue correctly.

 

Tongue tied and lip tied baby examplesTongue tie treatment example

Takeaways

  • Tongue ties are a common genetic anomaly in newborns that may persist into adulthood if not addressed.
  • Ties are suspected causes of issues with breastfeeding, speech, and tooth decay, as well as self-confidence issues later in life.
  • There are several types of ties and not all providers are equally experienced with diagnosis and treating them.
  • Depending on the type of tie and the age of the baby, your provider may do the procedure in-office or refer you to someone who can.

Sally sells seashells by the seashore is a tongue twister that may leave you tongue tied but Akyloglossia is no joke. If you have a story to share, leave it in the comments!

Resources

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Having trouble with breastfeeding? Your baby may have a tongue tie. Here are the symptoms of what to look for (including pictures)

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6 Comments

  • My son had a very noticeable tongue tie from birth – had the forked apprentice and I saw it right away because I had one as a child myself. I had mine clipped at about 12 years old and it was pretty painful. The decision to get my sons done as an infant was upsetting but I knew it was best to do it now so he wouldn’t remember. Technology has come a looooong way and his was done with a laser! He had both a tongue and upper lip tie and the laser procedure was done in about 1 minute – not kidding! I immediately nursed him after and it was like night and day for breastfeeding. I highly recommend it for parents on the fence about it. It’s so great for the development of his teeth later in life as well. We had it done by a Pediatric Dentist who specializes in it – young doc who knew his stuff!

  • I struggled with shallow latch and painful nursing for 7 weeks when my friend brought up that my infant might be tongue or lip tied like her son. As soon as I googled it I realized that was most likely our problem. And after inspecting my husbands and my mouth we realized he had quite the lip tie! We live in Boston and so luckily there are quite a few doctors and or pediatric dentists that specialize in it so I took him to a pediatric dentist at 7 weeks. They confirmed he was lip and tongue tied and did a very quick laser procedure. I was able to nurse immediately after and I saw an improvement in his ability to latch properly. It got better and better over the next 3 weeks until it fully healed. The worst part is the exercises you do to keep it from growing back. It was definitely the answer to our nursing problems (and nursing finally became mostly pain free!)

  • Bravo!! 👏 This is one of the best summaries about tongue tie I have read. I was worried at first when I saw you did a post on tongue tie because there are so many skeptical opinions. I thought, “oh no, not another one” but this is fantastic. And Dr Ghaheri… 👏👏👏 so much love for that man! Thank you!

  • After two months of terrible nipple pain, mastitis, thrush, and weight loss for my son a lactation consultant finally caught a minor posterior tongue tie. I had seen four lactation consultants before who did not catch it! Such a quick and easy procedure to fix it (by a pediatric ENT) and we’re still very happily nursing pain free. My son was upset for a second and I immediately nursed him and it was like it never happened by the time I was done nursing. Do not hesitate to get it cut! It can be a seriously debilitating surgery if you have it done later in life.

  • Oh man did tongue tie ever mess with nursing for us!! My husband before we left the hospital was like “I think he has tongue tie.” And I was like “no way, he doesn’t.” Sure enough in 2 months time after some extreme nursing pain I came to the conclusion my husband had been right!! We got his tongue snipped and it helped a ton but his latch was permanently funky and I got blocked ducts at least twice a week until he weaned. SO catch it early (or just listen to your husband) and even ask at the hospital for them to check it if you want to be safe! It’s way more common than I realized at the time.

  • I halve learned several things regarding lip and tongue ties. First, you should always have the lip tie clipped because it will act as a muscle and move the front two teeth apart. I did not have mine clipped as a child and ended up with a gap. That is the first thing my dentist did when I was an adult and was pursuing veneers for my teeth. I had also had a tongue tie when I was born. My daughter had both a lip and tongue tie as well. We now know that this is a sign of the MTHFR gene mutation. This mutation can cause a person a plethora of other issues as well. I am living with it and take medication for it. If you’ve or your kids have any kind of ties, I would advise looking into the possibility of the MTHFR mutation.

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