What is a tongue tie? CLICK HERE FOR PDF
Tongue Tie – also known as ‘Ankyloglossia’ or ‘anchored tongue’ – occurs in 3-10% of births but is often overlooked or goes undiagnosed. Tongue tie is a congenital oral anomaly that may decrease mobility of the tongue and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Severity varies in degree from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered (tied) to the floor of the mouth. Because it is a membrane, it does not stretch over time. It is often genetic and can often be seen in other family members. Some babies who have tongue-tie don't seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed. To breastfeed successfully, the baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage. The tongue needs full range of motion to create adequate suction to express milk from the breast. Breastfeeding works less like a straw and more like a vacuum for transferring milk. When the tie is severe enough to impact range of motion, children as also at risk for speech disorders such as a lisp, difficulties transitioning to solid foods, and an increased risk of dental cavities because their tongue cannot sweep food off of the teeth effectively.
If you're breastfeeding your baby and they have tongue-tie they may:
- Have difficulty getting a deep latch or staying latched for the full feed.
- Very long feedings. Unsettled and seems to be hungry all the time.
- Slow gain weight. Fewer wet diapers than anticipated. Not pooping daily.
- Gassy, fussy, and/or symptoms of reflux including excessive spit up
- Make a "clicking" sound as they feed – this can also be a sign you need support with the positioning and latch of baby at the breast
- Leaking milk from the lips while feeding from breast or bottle.
- Fatiguing, falling asleep, or “shutting down” at the breast
- Clamping/biting down or chomping on the breast, dimpling in the cheeks when sucking
- Lip blisters and/or two tone from compensating for the tongue with the lips
- White coating on the tongue from milk residue that gets misdiagnosed as thrush
- Having a high palate and/or a heart shape on the tip of the tongue
Tongue-tie can also sometimes cause problems for a breastfeeding mother. Problems can include:
- The nipple looks flattened or like a new lipstick tube when the baby comes off the breast
- Pinching, stabbing pain during breastfeeding resulting in sore,cracked, or damaged nipples
- Low milk supply caused by the baby not transferring milk effectively and not emptying the breast during feedings.
- Oversupply with very fast let down and the baby coughing and choking during let down
- Recurrent plugged ducts, milk blebs and mastitis
- Blanching of the nipple tip/vasospasm that gets misdiagnosed as thrush
ation of the breast), which may keep recurring
To be diagnosed, both the form and function of the tongue need to be considered. Form means what the tongue looks like and function is how it moves. There are four classes of tongue tie. Class 1 is where the lingual frenulum attaches at the very tip of the tongue and the tip of the tongue often looks like the top of a heart. Class 4, or posterior tongue tie, can only be seen by moving the mucous membrane under the tongue away and is the hardest to diagnose. If the lingual frenulum attaches to the tip of the tongue, but the tongue can still freely move, nothing needs to be done. If the lingual frenulum attaches in the middle of the tongue, but there is reduced range of motion, mom is experiencing nipple pain during feedings and her nipple is becoming damaged, if baby is not gaining good weight or making enough wet and dirty diapers during the day, the lingual frenulum causing the tie needs to be clipped or cut. This can be done by scissors, scalpel or laser by a highly trained pediatric dentist or ENT.
The upper lip also has a labial frenulum which can be tight or tied. Unlike the tissue under the tongue, the lip frenulum can stretch over time. Lip ties impact the ability to create a seal of the lips around the nipple reducing the ability to latch or stay latched during feedings. Everyone has a visible lip frenulum and diagnosis of upper lip tie is based more on movement of the lip and seal at the breast than how it looks.
When a tongue and/or lip tie are diagnosed and need to be treated, it is important to go to a preferred provider for the clip, called a frenotomy or frenectomy. Current research shows the sooner the tongue tie is diagnosed and clipped, the better the outcome for breastfeeding. In preparation for the procedure, chiropractic and/or craniosacral therapies may be helpful for preparing the body. Tongue stretches for coordination and range of motion are also helpful and recommended to be completed 4x per day:
- Slowly rub the lower gumline from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
- Let your baby suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
- Let your baby suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue. Alternatively, once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you.
- With one index finger inside the baby's cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.
- Videos for completing these exercises
Preferred Providers in the greater Los Angeles area:
Dr. Chelsea Pinto, DDS, Calabasas,310-272-5671
Dr. Bethany Kum, DDS, Altadena, 626-797-7551
Dr Alexis Rieber, ENT, Pasadena, 626-796-6164
Dr. Shari Carroll, DDS, Redondo Beach, 310-357-4414
Dr. Elena Rumack, DDS Encino, 818-943-8228
Dr. Tracy Tran, DDS, South Redondo/OC, 323-303-6291
Dr. Jessica Choi, DDS, San Marino, 626-360-4500
Dr. Kimi Marran, Redondo Beach, 424-352-1212
Dr. Jess Manske DDS, Beverly Hills, 424-322-4780
Dr. Anna Lee, DDS, Glendora, 626-335-5114
Dr. Brianne Hama, DDS, Torrance, 424-271-0661
Dr. Lydia Elias, DO, Torrance, 310-953-0020
Dr Mori Aletomeh, DMD, Torrance, 424-999-5478
Dr. Sandi Calleros, DDS, El Segundo 310-414-9564
Dr. Nina Yoshpe, ENT, Long Beach, 562-242-1312(medical)
Seastar Pediatric Dentistry, Cypress (714) 723-6271 (medical)
Dr. Abhay Vaidya, ENT, Thousand Oaks, 805-379-9646
Dr. Sherry Sami, DDS, Agoura Hills, 818-578-4894
After care : After the release by scissors or laser, it is very important to stretch the tissue under the lip and tongue to keep it from re-attaching. Here is my hand out that I give parents for what to expect post release: Tongue Tie Wound Care
Another video for how to complete the stretches is found on Dr. Chelsea Pinto’s website: HERE