June 10, 2016
ARTICLE:

Tongue-Ties in Newborns

By Chris Toumpas

PIP-Tounge-tie-Large

A tongue-tie (ankyloglossia) is a short, thin piece of skin under the baby’s tongue (lingual frenulum) which restricts the movement of the tongue and can potentially limit a baby’s ability to attach properly when breast feeding. A baby with a tongue-tie may not be able to protrude the tongue beyond the lips or the tongue tip may be notched or heart shaped. It occurs in about 2-5% of babies depending on the classification system used and tongue-ties can run in families. Babies with a lingual frenulum can attach and breast feed well. Tongue-ties can improve without treatment by the age of two or three, but they can also cause problems such as nipple damage and infection and reduced milk supply for mothers and poor feeding or a clicking noise while feeding for babies.

 

The controversy:

There is a great deal of controversy surrounding tongue-ties. In fact, it is an epidemic problem. This is compounded by the lack of good quality research into the different types of tongue-ties and long term outcomes with various treatments. It is therefore very important to talk to an experienced doctor and lactation consultant about breastfeeding problems as early as possible to monitor and treat potential problems and assist with breastfeeding establishment. They will be able to check the tongue and attachment and provide the best advice about treatment options based on the best research. A doctor can discuss treatment of a classic tongue-tie (ankyloglossia). This involves snipping the thin piece of skin under the tongue in a procedure called a frenectomy (see below). There is no high quality, placebo controlled studies regarding diagnosis and treatment for other types of tongue-ties (e.g. posterior tongue-ties) and lip ties. There is insufficient evidence to suggest treatment of tongue-ties improves speech and language development. (1)

 

Treatment:

If a classic tongue-tie is interfering with breastfeeding, then a frenectomy may improve attachment. (2) It is common to have a small amount of bleeding following the procedure. A frenectomy can be done quickly by an experienced doctor. During the procedure, the baby is most uncomfortable by being held and having a finger in the mouth. The baby quickly settles after the procedure. There is no anaesthetic required for a newborn, sucrose can be given for comfort and breast feeding straight after the procedure is beneficial. A difference may be noticed straight away or take a few days for the most improvement.

Please see this link from Dr Pamela Douglas for a concise overview of tongue-ties with links to further information.

The Speech Therapy Department at the Royal Children’s Hospital in Melbourne has further information regarding tongue-ties and speech in this link:

http://www.rch.org.au/uploadedFiles/Main/Content/speech/RCH_speech_path_Tongue_tie_presentation.pdf

 

References:

1 Treatment of Ankyloglossia for Reasons Other Than Breastfeeding: A Systematic Review, Chinnadurai, Pediatrics, June 2015, Vol 135 / Issue 6

http://pediatrics.aappublications.org/content/135/6/e1467

2 Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review, Francis, Pediatrics, June 2015, Vol 135 / Issue 6

http://pediatrics.aappublications.org/content/135/6/e1458

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