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What is a tongue-tie and how it can affect breastfeeding?

A short and/or tight lingual frenulum restricting tongue mobility. The frenulum is a piece of membrane connected from the floor of the mouth to the tongue. The incidence of tongue-tie varies from about 2 to 12 percent.

Very obvious tongue-tie type 1.
Tongue-tie type 1

How does tongue-tie affect breastfeeding?

The tongue plays a major role in feeding. When baby is breastfeeding or bottle feeding he or she needs to use his/her tongue in order to create a seal either around the breast or bottle and create a vacuum in order to remove milk efficiently. The peristaltic movement of the tongue pushes the milk back into the mouth and assists the swallowing reflex. Some babies who have restricted tongue mobility struggle with the feeding process.

Tongue-tie often causes ineffective milk removal that, in turn, leads to milk stasis. Mothers may experience engorgement, plugged ducts, or other forms of breast inflammation associated with milk back-up and their milk supply will be affected in the long run. Babies may experience compromised weight gain, slow feeding, or frustration during feeding; they may refuse to feed altogether. 

Some babies will not be able to latch on and create a seal while others will keep slipping off the breast. Some babies will learn to compensate for their handicap by using their gums instead of their tongue to create a seal which will be painful for the mother and her nipples will get sore

Babies who are bottle-fed may also experience feeding difficulties. They may take a long time to finish a bottle or take a bottle too quickly and end up choking, spluttering, coughing or leaking milk from the corners of their mouth.  

Some babies can also suffer from colic or reflux as a consequence of a tongue-tie as they are struggling to coordinate the complex process of breathing, sucking and swallowing. 

Can tongue-tie cause a problem when my baby gets bigger?

It is very difficult to tell if your baby's tongue-tie will cause any problems in the future.  It all depends on how severely the tongue's mobility is affected. 

Tongue-tie can also contribute to the formation of speech articulation errors, oral cleanliness compromises, and suboptimal formation of the jaw and mouth. Compromised orofacial development may possibly lead to long-term dental and airway integrity issues

Potentially, social issues may arise from tongue-tie: embarrassment; self-esteem compromise; social sensitivity; and difficulty engaging in the activities of daily living such as playing certain musical instruments and licking the lips, lollipops, and ice cream cones. Little research quantifies these issues. Despite the lack of research evidence, anecdotal reports show that these issues can have a profound impact on the individual, and should be seriously considered when making treatment decisions. 

Although more research needs to be done to confirm this hypothesis, infancy still appears to be the ideal time to treat tongue-tie. Early treatment may prevent the development of problems later in life when treatment is much more complex and invasive. 

What is the treatment for tongue-tie?

Scissors used to divide a tongue-tie together with retractor which might be used, but might not.

The procedure for the treatment of tongue-tie is called frenotomy (also called ankylotomy, clipping, division, frenulotomy). The procedure utilizes a pair of scissors to incise or cut through the lingual frenulum. It is a quick procedure performed without any anaesthesia and can be performed at home. There is usually little blood loss and your baby will probably cry for few minutes after the procedure. 

No anaesthesia is necessary as it is not possible to inject the frenulum. Injecting the floor of the mouth and tongue would cause more discomfort than the frenotomy. Although the babies object to being held still, the entire procedure takes only seconds. 

What to expect after the procedure

Healing after the division.

The risk of heavy bleeding is very low, 1 in 100 000. The risk of infection is 1 in 10 000 according to a South Hampton study. No other complications were recorded. 

Your baby might be a little bit unsettled for a couple of days, however from my experience, babies are more upset after their first vaccination than a frenotomy. 

If your baby is over 8 weeks old you can give them Calpol. 

A white or yellow looking blister will appear on the following day which is a normal process of healing. 

If your baby feels hot, check his or her temperature. If the temperature is elevated it is a sign of an infection. It is important that you take your baby to your GP, walk-in clinic or A&E as soon as you can.  

In 2 percent of cases, the bottom of the tongue gets fused to the floor of the mouth. Encouraging your baby to stick his or her tongue out can prevent the tongue from fusing back. 

There are 4 different types of tongue-ties

Here are some examples:

Type 4 (posterior tongue-tie)

Type 1

Type 2

Type 1

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