Tongue Tie

Pediatric Tongue Tie

The medical term for a tongue tie is ankyloglossia.
This is a fairly common problem that presents at birth in some babies. It happens when the band of tissue (called a frenulum) under the tongue does not separate from the floor of the mouth. This causes a tight attachment and restricts the tongue’s normal movements. This condition can pose problems with breastfeeding and, if severe enough, speech later in life.

Some tongue ties are very obvious, and others are harder to diagnose as they are not as obvious appearing, but cause problems with breastfeeding down the road. Some tongue ties are more restrictive than others as well. We classify them into 4 categories-
- Here is a photo for reference:

Once a tongue tie is diagnosed on the baby's exam, we will score the tongue based on its shape, attachment to the mouth, lift, and protrusion.
- Here is another photo for reference:

A frenulectomy or frenotomy is the procedure that can correct a tongue tie. The pediatric dentist or ENT will use sterile scissors or a laser to cut the frenulum and allow the tongue to have unrestricted movement in the mouth. This procedure is quick, safe, minimally painful, and very effective. Infants will breastfeed almost immediately after this procedure is completed and the full recovery time is usually 24-48 hours or less.

Reasons to seek an evaluation for revision include (but are not limited to):
- Difficulty latching, causing nipple pain for breastfeeding parent once latched on, unable to transfer adequate milk from the breast, the nipple is lipstick shaped or pinched after feedings, or poor weight gain when exclusively breastfeeding.
Remember, some babies do just fine breastfeeding and speaking without any tongue tie correction, so in most cases we will wait and see how things go before sending for a consult.

These are some stretching exercises that we recommend to help prevent the tongue from re-adhering to the mouth:

Start with a gentle cheek massage, then place a finger in their mouth and allow them to start to suck.
Once they start to suck, pull their lower lip down and observe for cupping of the tongue around your finger. Then move your finger left, right, in and out, and aim for the tongue to remain suctioned to your finger. We call this a little “tug of war” with your finger and their tongue.
Lift their tongue to the roof of their mouth with both index fingers and hold. You will see a diamond shaped wound that typically looks white or yellow. That is normal. Make sure you’re pushing the tongue up, and not backward.
Then you can perform a finger sweep under the tongue, moving your finger back and forth while feeling for a smooth transition and separating the top and bottom of that diamond shaped wound.
Roll your finger back and forth on the lower gum line to encourage their tongue to follow, and help with strengthening the lateral movements of the tongue.
When they are sucking on your finger, turn your finger over so the soft pad of your finger presses down on the middle of their tongue, and allow them to push back up on your finger with their tongue, toward the hard upper palate. This will strengthen their tongue as well.