Q: What exactly is a tongue tie? ​

The lingual frenulum is a small fold of mucous membrane that extends from the floor of the mouth to the midline of the underside of the tongue. Find your own lingual frenulum by looking in the mirror, opening you mouth, and stretching your tongue towards the palate. See the whitish cord beneath your tongue? Ankyloglossia or tongue tie, is simply a lingual frenulum that is tight enough to restrict the movement of the tongue. It is a congenital oral anomaly caused by an unusually thick, or unusually short, lingual frenulum.

Q: Can you describe the treatment for a baby that is tongue tied? Does it hurt?

The infant frenectomy is a straightforward outpatient procedure that can be completed during the same visit as the initial assessment. If a release is recommended, the treatment takes only a few minutes and a baby can go to the breast immediately following. The baby is swaddled and safety goggles are always used to protect baby’s eyes - I use a pen-sized laser on infants to remove the tight lingual frenulum. I apply an effective topical anesthetic gel on the frenular tissue prior to treatment, allowing for zero to minimal discomfort during the procedure. The anesthetic lasts for approximately 30 minutes.

Q: If a tongue tie is left untreated, can it have any effect into childhood and adulthood?

Yes, indeed it can. Untreated tongue ties in infants can lead to difficulty chewing and swallowing firmer foods, altered jaw and dental development including a high palate and narrow facial structure, poor sleep patterns, mouth breathing, and increased gas and bloating resulting from poor tongue coordination and corresponding swallowing of air. Significant ties may result in delayed speech development due to the tongue being restricted in movement. Also, when tongue movement is restricted, the tongue cannot sweep across tooth surfaces and spread saliva, both crucial to oral cleansing.

Q: What types of breastfeeding issues may mothers of tongue tied babies experience?

Studies have shown that an infant with ankyloglossia can have issues latching, gaining weight, creating suction and staying awake during feeds due to the extra exertion required. In addition, mothers with infants who are tongue tied may experience significant pain in their nipples, to the extent that they can become cracked and abscessed. If symptoms including inadequate latch, poor breast draining, painful nipples and/or fussiness at the breast have not improved and a lactation consultant is concerned about a possible tongue tie, she will refer over mom and baby.

Q: How do you correspond with lactation consultants before and after treatment? ​

My goal during the first visit is to gather as much information as I can about the specific breastfeeding issues mom is facing. Therefore, prior to an initial consultation appointment, I am in contact with the lactation consultant working with mom and baby in order to gain background knowledge on their sessions together. This allows us to work together to best gauge a baby's progress in nursing.

I work with a number of reputable lactation consultants in my community who are comfortable in assessing oral restrictions. When communicating with moms pre-treatment, I cannot stress enough the importance of continued lactation support following the frenectomy procedure.

Q: What happens after the procedure?

Breastfeeding is encouraged immediately following the procedure, however typically there is a healing period that your infant must undergo before the full benefits are realized. I teach each mother proper active wound management and daily stretching exercises in order to facilitate healing. As explained in another post, I cannot stress enough the importance of continued lactation support following the frenectomy procedure. Post-treatment follow up is just as important as pre-treatment care. 

I send a detailed report of my assessment and/or procedure to the lactation consultant and stay up to date with baby’s progress after our 4-day follow up. Baby will continue to build strength over the healing period and will require further guidance on developing positive breastfeeding habits.

It is not only the tongue and jaw that prove to be key components in breastfeeding but in fact, the whole body. For this reason, tongue tied babies often have additional structural stressors to be addressed and I will recommend taking baby to see a bodyworker, a licensed professional such as an occupational, craniosacral or physical therapist. Bodywork encourages body awareness and encourages an infant to express postural reflexes and explore natural movement inclinations through the nervous system. After a tongue tie release, the infant's tongue will need to adapt to a new and profound range of motion. ​