How Tongue Tie in Children Can Affect Their Development

The medically termed condition ankyloglossia or in layperson language known as ‘tongue-tie’ is a congenital condition which some babies go through. The tongue is a vital organ which facilitates the movement of food during chewing and assists in the process of swallowing. The  tongue also plays an important role in speech and tasting of food. When babies are born with a tongue tie, their tongue cannot move as flexibly as required. This restricts tongue movements, making it difficult to reach each and every part of the mouth. As parents, if you observe that your baby has difficulty in speech, it may be due to a physical condition such as a tongue tie where the tongue is too short and tight. An experienced ENT doctor can help with an evaluation and address this condition.

Based in Singapore, The ENT Clinic is a specialist ENT center which caters to both pediatric and adult ENT disorders for citizens and tourists visiting the Little Red Dot. The ENT physicians at this medical practice are well versed in handling ENT issues in children and you can be assured that your child is in the best hands at their practice locations at Gleneagles Hospital and Mt. Elizabeth Novena Specialist Center. As the ENT Clinic  practices evidence based medicine, this clinic has access to the latest ENT medical diagnosis and treatment methods.

What is tongue tie?

Tongue tie is a condition where the lingual frenulum is restricted in movement. The frenulum is the small piece of tissue which connects the tongue to the bottom of the mouth. We all have a frenulum, but the length and thickness can vary from child to child. At times a baby’s frenulum is too short and tight that it is almost invisible. When this occurs the tongue is not able to move freely which results in a tongue tie. Around 5% to 10% of children have this congenital problem of a tongue tie. However, half of these babies can still breastfeed as usual. The rest may face difficulties in bottle or breast feeding. Children with tongue tie can have trouble eating food and speaking due to restricted tongue movements.

What causes Tongue Tie?

Prior to the baby being born, the lingual frenulum separates from the tongue. However, at times this may not occur due to unknown reasons. It may be genetic; boys have a three times higher chance of developing tongue tie than girls.

What are the signs that a baby’s tongue tie is causing problems?

If your baby’s tongue tie is causing it difficult for the baby to latch during breastfeeding, then you will notice some of these signs:

For the baby

  • The baby will have difficulty staying latched for a complete feed
  • The child may be fussy during feeds and unsettled
  • Clicking or slurping sounds may be heard when feeding
  • Urine output of babies maybe low
  • Weight gain in children will be slow or even a loss in weight observed
  • The baby will be seen unsatisfied with the feed and remain hungry despite frequent feeds

For the mother:

  • The mother may find it painful when breastfeeding
  • Sore, cracked and bleeding nipples is usual
  • Insufficient milk levels to meet the baby’s changing needs

Issues related to breastfeeding are not only due to a tongue tie. You may also want to check if your baby’s tongue is not moving far from side to side or the baby is not able to reach the roof of the mouth or if it has trouble  sticking out the tongue past the gums.  In addition if there is a V shape at the tip of the tongue when sticking out then an assessment by an ENT doctor is useful.

How is a tongue tie diagnosed?

To diagnose a tongue tie your ENT will conduct a physical examination to see what is going on. The ENT doctor will place a tongue depressor to take a look into the motion of the tongue.  In addition, he may want to know how the child is feeding.

What complications can a tongue tie bring?

An untreated tongue tie can lead to poor oral health. It can lead to dental caries, swollen and irritated gums. When your child starts solids, there is a higher risk of choking on foods and children will find it difficult to do basic things like licking on an ice cream. Children may also have trouble pronouncing sounds with the letter r, d, s, t, n and z. At the ENT clinic you can discuss with the doctor on when it is best to do a correction for this condition.

What are the treatment options for tongue tie?

There are two main ways to treat a tongue tie as listed below:

Frenotomy: This is a basic procedure which happens at an ENT center. This does not require any numbing agents. The ENT doctor will use a clean pair of sterilised scissors  to cut the frenulum. As this part of tissue doesn’t have many blood vessels or nerve endings there is not much pain. Only a few drops of blood may be released. Following the cut, the mother will be asked to breastfeed the baby to calm the baby and heal the wound.

During these procedures most babies show very little distress but they may be upset as they are wrapped tight and held firm to prevent any wiggle. Generally within the first 2 months this procedure will be done. However, if the baby has a more complicated tongue tie then it has to be treated under general anaesthesia by an ENT surgeon.

Frenuloplasty: This procedure is done when the frenulum is too thick for a quick snap. In this case the ENT surgeon will treat under anaesthesia using special tools to cut the frenulum. A few dissolving stitches may be used so that the wound can heal on its own. Alternatively a laser may be also used for the cut and in this case the child does not need any stitches.

What is to be expected after the tongue tie release?

After performing the tongue tie release, many babies will start breastfeeding and some mothers will notice the difference right away. However, others need a bit more time to relearn breastfeeding. If the baby is over 2 months then it may take a few days to possibly some weeks to see the difference.

What are the risks of tongue tie treatment?

During most instances both frenotomy and frenuloplasty are successful interventions which help with speech, dental or eating problems due to tongue tie issues. However at times there is the risk of bleeding, infection or damage to the tongue or salivary glands. Frenuloplasty may also result in scarring in your child’s tissues and the child may also have a drug reaction to the anaesthesia given.

The otolaryngologist will take a call if an immediate intervention is needed or it’s better to wait and watch as some tongue ties may loosen up over time on its own.