Do you think your baby or toddler has a tongue tie?
Are you having problems with breastfeeding? And nothing you’ve done has made any difference.
Does your child have issues with their speech, or with eating? Are their teeth crowded, or do they snore? Are there other breathing issues when they sleep?
In this article we’ll cover:
What is a tongue tie?
How and why do they occur?
What effects can a tongue tie can have on your baby or child?
What can be done about it?
Now, let’s be honest: all of the problems above can be caused by lots of different things.
What I’m hoping to show is that an untreated tongue tie can be a factor in all these issues, sometimes significantly!
Here's what to look for, so you can address it.
Ankyloglossia: what is a tongue tie?
The technical term for a tongue tie is ankyloglossia.
Beneath the tongue is a band of tissue called the lingual frenulum. This connects the tongue to the floor of the mouth.
A tongue tie is when this tissue is broader, thicker or tighter than it should be. This then restricts the normal movement of the tongue.
There are similar bands of tissue that attach the upper and lower lips to the gums. It is possible for the upper lip to be restricted by being tethered to the gum. A cheek can also be tied to the gum.
All of these together are called oral restrictions.
How common are tongue ties?
It’s estimated that between 4% to 10% of babies are born with a tongue tie. That’s up to one in ten.
The way that a tongue tie is assessed in babies is not standardised. There are quite a few different methods, and the approaches vary a lot. Some methods only look at the baby, while others take into account the experiences of the breastfeeding mum - something I think is very important.
So it’s possible the percentage of babies born with a tongue tie may actually be larger than estimated.
How oral restrictions form
A tongue tie forms while the baby is in the womb. It is there by the end of the first trimester. The same is true of lip and cheek ties, they don’t form later. So if your baby or child has a tongue or lip tie, it has been there since birth.
Right, we’re going to get technical for a short while, but I promise only a little bit.
When you fall pregnant, and an egg is fertilised, the first thing to happen is that there is a huge amount of new cell growth. Basically, a big ball of living cells grows, called a blastocyst. At certain points, this ball of cells needs to form into different parts. The embryo and the placenta form separately out of the blastocyst. The embryo itself then begins to form into a foetus, which is where it becomes more recognisable as your baby. A part of this process is where certain parts or tissues are reabsorbed by the developing foetus, to help create the final shape of your baby’s body. When this happens in the mouth of your unborn baby, that’s when the tongue, jaw, lips, etc, start to form more clearly.
If some of the tissue beneath the tongue is not reabsorbed as fully as it should be, the tissue beneath the tongue will be thicker and tighter than normal. This is when a tongue tie forms. It’s the same process for lip ties.
Why oral restrictions form
There is currently no clear consensus on why tongue ties occur. It is worth saying that it’s not the fault of the parents.
Here are a few of the current theories on why tongue ties form:
Genetics and folate
Pregnant women are routinely advised to supplement with vitamin B9 in order to prevent the possibility of their baby developing spina bifida. The most common way to do this to date is by taking a synthetic form of B9 called folic acid.
There is now some suggestion that folic acid may have an effect on the growing foetus’s development by changing the way certain genes are expressed during development in the womb, giving rise to a greater number of tongue and lip ties forming.
While there is no clear evidence to support this, some now suggest that increasing the intake of B9 in its natural form, called folate, instead of folic acid, may help address this.
Dietary folate intake comes from green leafy vegetables, fresh fruits, and seafood, among other things. Supplementing with B9 during pregnancy is still recommended, and you can get folate supplements for a bit more than folic acid usually costs.
Better care for babies with tongue ties
In the past, babies with severe tongue ties may have had such difficulty breastfeeding that they may not have survived. With the advent of formula and bottle feeding, babies were able to get the necessary sustenance despite the presence of a tongue tie, and so survived.
If tongue ties have a genetic cause, then these babies will then grow into adults, and in turn pass on the genes for tongue ties to their kids. So the prevalence of tongue ties has increased over the years. We now need to catch up in terms of appropriate recognition and treatment of ties that affect function and health.
Iodine deficiency
There is some suggestion that a lack of sufficient iodine during development may give rise to a greater incidence of tongue and lip ties. How this happened exactly is not entirely clear.
That’s enough of the technical stuff.
What is the tongue used for?
To understand what can go wrong when your tongue can’t work properly, you first need to know what roles your tongue plays when all is well.
The tongue plays an important role in a large number of activities:
Breastfeeding
The movement of the tongue is integral to the development of normal reflexes related to being able to breath, suck and then swallow, a cycle that is vital for effective breastfeeding.
Development of the face and jaw, and dental alignment
Upwards pressure from the tongue spreads out the hard palate, allowing the upper jaw to reach an appropriate breadth. This provides space for the teeth to grow appropriately, and for the airways in the nose above the hard palate. The tongue, if restricted, will also limit the growth of the lower jaw.
Eating
The tongue moves food around the mouth, and is instrumental in helping to clean the mouth after swallowing food.
Speech
If you can’t move your tongue properly, it can be hard to speak clearly. Difficulties with speech can in turn give rise to various psychological and social stresses, impacting quality of life in lots of ways.
Breathing
Proper tongue function is important for helping maintain the airways and therefore assisting with respiration. Poor tongue function can contribute to the development of conditions such as sleep apnoea, which in turn can have a vast impact on overall health.
Effects of oral restrictions in babies - what to look out for
If the list of things that the tongue plays a role in above is any guide, then you’ve probably already guessed that the effects of a tongue tie or other oral restriction can be pretty broad.
Here’s a list of some of what you might see in a baby:
Breastfeeding issues
Difficulty latching
Noisy feeding - pops, clicks, air sounds
Slips off the nipple after latching
Gumming or chewing of the nipple during feeding
Long feeds (up to an hour or more, sometimes!)
Excessive wind - burps and bottom burps
Blistering of the top lip
Flat upper lip during feeding
Can’t make it through a feed - falls asleep
Strong gag reflex
Signs of colic or abdominal distress
Reflux symptoms
Green poo
Short sleeps
Snoring or sleep apnoea
General fatigue or listlessness (sometimes a parent will talk about how well their baby sleeps, but the reality may be that the baby is exhausted from the effort of trying to feed with a tongue tie)
Postural asymmetries - always lying with the head turned to the same side, lying with a bend in the body
Pale, cold and clammy extremities, or in rare cases where breathing has been significantly affected, blue lips (this is known as central cyanosis. It can be caused by a number of things other than a tongue tie, and is serious)
It’s also important to take into account what’s going on for the breastfeeding mum too. Here’s some of the ways a tongue tie in your baby can affect you:
Impact on the nipples, such as:
Creased or flattened nipples during/after feeding
Cracked or blistered nipples
Bruised or bleeding nipples
Painful breastfeeding
Having to use a nipple shield
Poor drainage of the breast
Mastitis or nipple thrush
Low milk supply
Anxiety, stress, guilt or depression
A tongue tie can have a big affect on both baby and mum! If left untreated, oral restrictions can have implications into childhood, adolescence and adulthood.
How to treat tongue and lip ties
If a tongue or lip tie is affecting function, then the obvious treatment is to release the tie.
Beyond that, there may also be a need for rehabilitating movement and muscles, which can often be aided by manual therapy.
In babies, the assistance of a lactation consultant to help re-establish good breastfeeding can be hugely beneficial. In older children and adults, a speech therapist may be useful, too.
Let’s look at these more closely.
First, the release. This is usually a simple and quick procedure. It is typically performed either using surgical scissors to cut the tissue, or with a surgical laser to ablate (heating and vaporising) the tissue. There are benefits to both.
The main benefit of a release with scissors is that it is very quick. A single snip is enough, if performed correctly and well.
Lasers do take longer, but the procedure should last under a minute in most cases. There is also less chance of infection and inflammation with laser ablation. Importantly, because of this, there is also less chance of reattachment, which means you’re less likely to have to perform another release. Finally, because you can very specifically ablate small amounts of tissue at a time, you can often get much deeper under the tongue to the trickier “posterior” tongue ties, without damaging the nerves and blood vessels located there.
There are actually quite a few practitioners in Canberra with experience in detecting and releasing tongue and lip ties. At the time of writing this article, we work commonly with two practitioners in the region:
Dr Sarah Bombell is a GP who focuses on womens’ and childrens’ health. She is an IBCLC (international board certified lactation consultant), and has a wealth of experience managing a wide range of breastfeeding issues, including the division of tongue and lip ties. She is primarily based in Queanbeyan at the GP Superclinic.
Dr Linh Nguyen is a dentist in Kaleen, with a focus on laser dental surgery. She has a broad range of experience diagnosing and releasing oral restrictions by laser, as well as other dental and airway dysfunctions. She is the principal practitioner at Kaleen Laser Dental.
How can a chiropractor help with a tongue tie?
Next, let’s talk about why you might also pursue manual therapy or exercise rehab.
Anyone with a tongue or lip tie can develop some kind of compensation for this in their posture, the way they move or breath, or the tension in muscles in their mouth and face all the way to their neck and the rest of the spine.
Sometimes simply releasing the restriction will be enough for things to settle into a better way of functioning, but at other times some additional help can make all the difference.
A manual therapist with additional training and experience in paediatrics (and tongue ties) can do the necessary work to help release any built-up musculoskeletal tension associated with your baby’s tongue tie.
In older kids, adolescents and adults, a chiropractor or other manual therapist can help to identify and improve muscle imbalances, unhelpful movement habits and poor posture.
Depending on their training and experience, they may also be able to address any other related issues, such as regular headaches, poor balance, etc.
Orofacial myofunctional therapy (OMT)
Another component of correcting these poor habits in children and adults may require Orofacial Myofunctional Therapy (OMT), or Oral Myology (same thing, by the way). OMT involves a course of rehabilitation to correct poor function of the tongue, lips, mouth and jaw.
This can include the way you move all these parts of your face and mouth, but also the way you swallow and sometimes how you breathe. There can be some benefits in engaging in OMT in the lead-up to and following the release of a tongue tie in kids and adults. Some myofunctional dentists will offer this service, but other allied health professionals may have the necessary training to do so too (shameless plug: our principal chiropractor at Thrive Canberra, Dr Sam Bettison, has completed his OMT training).
In addition to this, if a tongue tie in a child or adult is affecting their speech, they may benefit from seeing a speech therapist too.
Lactation consultant for tongue ties
When breastfeeding is affected by a tongue or lip tie, then the help of a qualified lactation consultant (IBCLC) before and after releasing the tie can be pivotal in re-establishing good feeding technique and patterns.
Also, when breastfeeding is a struggle, it’s not uncommon for the mum to benefit from a bit of support, and a good IBCLC will be right on board with this.
Again, Canberra has a few qualified IBCLCs. We’ve had lots of positive experiences working alongside Mel Pearce and Ali Teate at Care Midwifery.
Can a chiropractor help your baby?
Contact us or book an appointment at our clinic in Canberra.