When faced with the question "Does my baby have a tongue tie? Do they have a lip tie? What about buccal tethering?" the amount of information you’ll find around this issue can feel overwhelming. You may find yourself wondering what they are, if they’re a big deal, and what to do if your baby has them.
What is a Tongue-Tie?
A tongue-tie occurs when the frenulum, a thin piece of tissue under the tongue, is unusually short and tight. This can restrict tongue movement, impacting functions like feeding and speaking. Along with tension under the tongue, oral tethering or tightness can be present in many areas through the mouth. The most common types of oral tethers are:
- Tongue-tie (ankyloglossia): A restricted frenulum under the tongue.
- Upper lip-tie: A tight frenulum limiting upper lip movement.
- Buccal tie: Tight tissue restricting cheek movement.
How Does Tongue-Tie Affect Feeding?
First, let’s talk about how the tongue works when your baby is feeding. During sucking while feeding, the tip of the tongue makes a cupping motion, this forms a tight seal around the nipple or bottle. The middle and back of the tongue then have a wave-like muscular contraction (called peristalsis) that draws the milk into the mouth. Swallowing then involves the whole tongue elevating to push the milk towards the back of the mouth. During this swallowing motion, we have folds that stop the milk from travelling up into the nasal cavity and a flap called the epiglottis that stops milk and other food from getting into our airways.
This sucking and swallowing requires a lot of coordination in your baby. If oral tethering is stopping the tongue from cupping, having full peristalsis, or good elevation/lift, it may get in the way of how well your baby is able to feed.
Newborns: Tongue-tie can make breastfeeding or bottle-feeding challenging. Signs to watch for include:
- Difficulty latching or staying latched
- Clicking sounds during feeding
- Short feeding sessions with poor weight gain
- Frustration and fussiness during feeding
- Shallow or chompy latch
- Gas, colic, reflux issues
- Breathing difficulties, such as snoring or congestion
- Lip blisters
- Open mouth posture at rest
- Minimal tongue lift when crying- may look cupped or curled
- Heart-shaped tip on the tongue
Mothers: What to look out for with breastfeeding:
- Pain with latching or during feeding
- Blanching, creasing, or flattening of the nipples
- Poor drainage, blocked ducts, or mastitis
- Premature weaning, maternal anxiety around feeding
Older Infants: Difficulty with solid food intake due to limited tongue movement.
Fussy Feeding, Gas, and the Frustration Cycle: When a tongue-tie hinders effective sucking, babies may struggle to transfer enough milk during breastfeeding. This can lead to frustration and frequent feeding attempts, which in turn can cause them to swallow more air. This trapped air can contribute to gas, discomfort, and increased fussiness. The cycle of inefficient feeding, air intake, and fussiness can be a major source of stress for both babies and parents. Early identification and management of tongue-tie can help break this cycle, promoting better feeding experiences and potentially reducing gassiness and fussiness.
Vagus Nerve Function and the Suck/Swallow Reflex:
The roof of the mouth contains nerve fibres connected to the vagus nerve. This nerve plays a vital role in digestion, heart rate, and overall well-being. As mentioned above, the suck/swallow reflex is a complex process involving coordinated movements of the tongue, lips, and throat. When the tongue elevates and presses against the roof of the mouth, it stimulates the vagus nerve, promoting a parasympathetic state – the body's "rest and digest" mode.
Conversely, difficulties with suck/swallow due to oral tethering may disrupt vagus nerve function and potentially contribute to a more sympathetic state – the body's "fight or flight" mode. Some studies suggest a possible link between oral tethering and issues like reflux or colic, which may be related to this imbalance in nervous system activity (1).
You may also notice that your baby sleeps with their mouth open. This tells us that the tongue is not resting on the roof of the mouth during sleep, which may negatively impact breathing, palate development, and quality of sleep.
How Does Tongue-Tie Impact Other Development?
Pressure on the roof of the mouth from the tongue contributes to optimal palate expansion and jaw development in infants and young children. Reduced or dysfunctional tongue movement can affect the proper development of the oral cavity, jaw, and sinuses. As far as dental development goes, this may lead to gaps between front teeth with a lip tie; conversely, with a tongue tie, we may see crowding of the teeth due to poor palate development. With a tongue tie, we may also see an open bite (upper and lower front teeth don't meet when closed), difficulty with swallowing, poor sinus development, and/or challenges with breathing.
The tongue also plays a role in helping our sinuses drain well. If we have poor tongue function and movement, this can lead to poor drainage of the sinuses. A buildup of mucus in the sinus cavity creates an excellent environment for bacteria to grow.
Tongue movement also plays a crucial role in forming specific sounds. Speech delays or difficulty pronouncing certain sounds (t, d, l, s, z) may occur with a severe tongue-tie.
Assessment and Diagnosis
A visual and hands-on examination by a paediatrician, dentist, paediatric chiropractor, or lactation consultant (IBCLC) can often find tongue-ties and other oral tethering. Simply having tension present in the oral tissues does not necessitate the diagnosis of a tongue tie. Other factors that are taken into consideration include the combinations of infant and maternal symptoms, outcome of the IBCLC consult, and the visual and physical assessment.
In some cases, a frenotomy (clipping or lasering the frenulum) or a frenectomy (removal of the frenulum) may be recommended. However, it's important to note that not all tongue-ties require intervention; if we are still having good tongue movement and function, the oral tethering may not be causing any issues.
Head to Part 2 to learn about tongue-tie management and individualised care if your child has a tongue tie.
References
1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390887/
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