Tongue Tie: How to Check Your Baby (and How to Fix It)

Despite colloquial use of the term, tongue tie isn’t solely related to speech. Infant tongue tie can cause a host of issues for both mama and baby, and all too often results in an unwanted end to breastfeeding.

Fortunately the solution is simple. Read on and see if you may have a tongue tied baby and how to resolve it.

What Is Tongue Tie on a Baby?

A tongue tie is when the band connecting the tongue to the bottom of the mouth, is too tight, too thick, or both. (The medical term for tongue tie is ankyloglossia.) It restricts the tongue’s range of motion, and can cause difficulty for babies when they feed.

What Causes Tongue Tie?

Studies suggest baby tongue tie is an inherited condition, but there isn’t concrete data to explain exactly why the tongue sometimes forms this way.

There is some evidence that the MTHFR gene plays a big role in the formation of the mouth, including infant tongue tie. This study reported that those with certain MTHFR mutations have a sevenfold risk of developing a cleft palate. Though there is still much to be learned about MTHFR mutations, researchers believe this genetic mutation is more prevalent in Caucasian and Asian populations, slightly rarer in Amerindian populations, and significantly lower in Black populations.

How Common Is Tongue Tie?

An estimated 4-11% of infants have a tongue tie, however the condition is commonly misdiagnosed, so this number could be higher. Interestingly, tongue tie is more common in boys. 

A tongue tie is often, but not always, accompanied by a lip tie, a condition where the piece of muscleless tissue connecting the upper lip to the upper gum restricts the mouth’s mobility, because it’s too thick, too tight, or both.

If Your Baby Has a Tongue Tie Does That Mean He/She Has a Lip Tie?

If baby has a tongue tie, it does not automatically mean he/she has a lip tie. My daughter Paloma, for example, who was examined by one of the best tongue tie/lip tie specialists in the U.S., did not have a tongue tie yet had a lip tie.

Experts say the tongue and the lip develop at different times and by different processes in utero. There is a reflex that links the tongue and the lip, which can make it challenging for baby to move one independent of the other. This phenomenon has probably increased the belief that most babies have both a tongue tie and a lip tie. It’s always a good idea to get your baby checked for both, since these conditions do accompany each other. Tongue ties affect breastfeeding more, while lip ties can increase susceptibility to tooth decay.

How to Tell If Baby Is Tongue Tied

Unless a tongue tie is severe, it often goes unnoticed and undiagnosed by many healthcare practitioners—even your pediatrician. Talk to a lactation consultant or a holistic dentist if you notice the following signs:

If baby is tongue tied, mama may

If baby is tongue tied, they may

  • Have trouble lifting the tongue up or from side to side
  • Have a tongue that appears heart shaped or notched in the middle
  • Dribble milk down the side of their mouth when feeding
  • Display excessive fussiness and/or colic
  • Have digestive issues like gas, reflux, and possibly vomiting
  • Pull off the breast/bottle, crying, hitting or tugging while nursing
  • Make clicking or noisy sucking sounds
  • Chew on the nipple or chomp down hard
  • Fall asleep while nursing (although many babies do this!)

What Does Tongue Tie Look Like?

There are four different classifications of tongue tie. Typically you’ll notice that the band under the tongue is tight and/or thick, though appearance depends on severity:

  • Class 1: The tongue tie is located at the base of the tongue halfway to the salivary duct.
  • Class 2: The tongue tie is located between the back of the salivary duct halfway to the base of the tongue.
  • Class 3: The tongue tie is located from the salivary duct halfway to the tip of the tongue.
  • Class 4: The tongue tie is located at the tip of the tongue and extends halfway between the salivary duct and the tip of the tongue.
Tongue Tie - Classifications

(image source)

How to Get Baby’s Tongue Tie Diagnosed

Your child’s pediatrician can look at your baby’s mouth to check for tongue tie, but some doctors are not trained at diagnosing a tongue tie (or its severity). The best ways to confirm the condition is to get a consult with:

  1. An International Board Certified Lactation Consultant (Find one near you here.)
  2. A Holistic Dentist (Find one near you here.)

Does a Tongue Tie Affect Breastfeeding?

Breastfeeding is possible, but it will likely be very difficult and painful, especially in the more severe cases. These researchers reported that out of 302 infants with breastfeeding difficulties, a whopping 57% had a tongue tie.

The degree to which a tongue tie affects breastfeeding depends on the severity, plus other mama/baby dynamics including nipple shape, alertness of the child, palate shape, and more. Some mama’s have very few symptoms, but their baby is plagued by issues, or vice versa.

“The thickness, shape and percentage length of the tongue tie were not predictors of success or failure… This suggested that the function of the tongue (the symptoms themselves) produced by a combination of tongue, mouth and tongue tie is more important than simply the appearance of a tie.” — Dr. Griffiths for the Journal of Human Lactation

If a tongue tie is interfering with baby’s ability to eat and causing mama pain and/or frustration, it may be best to work with a holistic dentist. If left untreated, it could lead to baby not getting enough nutrition, low breastmilk supply, cracked/sore nipples, and other issues. Here are some natural ways to help you cope in the meantime:

  • Use a nipple salve or healing salve on the nipples and areola between feedings. Here’s my recipe for all-purpose salve.
  • Pump and give baby a bottle if breasts are very sore and the pain is too much.

Can Tongue Tie Cause Speech Problems?

Even if baby is nursing fine now, speech issues may arise later in life.

The tongue is one of the most important muscles for speech and swallowing. (source)

Though some children won’t have any problems with speech, others may have trouble articulating certain sounds, especially ones that include l, r, t, d, n, th, sh, and z. In infancy, there is no way to tell whether or not a tongue tied baby will develop speech problems, though these characteristics are common signs of a problem:

  • V-shaped notch at the tip of the tongue
  • Inability to stick out the tongue past the upper gums
  • Inability to touch the roof of the mouth
  • Difficulty moving the tongue from side to side

If your child reaches the age of 3 and those outside of the family still have trouble understanding his/her speech, consult a speech language pathologist or a holistic dentist. 

Can a Tongue Tie Cause Tooth Decay?

If uncorrected, tooth decay, particularly in a baby’s molars, is possible. This happens because baby doesn’t have enough tongue mobility to sweep their mouth clean, causing milk to puddle.

Due to the restriction or pressure caused by tongue tie, baby may also develop gum recession, gaps between the upper and lower teeth, and tissue sensitivity.

To prevent tooth decay, Dr. Kotlow, a pediatric dentist, recommends parents pay extra attention to oral hygiene once teeth erupt, making sure there’s no residual milk in the baby’s mouth after feedings.

If your child’s teeth have white spots or discoloration, call your dentist, as this could indicate worn enamel.

Tongue Tie Surgery

If baby is feeding without any problems, experts say a tongue tie revision may not be necessary, however is probably a good idea due to decay and speech issue risks later in child’s life.

If a tongue tie is affecting baby’s ability to eat effectively, you may want to consider a revision, no matter what class of tongue tie baby has. 

For the most accurate assessment, a holistic dentist should examine the suspected tongue tie. The procedure is generally simple and safe, but it’s even more so when the child is still an infant. Older children may require general anesthesia during the procedure. (source)

What Happens During a Tongue Tie Revision?

Thanks to technology, the treatment is now less painful and more accurate. Dentists used to use scissors, but most doctors now use a laser treatment that reduces bleeding and is less traumatic for baby.

“Lasers are bacteriocidal, usually bloodless; do not require placement of sutures, anesthetic free (most dentists do use pain relief though), fast and a safe alternative for infants.” — Dr. Kotlow

A tongue tie revision takes just a few minutes. Here’s what you can expect:

  • The mom lays on the dentist chair holding her child
  • The dentist applies a topical numbing agent (EMLA is safest for infants,though proceed with caution) under the tongue (avoid general anesthesia)
  • About 30 seconds later, the dentist uses a small handheld laser (a strong-beamed light that can cut tissue quickly and relatively painlessly) to precisely “cut” the tongue tie
  • The baby can then nurse or be comforted by mom
  • The dentist will reviews post-op instructions, like pain relief measures and important post-procedure exercises

How to Help Baby Heal Naturally After a Revision

Some babies won’t show signs of discomfort, while other babies may need consoling and pain relief. The good news is the mouth heals quickly—baby should be back to normal within 48 hours.

Offering natural pain relief is still a good idea though. Here are some ways to help baby:

  • Nurse or feed baby immediately after the procedure for comfort
  • Do skin-to-skin
  • Ice the area
  • Apply a small dab of refrigerated coconut oil to the area
  • Administer Arnica Montana 10-30C to help with pain, discomfort, and inflammation
  • Have baby wear an amber teething necklace to promote a healthy inflammatory response.
  • If baby is experiencing extreme discomfort, some moms may choose to administer stronger pain relievers, like Tylenol or Ibuprofen, under the doctors care.

The Importance of Post-Procedure Exercises

Most dentists will give parent exercises to do with baby to keep the effects of procedure in place. It’s important to do these diligently. The band will reattach to some degree, but the idea is for it to regrow longer and thinner. If the tongue tie reattaches too tightly, then the procedure will need redone.

Tongue Stretch

  • Wash hands thoroughly
  • Lay baby in your lap, with his/her feet away from you.
  • Apply coconut oil to your finger, then place your finger under baby’s tongue.
  • Gently massage the area under the tongue back and forth for a few seconds, then move it as high as it will go. Stretch the tongue upwards for a few seconds.
  • Finish by massaging the area under the tongue back and forth for a few more seconds.

When to Call the Doctor

Complications are rare with laser tongue revision and generally involve some minor bleeding and discomfort. Call your doctor if: 

  • Baby is extremely upset and normal pain relief methods (arnica, breastfeeding, skin to skin, etc.) aren’t cutting it.
  • There are signs of infection, like fever, swelling around the revised area, excessive sleepiness or restlessness.
  • Excessive bleeding. Some bleeding after stretches is normal as the fibers are being broken apart, but excessive bleeding is not normal.

What This Means for You and Your Baby

A tongue tie can cause a lot of stress for a new mama and her baby, especially if it isn’t diagnosed right away. To prevent unnecessary struggle, get your baby checked by a lactation consultant or a holistic dentist as soon as you suspect an issue. And remember: A tongue tie is very treatable. A tongue tie revision can be done with minimal pain, and can make a world of a difference for you and baby. 

How About You?

Did/does your baby have a tongue tie? How did you know? How did you resolve it?

 

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