Ankyloglossia, commonly known as tongue tie, occurs when a baby is born with an unusually short, tight frenulum, that is, the band of tissue that connects the underside of the tongue to the lower part of the mouth.

This causes the tongue to not be mobile enough for the baby to attach properly to the breast, creating breastfeeding problems.

How tongue tie affects feeding

A baby requires good tongue function to be able to suck milk, whether from the breast or bottle. However, if the tongue is anchored to the floor of the mouth because of a tongue tie, they are restricted in their movement to suckle. Breastfeeding a baby with a tongue tie often results in problems such as nipple-feeding, when the nipple is not drawn into the baby’s mouth far enough, potentially damaging the woman’s nipple, inhibiting milk transfer to the baby, who is not receiving enough milk, and possibly even causing blocked ducts. Tongue tie also affects bottle-fed babies’ ability to get the nourishment they need.

Signs of tongue tie

If your baby’s tongue cannot extend beyond their lips, can’t move sideways, or its tip appears notched or heart-shaped, it’s possible that they have a tongue tie. Another sign to look for is if the tip of the tongue, when extended, looks flat or square instead pointed.

While these are the physical signs of tongue tie, if you, while breastfeeding, also notice nipple pain or damage, constant loss of suction on the breast or bottle, or if you keep hearing a clicking sound, it’s possible that the baby is not being able to suck well due to a tongue tie.

Finally, if you’re breastfeeding, the biggest signs of tongue tie to look out for is poor weight gain in the baby, because they’re not able to suckle enough milk, along with a decrease in milk supply. The latter is caused by a lack of stimulation, since the baby’s latch on the breast is poor; stimulation prompts and sustains milk production.

Long-term effects of tongue tie
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Long term, tongue tie can affect speech development. Children with tongue tie are unable to seal the tongue with the palate behind the upper front teeth — this same movement is behind t, d, r, th, sh and l speech sounds, which may therefore cause words to be mispronounced. Tongue tie can also cause the lower front teeth to be crooked, since the it can be accompanied by a tongue-thrust habit, putting force on the lower front teeth causing them to be crooked.

How to treat tongue tie

It is often the lactation consultant who is the first to discover a tongue tie, when mothers reach out for help upon noticing a low milk supply or sore nipples.

Tongue tie is normally treated as a minor, out-patient procedure performed by an ENT specialist or a pediatric dentist, who helps release the tongue tie by clipping the frenulum. A scalpel, scissor or laser maybe used for this procedure, know as a frenectomy (or frenulectomy or frenotomy).

After a couple of hours, the baby maybe sore and, hence, may be fussy or refuse to feed, but basic analgesic medication prescribed by the pediatrician can help ease this soreness.

One can nurse immediately post this procedure. Although most women will be able to notice a difference in the baby’s suckling and feeding mechanism at that point, many babies do require time to figure out what to do with the new mobility of their tongue. When the tongue tie is released, the baby has no muscle memory of how to use their tongue without the restriction there; it takes time for the brain to rewire itself and for the baby to figure out how to suck effectively once the frenulum has been clipped. It can take babies up to two to three weeks to master their tongues, and feed without problems, even if they have breastfed well immediately after the clipping.