Tongue-tie is the non-medical term for ankyloglossia, which comes from the Greek words ankylos, meaning “curved” or “crooked” and glossa meaning “tongue”. A relatively common congenital anomaly, tongue-tie impedes tongue function with an unusually thick, tight, or short lingual frenulum. (Hall DM, 2005)
Tongue-tie can disrupt breastfeeding causing many issues from occasional discomfort to extreme pain in a mother. Mothers often report raw, cracked and bleeding nipples and lip blistering is very common in babies, whether breast or bottle-fed. (Genna, 2013) Babies usually suffer from a myriad of issues that often include reduced sleep, slow weight gain, failure to thrive, colic and digestive issues and can be plagued with hiccups and reflux symptoms.
When identified early, many of these issues may be avoided with a simple procedure, called frenectomy, when performed by an experienced, knowledgeable medical provider and so long as specific and adequate aftercare is also carried out. (Praborini, 2015) Even older children benefit from this procedure. (Baxter, 2020)
There are several different methods used to release tongue, lip and buccal-ties, the most common being scissors, dating back to the 1600’s (Obladen, 2010), and more commonly used today are electrically charged lasers such as the Co2 Laser. (Fernando, 1998) There is much controversy surrounding the different tools and methods used to release ties. However, one of the most important aspects is how thorough the release of the ties. (Hall DM, 2005)
Clear evidence suggests breastfeeding success appears to be most often directly related to the full release of the tie or ties. The fibrous attachment beneath the tongue must be released at least enough that it becomes a diamond shape allowing far greater tongue movement including the ability to lift which is necessary and vital in breastfeeding and proper swallowing. (Genna, 2013)
Once the tongue has been fully released it then becomes the responsibility of parents and caregivers supported by their healthcare provider, usually an IBCLC, to keep the area from healing too quickly allowing for healing by secondary intention. (Devishree, 2012) This can be difficult since the mouth heals very quickly, therefore instructions for aftercare management of healing should be carefully followed.
Many experts agree and recommend the release of tongue and/or lip-ties that restrict proper function. It is current best practice to incorporate appropriate physical therapy for commonly associated and sometimes very obvious (but not always) but often restricted neck and jaw muscle tension that nearly always exists due to the nature of ties. (Genna, 2013), (Bickford, 2014)
Mothers can experience all of the many health benefits of breastfeeding their babies if they ‘insist on diamonds’, and are consistent with aftercare as it can be considered a shortcut to comfortable and successful breastfeeding.
René Moore is a registered IBCLC in private practice in Phoenix Arizona. Her interest and passion for breastfeeding began in 1996 upon becoming a mother. In 2000 she became a La Leche League Leader and still leads local meetings for groups she started in her area, then also became an International Board Certified Lactation Consultant to be able to help more mothers, babies and families. She’s been performing in-home lactation consultation visits for well over a decade and regularly attends procedures when requested by parents and welcomed by providers.
She believes that restrictive tongue/lip-ties are much more common than statistics suggest and that there are likely millions of adults completely unaware that issues they might be suffering with may be associated with undetected or under diagnosed tethered oral tissues.
American Breastfeeding Foundation is dedicated to providing access to education and lactation care to ALL vulnerable breastfeeding families. If you are struggling with breastfeeding or have questions, American Breast Feeding Foundation is here to help.
References
1. Hall DM, Renfrew MJ. Tongue tie: Common problem or old wives’ tale? Archives of Disease in Childhood 2005. 90:12-11-1215. https://pubmed.ncbi.nlm.nih.gov/16301545/
2. Watson Genna, C. (2008). Supporting Sucking Skills in Breastfeeding Infants. Sudbury, MA: Jones and Bartlett.
3. Coryllos E, Watson Genna C, Salloum A. Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics 2004 1-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082757/
4. Clinical Lactation, 2015, 6(1), http://dx.doi.org/10.1891/2158-0782.6.1.9
5.Richard Baxter, DMD, MS1 , Robyn Merkel-Walsh, MA, CCC-SLP/COM2,3, Barbara Stark Baxter, MD, FACP4, Ashley Lashley, BS1, and Nicholas R. Rendell, MSc, PhD5 Clin Pediatr (Phila). 2020 Sep; 59(9-10):885-892. doi: 10.1177/0009922820928055. Epub 2020 May 28. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study, https://pubmed.ncbi.nlm.nih.gov/32462918/
6. Northcutt, ME. Overview: The Lingual Frenum. JCO, 43(9), 557-565. Fernando C. Tongue Tie – From Confusion to Clarity;A Guide to the Diagnosis and Treatment of Ankyloglossia. Tandem Publications, ISBN: 0646352547
8. J Clin Diagn Res. 2012 Nov; 6(9): 1587–1592. Published online 2012 Nov15. doi: 10.7860/JCDR/2012/4089.2572
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