Tongue Tie Infants /

Feeding Concerns

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Tongue Tie in Infants

Tongue ties have associated tight muscles and joint dysfunction that affect the baby's ability to suck, swallow or breath, in some feeding positions. For example, if the temporal mandibular joint of the jaw (TMJ) is restricted, the baby cannot open wide. This can lead to a shallow latch, or the baby slipping off the breast or compression of the nipple.

If muscles of the jaw, mouth, or tongue are tight, their function is weak. Weak muscles have less endurance. Babies will get tired and sleepy at the breast as they get tired from working too hard to drink milk.

Tongue-tie (ankyloglossia) is a problem that is present at birth. It happens when the tissue that attaches the tongue to the bottom of the mouth (lingual frenulum) is too short. This can limit the movement of the tongue.

The restriction caused by a tongue-tie can lead to changes in the development of the mouth, face, and skull, and are often accompanied with an open mouth posture or mouth breathing in children. This can in turn lead to symptoms including speech difficulties, ADD and ADHD, sleep disordered breathing and conditions such as sleep apnea, and jaw and facial pain/tension.

What are some signs and symptoms of a tongue restriction?

  • Shallow latch

  • Short time between feeds

  • Clicking while feeding

  • Difficulty latching on or sucking from the breast

  • Mother in significant pain while nursing

  • A baby who constantly fusses at the breast

  • Milk leaking out of the sides of the mouth

  • Poor milk transfer, poor weight gain and failure to thrive in an infant

  • V-shaped or heart-shaped notch at the tip of the tongue when it’s stuck out

  • A toddler’s difficulty in licking a lollipop or ice cream cone, touching the roof of their mouth, moving their tongue from side to side, or sticking out their tongue past the upper gums

  • Enunciation problems that continue after age 3, especially when articulating these sounds: t, d, l, r, n, th, s, and z

  • Persistent dental problems, such as a gap between the front lower teeth and tooth decay or gingivitis (gum inflammation) because your child can’t get rid of food debris naturally with her tongue

  • Difficulty chewing age-appropriate solid foods

  • Gagging or choking on foods

  • Persistent dribbling/drooling


What is a Frenectomy?

A frenectomy, also referred to as frenulectomy, frenuloplasty or functional frenuloplasty is a simple incision into the connective tissue at the bottom of the tongue to free the tongue from the floor of the mouth. This involves removing or altering the connective tethered tissue under the tongue. In the majority of cases, the procedure is done using local anesthetic as general anesthetic is rare with this procedure. The procedure is low risk and can be performed with a laser, a scalpel, or scissors. When it’s done by laser, no sutures are required. With a scalpel or scissors, sutures will be placed to help the wound heal. Wound healing usually takes one to two weeks, although it may take longer. 

what should you do when your baby is tongue tied

Has your baby had a tongue tie release surgery that was unsuccessful? 

We see this quite often with babies/toddlers that get tongue tie releases at an early age without preparation and optimal timing. The orofacial muscles and connective tissues require therapeutic measures to reduce compensations and optimize functional movement. This can be assessed and addressed up until the age of 12 months. An examination by a Myofunctional Therapist can take place once again at the age of 3-4 years old. If the tongue has some re-attachment and still presents with a restriction, myofunctional therapy can be introduced with the possibility of a frenectomy revision.

Pre and post operative myofunctional therapy is essential for optimal recovery and to achieve the desired results.