What is a tongue tie?

A tongue-tie, medically known as ankyloglossia, occurs when the thin piece of tissue under the tongue (the lingual frenulum) is shorter, thicker, or tighter than usual, restricting the tongue's movement.

Tongue-ties are quite common and can range from mild to severe. For some babies, a tongue-tie may not cause significant issues, while for others, it has been thought to interfere with breastfeeding, speech development, or oral hygiene later in life.

However, according to a new report by the American Academy of Pediatrics, whether the release of a tongue-tie improves breastfeeding is not clear. Many of the symptoms of a tongue-tie overlap those of other breastfeeding difficulties. 

So if you’re told that your baby has a tongue tie, it’ll be crucial for your healthcare providers - including your pediatrician, lactation consultant, ENT specialist, and dentist - to work with you as a team to identify what’s best for your baby.

The challenge

There are no standard guidelines for diagnosing a tongue-tie, and there’s no agreement on how to treat it, leading to different approaches in the US and around the world.

Recently, diagnoses of tongue-tie and the number of surgical interventions have increased globally. Some doctors and researchers worry that too many infants and children may have surgical interventions for tongue-tie unnecessarily.

‍Current management options

Minimal interventions

For mild cases, minimal interventions can be effective. Lactation consultants may help you explore techniques to improve your baby’s latch during breastfeeding, which can reduce discomfort and help your baby get more milk.

Gentle stretching exercises, often guided by a specialist, can also improve tongue mobility over time.

Surgical interventions

For more severe cases, surgical options may be recommended. A frenotomy, a quick procedure involving a snip of the frenulum, is often done in infancy without anesthesia and requires minimal recovery time.

In severe cases or older children, a frenuloplasty may be recommended, which involves more complex surgery, stitches, and a longer recovery period. 

Factors to consider

When deciding how to proceed, several factors come into play. The severity of the tongue-tie and its impact on your baby should be carefully assessed. Healthcare professionals can provide recommendations tailored to your baby’s needs, but your personal preferences and values also matter.

It’s important to weigh the potential benefits of intervention against the risks or discomfort of any intervention. It’ll be important for your healthcare providers to work as a team to help you feel confident in the decision-making process.

Aftercare and recovery

If you choose a surgical option, aftercare plays a crucial role in ensuring a smooth recovery. Post-procedure stretches are often recommended to prevent the frenulum from reattaching. These exercises may feel daunting at first, but healthcare providers can guide you through them.

Monitoring your baby for signs of infection or discomfort is important, and follow-up visits with a specialist will help track progress.

Setting your baby up for success

Learning that your baby has a tongue-tie can feel overwhelming at first, but it’s a manageable condition with many options for support and treatment. By staying informed and working with your healthcare team, you’ll set your baby up for success, whether through breastfeeding support, other interventions, or simply monitoring their development.

Additional resources:

• ‍Pediatricians Warn Against Overuse of Tongue-Tie Surgeries (New York Times)