Tongue-tie advice and information
Tongue-tie occurs in about 10% of babies but left untreated, can lead to problems with feeding – including weight loss. Learning what a tongue-tie is and how it can affect babies might help you to spot the condition in your own child, find treatment and prevent unnecessary problems later on.
What is a tongue-tie?
A tongue-tie (also known, less snappily, as ankyloglossia) occurs when the piece of skin (lingual frenulum) that attaches the tongue to the bottom of the mouth is too short. This restricts the movement of the tongue. Tongue-ties can be visible at the front of the mouth where you’ll notice the tip of the tongue is connected by the piece of skin to the bottom of the mouth. Some tongue-ties are harder to spot, usually because they are at the back of the mouth, known as a ‘posterior tongue-tie’.
The condition varies in severity. Slight tongue-ties might not present any problems while severe ones can see the tongue completely attached to the bottom of a baby’s mouth, meaning he is unable to suckle.
Most tongue-ties are diagnosed in the first few months of a child’s life but some can go undiagnosed until much later and might not present a problem until your child is speaking. As tongue-ties are often missed, it’s difficult to say how many babies are born with one but experts suggest the figure is close to 10% of all children. Some evidence suggests that tongue ties may also be hereditary.
What are the problems associated with a tongue-tie?
Tongue-ties primarily cause problems with feeding. Occasionally a bottle-fed baby with a tongue-tie can have trouble feeding if the tie is severe but it is far more common for the condition to impact upon breastfeeding. In order to latch on properly during a feed, your baby needs to get a good mouthful of breast. The restricted movement associated with a tongue-tie can prevent him from opening his mouth widely enough to do this and means that he’ll be unable to feed properly. This can lead to poor weight gain in your baby.
A poor latch resulting from a tongue-tie can also cause problems for you including:
- Engorged breasts. This is as a result of your baby not ‘draining’ the milk efficiently during a feed.
- Low milk supply. Milk production works on a supply-and-demand basis. When your baby is feeding properly it sends the signal to your body to produce more milk. The opposite is true when he is not feeding properly – he won’t be emptying your breasts and consequently your body won’t know to produce more milk.
- Cracked or sore nipples. These can be caused by your baby sucking at your nipple rather than latching on effectively.
- You could also develop mastitis or blocked milk ducts as a result of your baby not feeding properly and emptying your breasts.
If a tongue-tie has been missed or left untreated, you may notice problems when your baby begins eating solid foods as he may struggle to chew properly. Delayed speech development when he is a toddler can also be linked to an untreated or missed tongue-tie and may mean your child struggles to form words.
How can I tell if my baby has a tongue-tie?
If you are concerned that your baby has a tongue-tie, then you should speak to your GP, health visitor or midwife. They’ll often diagnose it by sweeping a finger under your baby’s tongue.
Sometimes tongue-ties are picked up before you leave the hospital by a savvy midwife who has noticed your baby hasn’t latched on during breastfeeding but more often than not, diagnosis follows in the first few months. Signs that your baby has a tongue-tie include:
- Being able to see it. When your baby opens his mouth, check to see if the tip of his tongue looks slightly heart-shaped. Not all ties are visible, particularly those at the back of the mouth, but you may notice an obvious one.
- Restricted mouth or tongue movement. Your baby might have trouble opening his mouth or sticking out his tongue. If a health professional is assessing your baby for a tongue-tie, movement is one of the first things they will check for. If your baby’s tongue doesn’t touch the roof of his mouth or he can’t stick it out, a doctor is likely to consider this a strong sign of a tie.
- Even if your baby can initially latch on for feeding, you may notice that he has trouble staying attached during a feed and may break away regularly during feeding.
- Unsettled after a feed. If he’s not feeding properly, he may still be hungry.
- Poor weight gain. If your baby is having trouble gaining weight, make sure that your health visitor or midwife assesses him for a tongue-tie that may be interfering with feeding.
- Clicking noises or biting when feeding.
- Problems with breastfeeding. If you notice any of the problems listed above such as recurring mastitis or engorgement, then it’s worth investigating whether the cause could be a tongue-tie.
How is a tongue-tie treated?
If the tongue-tie is considered mild and not causing your or your baby any problems then you may be advised to forego treatment. Sometimes the condition can correct itself as the skin stretches out over time.
Where a tongue-tie is causing problems for either of you, treatment would be a ‘tongue-tie division’. This involves snipping the skin that attaches the tongue to the mouth, freeing it up and creating more movement. It’s a simple and quick procedure and can be carried out by anyone trained to do it, including midwives.
In many cases, the procedure is done without pain relief. This is partly because it’s over so quickly and partly because there are very few nerve endings in the bottom of the mouth, meaning your baby is unlikely to feel anything. You will need to hold your baby’s head very still during the procedure. If you prefer for your child to have pain relief, then young babies can be given a local anaesthetic to numb the area. You can usually feed your child straight after. Many mums report an immediate improvement in feeding, although it can take longer for babies who have had a severe tongue-tie.
Occasionally, a tongue-tie that is left untreated can cause speech problems for older children, particularly when they begin school or they are socialising more. If your older child needs to have a tongue-tie snipped, then the procedure is likely to be carried out under general anaesthetic as he’ll be more susceptible to pain.
Despite the commonality of tongue-ties, corrective treatment is not always readily available. You may have to wait a few weeks depending on which area you live in. While you are waiting for NHS treatment, you might want to consider mix feeding your baby. Combining bottle feeding with breastfeeding can help to avoid any further weight loss or breastfeeding problems. There are also private lactation consultants available who can carry out this procedure at your home or a clinic. If you can afford to do so, having the tongue-tie snipped sooner rather than later may be beneficial in terms of keeping breastfeeding going successfully.
You will normally be given exercises to do with your baby after the treatment and will be advised to feed him every two to three hours. This will prevent the snipped skin from reattaching.
What Mumsnetters say:
- “My daughter was eight weeks old when her posterior tongue-tie was divided. I had been hoping for the miraculous change that so many people on the internet reported, but actually it took around a month for her to relearn how to feed properly. My understanding is that the later the division takes place, the longer it can take for babies to get back up to speed. I'm still breastfeeding her a year later, so it definitely made a big difference.”
- “My son had his tongue-tie snipped at 18 months under general anaesthetic because he was older. My nephew had it snipped at a few weeks old and they did it in the clinic by swaddling him and snipping it – much quicker and less traumatic for all involved.”
- “My daughter had her tongue-tie cut at two weeks. I definitely think it was the right thing as she had a snake tongue from it. My husband has a tongue tie and didn't have his cut. He’s in his 30s and speaking clearly is still hard for him.”
- “I got my daughter’s tongue-tie snipped at 16 weeks. So, so glad I did. Feeding had been difficult but within about ten days it was so much better. She was also able to go longer between feeds, sleep better and had less painful wind.”