Tongue Tie, or ankyloglossia, is caused by a short or tight lingual frenulum under the tongue. This is a fold of fascia which runs uninterrupted from the tongue to the toe.

 

A Tongue Tie can be classified in various ways including anterior (front), midline (middle) or posterior (back), or by % tied. 100% tied is anterior, 50% is midline or less that 25% is posterior.

 

The severity of a Tongue Tie is not defined by its tie location or the %, instead it is to do with the impact on the function of the tongue.

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I use the Hazelbaker ATLFF tool. This is the only assessment tool to provide quantitative results that are valid and reliable.

 

Research currently suggests that around 1 in 10 babies may be born with some membrane present under the tongue, around half of those have impaired tongue function needing division. (Research shows the incident range is anywhere between 2-11%).

A tied tongue can affect the function of the tongue. A fully moving tongue is able to move side to side (lateralisation), up and down (lift), in and out (extension), as well as cupping (suction on sucking) as well as rhythmic movement (peristalsis).

 

If one or more of these movements are impaired, then feeding can be affected.

 

For the baby:

• Short and frequent feeds

• OR long feeds 

• Aerophagia causing colic or reflux symptoms 

• Difficultly latching to the breast/chest and staying attached 

• Unsettled and unsatisfied 

• Dribbling 

• Clicking sounds heard when feeding (this is called SnapBack when the tongue looses suction and drops back to the floor of the mouth) (Seen with bottle feeding too)

• Weight issues. Weight loss at the start (could exceed 10% loss), slow weight gain, or weight plateau 

 

For the feeding parent:

• Pain on latching, or throughout the feed 

• Misshapen – wedge or lipstick shaped nipple after a feed 

• Milk blebs, blocked ducts or mastitis 

• Milk supply can be affected 

Firstly, you do not need to do anything. It is your decision to make as a family, taking into account everyone’s thoughts and feelings on the matter.

 

Sometimes some simple changes to position and attachment at the breast/chest is enough to reduce comfort for the feeding parent. The laid back, koala or side lying positions can really help. 

 

A division, or Frenulotomy is sometimes needed. This is a small and quick surgical procedure to cut the frenulum and allow better movement and function of the tongue.

 

Bodywork or muscular release - If you baby has Tongue Tie, they will almost certainly have some element of muscular tension. There are 8 pairs of muscles controlling the tongue, so if the tongue function is impaired then the body compensates and uses the muscles in a different way to help them feed.

You baby will need some muscular release before a division and continued for several weeks afterwards. Sometimes, muscular release is enough to free the tongue and improve the function without needing a division.

 

The key to this decision is working out how sustainable your current situation is.