As a grandmother, I raised my children quite a few years ago, and I never heard of tongue tie. These days, I hear about it often. What is tongue tie? And is it a new problem, or has it always been an issue but people were unaware of it?
Heather McCormick, a
speech therapist and certified lactation counselor who works at the Tethered
Oral Tissues Clinic (TOT) at Kennedy Krieger Institute, explains that tongue
tie (or ankyloglossia) is a term used to describe functional impacts when the
tongue does not move freely in the mouth because the frenulum, that thin strip of tissue connecting the tongue and the
floor of the mouth, is tight or shorter than normal. “Tongue ties can
also occur with lip ties (under the upper lip) and buccal ties (in the cheeks),”
she says. “The term Tethered Oral Tissues (TOTs) is the umbrella term that
includes all of these. Assessment of TOTs is based on how the baby is
functioning, not how the frenula look.”
Tongue tie was often not recognized because, in the
past, many mothers did not nurse their babies. Chani, now a great grandmother,
says. “I was determined to nurse my children. This was back in the early ’60s,
and my parents were very upset. Nursing was considered primitive in the 1940s
and 1950s. It was more ‘scientific’ to sterilize bottles and give formula. My
parents worried that my baby would be hungry because I was unable to measure
the amount of milk he was getting.”
Sarah and Kayla,
mother and daughter, described their experience. Sarah says, “I thought that
tongue tie was a new invention and probably a hoax. Then my grandson had
trouble learning how to talk.”
Kayla continues,
“Tongue tie often shows up when the baby has trouble nursing. I bottle-fed my
son, so the tongue tie did not affect his ability to suck. When he was about 18
months old, he did not talk at all, although he understood speech very well,
and I started to be concerned. After taking him to speech therapy and to an
ENT, we decided to have the minor surgery. We had to do it in the hospital
because he was not a baby anymore. Miraculously, he started speaking right
away.”
Amazed at how quickly
the speech problem was solved, Grandmother Sarah says, “I guess tongue tie is
not a hoax!”
*
* *
Heather McCormick
helped me understand some of the issues that relate to tongue tie: First is
trouble nursing. “TOTs are not the only reason babies struggle with feeding,”
she says, “but the rise in tongue tie diagnosis and treatment is most likely
attributable to the increase of nursing and increased awareness of the impact
of TOTs on feeding and development.”
“I was determined to
nurse my children,” says Chani, now a great-grandmother. “This was back in the
early ’60s, and my parents were very upset. Nursing was considered primitive in
the 1940s and 1950s. It was more ‘scientific’ to sterilize bottles and give
formula. My parents worried that my baby would be hungry because I was unable
to measure the amount of milk he was getting.”
A baby with tongue
tie may be very fussy and cough or choke while nursing. He may have poor weight
gain. He may only be comfortable nursing on one side. Some babies develop asymmetrically
and are stiff. Tongue tie can affect development as the child grows up, too.
According to Heather, “There has been a lot of interest recently in the
long-term impacts of TOTs on development. Some possible long-term impacts
include articulation issues, airway and sleep disturbance, differences in
facial development, and postural issues.”
Dina, a speech
therapist, sometimes sees children who are affected by tongue tie. “Older
children sometimes cannot say certain sounds. They may have more cavities in
their teeth because their tongue does not move efficiently though the mouth.”
When a baby is
newborn, tongue tie can be treated very easily, says Heather. “As far back as
the 16th century, if a baby struggled with nursing, a midwife
would use a sharp fingernail to cut the tongue tie. Nowadays, many babies with
functional impacts from TOTs undergo a frenectomy. It is a minimally invasive
procedure that is done in-office without sedation, in which a provider (often a
pediatric dentist or ENT) removes or modifies the frenulum using scissors, a scalpel,
or a laser. The baby can nurse immediately afterwards. Some families see immediate
improvements after release, but some babies benefit from pre- and
post-procedure treatment.
“Families who are
nursing should also work with a lactation consultant who is knowledgeable and
experienced in TOTs,” Heather continues. “If they think their baby is being
impacted by TOTs, they should seek out a knowledgeable and experienced provider
– often a speech-language pathologist, occupational therapist, physical
therapist, and/or lactation consultant – to have a functional assessment to
determine the need for treatment.”
*
* *
Making the decision
to treat a tongue tie is only the first step. Sometimes the tongue tie grows
back, and sometimes other problems reveal themselves.
Miriam, a young
mother who brings her baby to Heather McCormick’s clinic, shares what she
learned through her experiences with her three children, all of whom had tongue
tie: “I first heard the term when I had difficulty nursing my first child and
went to see a lactation expert,” says Miriam. Here is what she learned along
the way.
1) “Go to a provider
who focuses on wound care,” says Miriam. “My first two children’s tongue tie
grew back because proper wound care was not taught. When I got my third child’s
tongue tie removed, I thought it was growing back three weeks later. The doctor
was able to push away the re-growth with his finger, and it then healed
beautifully.”
2) “Go
to a provider who specializes in body work. Tongue ties can cause problems with
tone in the body. My first child had a low tone and never learned how to crawl
because of it. My second child screamed while taking bottles for most of her
bottle career. This was because her whole body tensed up while trying to help
her tongue work properly.
3) “Tongue
ties can cause problems when learning how to eat solid food. If the baby was
not used to feeding with the nipple far back in the mouth (babies with tongue
tie often prefer bottles with a small nipple or have a shallow latch while
nursing), they may gag when presented with solid food. Feeding therapy can help
the child use his mouth properly so this does not occur.
4)
“I wish someone told me that babies with tongue tie are at risk for not having
good tongue resting posture. It is important that our tongue is suctioned to
the top of our palate because it promotes nose breathing. My first two babies
became addicted to their pacifiers and even kept it in their mouth while
sleeping. This can cause a lot of problems down the line, such as possible
sleep apnea or even ADHD symptoms due to lack of sleep quality. You can check
your baby’s tongue resting posture by pulling down on his chin while he is
sleeping and seeing if his tongue is suctioned to the roof of the mouth.”
Miriam
is happy to speak to others about her experiences and can be contacted at adswww@aol.com. For more
information about the TOT Clinic and Heather McCormick, M.S., CCC-SLP,
Speech-Language Pathologist and Certified Lactation Counselor, contact:
Tethered Oral Tissues (TOTs) Clinic, Kennedy Krieger Institute. Referral line:
443-923-2638.
