Tongue Tie in Babies

Welcome back or hello to the first timers!!

Now let’s talk Tongue Tie!!!

Though, I offer several services many of the enquiries I receive are infant feeding and tongue tie related. There are many debates surrounding tongue tie and how effective it is and whether it is just a new ‘fad’, which is commonly stated. The opinions amongst healthcare professionals fluctuates enormously regarding the diagnosis and treatment. This is due to a lack of extensive evidence-based research to develop an optimal management tool, creating a uniformed approach in assisting families¹. Consequently, resulting in contradictory information and advice being given to families, leaving them vulnerable on their infant feeding journey.

Tongue tie has been recognised for approximately 500 years²; with approximately 4 – 11% of babies currently being reported to have a tongue tie³. However, those figures reported are not reflective of the number of families we are seeing with tongue tie or oral dysfunction. In Brazil, infants are routinely screened for tongue tie, and they have a reported occurrence of 32.5%.

Tongue tie or Ankyloglossia as it is also referred to; is caused when the sublingual frenulum (a fold of mucous membrane that extends from the floor of the mouth to the underside of the tongue³) restricts the movement of the tongue consequently impeding its function¹. The aetiology of tongue tie is uncertain, though genetics has been identified as having a role in this midline anomaly³. To effectively feed the tongue moves using a peristaltic wave against the breast or bottle, which enables the release of milk. A tongue tie hinders this; consequentially effecting milk release and in some circumstances triggering friction resulting in trauma and sore nipples³. The suck, swallow, breathe mechanism is an innately established and fundamental reflex for infant feeding and survival⁴, allowing them to extract milk whilst coordinating their ability to swallow and breathe, enabling a protected transfer of milk and maintenance of their cardiovascular system.

The best management of tongue tie is highly debated, with several tools available⁵. These classification tools include The Bristol Tongue Assessment Tool (BTAT), Tongue Tie and Breastfed Babies tool (TABBY), The Hazelbaker Tool (ATLFF), and the Martinelli. The TABBY and Martinelli tools use visual representation to assess the frenulum; this provides most healthcare practitioners with the skill to assess using a more user-friendly tool with limited subjectivity⁶. Equally the main aim of assessing a tongue tie, is to identify if the structural position of the frenulum restricts the tongues’ ability to function optimally and this cannot be assessed by observation alone. Thus, meaning these tools cannot be used in isolation⁶. The ATLFF not only assess appearance but also the function of the tongue. The only restriction of this tool is its inability to be used on babies over 6 months as some of the reflexes assessed have started to dimmish by this age.

Part of the problem with assessing and having a timely referral for tongue tie is a lack of understanding, as well as a lot of the signs and symptoms being disregarded as normal baby behaviour. I think it is also key for practitioners and healthcare professionals to listen to parents concerns and instincts and parents if you feel that something is not right with your baby’s feeding, eating or sleeping habits get another opinion. The list of signs and symptoms on my website will help to aid you to see, if any of them pertain to your family. Tongue tie can have an enormous impact on a dyad whether breast or bottle-feeding⁷. The limited research and disjointed opinions amongst healthcare professionals means that these families can have delayed assessments and treatments. This results in the premature cessation of breastfeeding and misdiagnose of other conditions such as reflux, allergies, or normal infant behaviour. Thus, resulting in stress, anxiety, and trauma for the feeding dyad.

Go with your gut parents and healthcare professionals if you are not trained to assess please refer to someone who is!

References

1 (Lefort, et al 2021) 2 (Obladen 2010) 3 (O’Shea, Foster, O’Donnell 2017) 4 (Geddes, Sakalidis 2016) 5 (Ferres-Amat, et al 2016) 6 (Ingram, et al 2019) 7 (Muldoon, et al 2017)