Most people have probably heard the term ‘tongue-tied’ used to describe someone who is speechless, confused or tripping over their words. While the expression touches on a potential outcome of tongue-tie, it doesn’t explain what it actually is. Tongue-tie is particularly meaningful to me because my third son suffered with it. He also had a lip-tie. Double whammy. Both are poorly understood conditions, and not one many expectant parents worry about.
Tongue-tie is a congenital abnormality present at birth. It is medically known as ankyloglossia and is characterized by an unusually short, thick frenulum. The frenulum is that band of tissue that connects the underside of your tongue to the bottom of your mouth. If you look in a mirror, pull your lower lip down, and curl your tongue up, you’ll see it. Tongue-tie is when that ‘membrane’ is short and thick.
Oftentimes, tongue-tie leads to decreased mobility of the tongue that may affect things like sucking, chewing, and speech development. It can also lead to difficulties with breastfeeding. For me, breastfeeding pain was the first clue that something was wrong after my littlest boy was born, but more on that later.
Lip-tie, less well known than tongue-tie, is a similar condition. A lip-tie affects the band of tissue (the labial frenulum) that tethers the upper lip to the upper gum. You can feel it when you run the tip of your tongue along your upper front gum area. Most people have some degree of tissue there, but lip-tie occurs when this membrane is large and tight. This can lead to gapped teeth and can prevent the upper lip from spreading out to the extent needed for breastfeeding.
A doctor, nurse, or midwife will screen newborns for tongue-tie shortly after birth; this as part of their routine checks. That said, some cases go undetected even with screening, which was the case for us. This article shares the learning I took away from the experience with my son in the hopes of educating expectant and new parents about the condition.
7 Tongue-Tie Can Be Difficult to Diagnose
Some cases of tongue-tie are obvious. Sometimes, a newborn has only to open his or her mouth and a diagnosis is made. The obvious cases are usually those that are referred to as ‘anterior’ tongue-ties. A ‘posterior’ tongue-tie is tougher to detect because the tie is actually hidden under the mucous lining of the mouth. This is when the tie is at the back of the tongue, hence the term ‘posterior’. In these cases, you don’t see a short, thick band of tissue because the compromised part is hidden. Experts can easily spot the signs of a posterior tie. Further, it can be felt underneath the tongue with a finger.
Seek the Right Professional for Diagnosis
In our case, at least three or four health-care practitioners poked into our baby’s mouth over our 24-hour hospital stay and none even murmured the possibility of a tongue-tie. His tie was anterior, so it was not immediately visible. I later learned that other signs were there. We didn’t have confirmation of the tongue and lip-tie until our son was 11 days old. A dentist, who was an expert on the subject, confirmed his condition. My son and I both suffered during that time.
After conducting some at home tongue-tie diagnostic tests, I determined that this was most likely our issue. I immediately made an appointment with the right expert to have my son evaluated properly. Had I known then what I know now about the condition, I would have pushed for a diagnosis in the hospital.
6 It Can Affect Breastfeeding
Oh, the pain. I can’t even properly describe it. There were many moments when I would have traded latch-on pain for contraction pain. It was that bad. Because my sweet baby couldn’t flange his upper lip properly or extend his tongue to cover his lower gum ridge, it felt like I was being chomped by two concrete blocks every time he latched on. Repeat this process every 2-3 hours day and night and you can imagine what that did to my breasts over 11 days. It hurt to wear a shirt. When I pumped milk, it was tinged pink from the blood. It was agonizing.
Some Moms Abandon Breastfeeding
I don’t doubt that many women would consider quitting if this was their experience breastfeeding thinking this was normal. At least, I had two other experiences to compare so I knew it wasn’t supposed to be that painful. Yet, I couldn’t help but ask myself why the hell it was so hard this time? Doubt crept in.
I did have some issues nursing my first two babies, but both times the problems were corrected quickly. I simply adjusted my breastfeeding position, a technique recommended by my lactation consultant. I wasn’t initially surprised when things were heading in that direction with my third son; only no amount of adjusting seemed to help this time. Even my lactation consultant missed the tongue-tie.
Baby May Not Get Enough Milk
More important than discomfort for mom, tongue-tie can also affect baby’s ability to get the milk they need. This has obvious implications for the well-being of the baby, as well as mom’s milk supply.
That said, sometimes tongue-tie doesn’t have any ill effect on breastfeeding. Further, it’s quite tough to predict when it will, given that the mother’s anatomy also plays a role. In addition, sometimes a baby can adjust his or her positioning to improve the latch.
If breastfeeding is painful, and you hope to continue, I encourage you to explore the possibility of a tongue or lip-tie as a potential issue. As explored below, it can be corrected quickly, leading to successful and pain-free nursing.
5 Tongue-Tie Can Lead to Other Issues
Suffice it to say, the tongue has several important functions. When restricted by the frenulum, it can lead to many issues such as eating problems, speech impairment, and breathing issues. Some of these can be quite serious. For example, because of the tongue’s compromised position, breathing difficulties can arise during sleep.
Tongue-tie can also inhibit proper jaw and facial growth leading to overbites and crowded teeth. Additionally, because the tongue cannot move freely to clean the mouth, cavities and tooth decay are more common among those with tongue-ties.
Beyond the associated physical health concerns, these things can also influence a child’s self-esteem. A child who has trouble pronouncing certain consonants may have problems throughout life, including the ability to fit in, succeed academically, and secure employment.
4 It Can Be Corrected Fairly Easily
While it isn’t always necessary to correct tongue-tie, and some parents choose not to, it can be corrected fairly easily. Surgically treating tongue-tie is sometimes referred to as a ‘frenotomy.’ Treating tongue-tie may involve one of the following:
- oSnipping the frenulum
- oSurgical revision of the frenulum under a general anesthetic at or after 6 months of age
- oRevision of the frenulum by laser with a local or topical anesthetic
In our case, my son’s tongue-tie was corrected by snipping it with surgical scissors and the lip-tie was corrected via laser.
Corrective Procedures Can Be Fast
Both procedures took about 10 minutes. In our case, it was absolutely necessary to enable breastfeeding but it was not without subjecting my son to pain. Having said that, based on his reaction, the pain was short-lived. He cried hard for a few minutes and then nursed immediately. I was amazed at the immediate difference the procedures made in my comfort level and his seeming satisfaction.
For 10 days following the procedure, I had to ‘swipe’ the areas with my fingers for several minutes after nursing to ensure scar tissue didn’t form, and to prevent the issue from reoccurring. I also had to help him do some tongue exercises. He found these activities very uncomfortable but I did the ‘homework’ religiously to ensure he healed properly. We successfully nursed for over a year.
3 It Isn’t Always Necessary to Correct
Even though tongue-tie can be corrected fairly easily, it isn’t always necessary or desirable to correct. Some babies with tongue-tie grow up without any problems. If feeding is okay, then it may be appropriate to wait and see if it becomes a greater problem later, such as when speech begins to develop. If the tongue can stretch beyond the bottom teeth, then speech may develop appropriately. Furthermore, some suggest that the frenulum can stretch indicating that the tongue-tie may correct itself adequately as the baby grows.
A close friend’s son was born with a tongue-tie and they decided not to correct it at birth. They had no trouble nursing and they have kept a close eye on him through speech development. Now school age, he cannot fully stick out his tongue but aside from that, they don’t have any issues.
Furthermore, my five-year-old most definitely has a lip-tie. He has an adorable gap-toothed set of chompers that give his smile such character. I can identify the lip-tie easily now knowing what I know, but see no reason to correct it at this age.
2 High Folic Acid Intake Linked to Tongue-Tie
Although pinpointing the specific causes of tongue and lip-tie are difficult, there may be a hereditary component. While statistics show that it affects approximately 10% of newborns, the condition tends to be slightly more common with boys. I had a lip-tie corrected in my late teens to close my gap-toothed grin, so my two youngest certainly come by that honestly. (By the way, it hurt like a mofo.)
There is some suggestion that cases of tongue-tie are on the rise. That said, this is a bit of a controversial topic. This could be because more moms are nursing. If breastfeeding problems are an indicator, then more cases of tongue-tie will come to light.
The dentist who corrected my baby’s tongue and lip-tie implicated folic acid specifically. She asked if I was taking a folic acid supplement, and how much. She suggested that high levels of folic acid might be leading to an increased incidence of tongue and lip-tie. This was news to me, but it makes sense when you think about it.
Folic Acid and Mid-Line Deficits
All pregnant women are encouraged to take to a folic acid supplement, even before conception, to combat low levels of folate, which, as we all know, can lead to neural tube deficits. Given that low folate has implications for mid-line deficits, it stands to reason that higher levels will tighten everything in the mid-line. This was the explanation provided by our dentist. I am not a doctor or a dentist, so I am not going to get any more specific into the anatomical implications of folic acid. I will say that all you have to do is engage a search engine to have your fill of information.
Education is Key
Would any sane person choose a neural tube deficit over tongue-tie? Of course not. But, from my perspective, education is key so that the condition can be diagnosed perfunctorily to avoid undue stress, subsequent breastfeeding abandonment, and later developmental issues.
Is there an ideal amount of folic acid to take? Perhaps. I took a maternal vitamin that contained some folic acid and a specific folic acid supplement. Did that put me into overdose territory? Perhaps. Would I change anything about my dose given the outcome? Probably not. Do I wish I had been aware of the plausible relationship between tongue-tie and the supplement? Absolutely.
1 It Isn’t the End of the World
When I think back to the 21 days or so that we dealt with tongue-tie, it feels like a short blip in life. My sweet baby will never remember any pain or discomfort. And, it certainly isn’t something that has scarred me. That said, during the time leading up to the diagnosis, it was incredibly painful, frustrating and stressful. My son was getting enough milk but I don’t doubt he felt my anxiety. For us, correcting it was the answer to ensuring successful breastfeeding and preventing future developmental issues.
When I think about all of the worries in life and all of the things that could go wrong, tongue-tie is certainly not the end of the world. There is plenty of information available about it and many professionals who know how to diagnose and deal with it. Certainly if you suspect a tongue or lip-tie, speak with your doctor right away. My hope is that it becomes another thing that expectant and new parents will seek to understand as they prepare for their new person’s arrival.