Tongue tie in babies: What you need to know

When we think of tongue tie, we often think of a nervous speaker stumbling over their words, or mixing up our words during a conversation. However, many people don’t realise that tongue tie is a medical condition found in some babies, also known in medical terminology as ankyloglossia. From how common it is, to the implications for your child, here’s everything you need to know about tongue tie in babies.

Tongue tie occurs when the babies’ frenulum (the strip of tissue connecting the tongue to the floor of the mouth) is shorter than usual. This is a relatively common condition, affecting between 4%-11% of babies, but studies have shown it’s actually slightly more common in baby boys. Tongue tie is present at birth, and some studies have shown that it can be hereditary (passed from parent to baby), so if you know that you suffered from this then make sure to tell your doctor or midwife. There are other signs that your baby may be tongue-tied, which include symptoms for you too, so be aware of any changes in your own body as well.

Signs That Your Baby Might Have Tongue Tie:

• Persistent very sore or damaged/blistered nipples – however it’s important to note that there may be no nipple pain/trauma.
• Compressed nipples (change in shape) and/or blanching after feeding.
• Excessive weight loss or slow weight gain for your baby(may not occur if topping up).
• Difficulty establishing breastfeeding or baby refuses to latch.
• Excessive hunger/weight gain in baby.
• Excessive sucking need – baby wants to feed or suck very frequently/constantly.
• Baby only swallows infrequently or swallows well for initial “milk ejection” (letdown), but then swallows become less frequent/sporadic. In young babies this may result in falling asleep quickly at the breast.
• Cannot maintain a seal at the breast/bottle, often has gaps at corners of mouth which milk may spill out from.
• Mammoth feeds – or falls asleep quickly and then wakes hungry as soon as breast/bottle is removed.
• Baby doesn’t seem satisfied after a breastfeed.
• Very frequent feeds.
• Fussing at the breast shortly into a feed or takes very short, fast feeds, baby may pull away and cry, arch back – bobbing on and off.
• Parents may comment they can hear air being gulped, milk hitting the tummy, or baby is a very “noisy feeder” with loud swallow sounds.
• Low milk supply.
• Mastitis/blocked ducts.
• Gagging.
• Reflux.
• Frequent hiccups.
• Colic.
• Food intolerances due to digestive disruption.
• Baby rarely/never settles to a deep restful sleep – some “catnap” and are described as very poor sleepers.
• Windy/squirmy and unsettled when sleeping.
• Excessive flatulence.
• Green stools.
• Sucking blister on upper lip.
• Latch trouble or slipping down the nipple when feeding i.e. as though struggling to remain attached at times- resulting in “nipple hanging."
• Clicking sound when feeding. May pop on and off.
• Disorganised suck/swallow pattern – may result in coughing/spluttering/gagging and give an appearance of oversupply, (Bottle feeding mums may note this happens even with the slowest flow teat).
• Weak suck/poor sucking reflex.
• Oral aversion/increased sensitivity – frequently refuses breast and/or bottles and/or spoons. May gag frequently.
• If baby led weaning, may be very slow to start solids compared to peers, may appear keen but spit rather than swallowing food.
• If breastfeeding may refuse bottles/cups.
• Tongue tremor whilst feeding.
• Noisy breathing/snoring sounds when sleeping.
• Opens mouth to attach but doesn’t, shakes head or bobs on and off before becoming frustrated.
• Small mouth gape.
• Gape is wider horizontally than it is vertically when crying.
• Unable to protrude tongue (some with tongue tie can, protrusion does not rule out tongue tie).
• Excessive drooling/bubbles at the mouth.
• Displays stressed body language when feeding – hands up near face, fingers splayed.
• Breastfeeding requires “advanced” techniques such as nipple flipping or pin point accurate positioning which mum struggles to replicate at each feed when not assisted. Mum may feel a need to support the breast from the side to keep in baby’s mouth or he/she slips off (due to ineffective seal).
• Restricted tongue elevation when crying.
• Sometimes these babies will have a much larger than average weight gain, perhaps due to obtaining larger quantities of lactose (sugar) rich fore milk or maybe due to frequent feeding. These babies are more likely to slip through the system and even receive medication for reflux/colic.  Tongue tied infants present in a wide variety of ways, often not related to severity of tie.

Feeding a Baby With Tongue Tie

Some babies with tongue tie have no problems stemming from the condition at all; bottle fed babies are usually fine, as the teat from the bottle doesn’t require the same tongue action as breastfeeding. However, tongue tie can cause difficulty when breastfeeding, as the baby’s tongue is essential for proper suction to the breast. A baby with tongue tie may end up compressing mum’s breast tissue during feeding, which can lead to nipple soreness and damage. This inability to feed correctly can lead to low weight gain and fussiness. A tell-tale sign of a baby with tongue tie is a clicking sound when feeding, but this can also be a sign that you need support with the positioning and attachment of the baby at your breast, so just check to make sure.

Read The Comprehensive Guide to Tongue Tie: Baby Jessica's Story

It can be difficult to tell if a baby has tongue tie, but if your baby struggles to extend his tongue out beyond his lips or if his tongue has a heart shaped appearance at the tip, it might be worthwhile getting him evaluated by a doctor. In most cases, the frenulum will recede by itself over baby’s first year, but in some cases a small surgical procedure may be required. This is a very simple operation known as a frenotomy, which is a safe and uncomplicated procedure usually performed in office at the GP’s surgery. No anaesthesia or stitches are needed; it’s a very easy and painless procedure. However, needing this procedure is rare, and only required in cases where the baby is struggling to feed or when mum is very uncomfortable. The baby can feed with ease straight after the procedure, and many mums note that comfort during breastfeeding improves almost instantly.

Luckily, modern mums and babies have little to fear from tongue tie. If the condition doesn’t naturally remedy itself, it’s easily fixed with a short trip to the GP, to help mum and baby breastfeed with ease, and enjoy those precious moments.

Have you experienced this condition with your baby? If so, why not share your experience with us? Your stories are invaluable to other parents going through the same issues as you and we always encourage our followers to share their stories as they might be of help to someone else.