Ankyloglossia: Signs and Symptoms of Tongue-Tie in Babies

Some congenital conditions can be very apparent at birth, while others are a bit more subtle. Although not necessarily dangerous, tongue-tie is one subtle condition that may cause challenges for babies and new mothers. To help you better understand what this is and how you can address the challenges it brings, here is some important information about the signs of tongue-tie in babies.

What is Tongue-Tie (Ankyloglossia)?

Tongue-tie, or ankyloglossia, is a condition present at birth that restricts the tongue's range of motion. It occurs when the lingual frenulum, a small band of tissue connecting the bottom of the tongue to the floor of the mouth, is unusually short, tight, or thick. Tongue-tie isn't medically dangerous, but the restriction in tongue movement can make certain things more difficult.

Different Types of Tongue-Tie

There are two types of tongue-tie, which differ mainly in the location and visibility of the frenulum attachment under the tongue.

Anterior tongue-tie is more common. In this type, the frenulum is located toward the front of the tongue, making it more visible and easier to diagnose. This type typically restricts the tip of the tongue, which may impact things like breastfeeding, swallowing, or producing certain sounds.

In contrast, posterior tongue-tie involves a frenulum positioned further back and can be deeper or less visible, often creating subtler symptoms. Because it’s harder to spot, posterior tongue-tie may go undiagnosed or be mistaken for other issues, but it can still cause similar functional challenges in babies.

While both types of tongue-tie can be managed with appropriate interventions, understanding their distinctions helps healthcare providers decide on the best approach for each child.

How Common is Tongue-Tie in Babies?

About 10% of babies are born with tongue-tie, making it a fairly common condition. Most babies diagnosed with tongue-tie have issues with the anterior frenulum (the part of the tongue visible right near the front). Some studies suggest that male newborns are twice as likely to be tongue-tied as females. It's also more common in first-born babies.

What Causes Tongue-Tie?

During fetal development, a baby's tongue is held in place to restrict motion. This means that the lingual frenulum is stuck or adhered to the tongue and begins to slowly thin and separate as your due date gets closer. However, some babies may not experience this complete separation, resulting in tongue-tie. The reason this happens in certain pregnancies is still unknown, but some believe that it has a genetic link.

What Does Tongue-Tie Look Like?

If born with a tongue-tie, the tip of a baby's tongue looks a little bit like a heart, with a small notch in the middle. This is due to the restriction caused by an unseparated frenulum. However, some instances of tongue-tie do not result in a shape change or may be so subtle that you can't notice it.

Tongue-Tie Symptoms in Babies

Sometimes, it can be hard to pinpoint specific symptoms in babies, especially if you're a first-time parent. To help you recognize any potential challenges early on, here are some of the most common signs of tongue-tie in newborns:

• A heart-shaped tongue
• Trouble latching to nipples while breastfeeding
• Long feeding times
• Compressing the breast rather than sucking
• Noisy feeding sessions that sound like clicking (air being swallowed)
• Leaking during feedings
• Trouble breathing while breastfeeding
• Low number of soiled diapers
• Inability to keep a pacifier in the mouth
• Tongue mobility issues
• Struggling to move the tongue from side to side
• Inability to lift the tongue to the roof of the mouth
• Trouble sticking tongue out of mouth

It's important to note that the presence of one or more of these symptoms doesn't necessarily mean your baby has tongue-tie. For example, if your baby has trouble forming a strong latch, it doesn't mean they have a tongue-tie. Many babies struggle with breastfeeding due to various reasons. Try not to worry; instead, schedule an appointment with your pediatrician and seek the help of a lactation consultant. This will help you determine whether the symptoms are caused by tongue-tie or something else so you can address them accordingly.

How to Treat Tongue-Tie in Newborns and Infants

Some of the best ways to treat tongue-tie include the following:

Working with a Lactation Consultant

New moms struggling with finding a good breastfeeding position or strong latch can partner with a lactation consultant for help. As breastfeeding and nursing experts, they'll be able to help you try out new positions and offer plenty of support throughout the process. This can be extremely beneficial to new moms, as nursing challenges can be both physically and emotionally tolling.

Switch to Bottle Feeding

Due to the difference in sucking motions between nipple feeding and bottle feeding, a tongue-tie very rarely affects the latter. Therefore, if you're having trouble with a latch, you'll need to use bottle feeding to ensure your baby gets enough nutrients. Some new mothers choose to breast pump and build a freezer supply to bottle-feed breast milk, while others opt for formula. Although breast milk is the gold standard for nutrients, everyone's circumstances differ. Working with your doctor or lactation consultant can help you find the best solution.

Frenotomy

Most babies with tongue-tie do not require surgery, as issues can typically be addressed with a few adaptations. However, in rare cases, if your pediatrician thinks that the tongue-tie can cause long-term problems, a frenotomy may be recommended. This very minor procedure clips the lingual frenulum to eliminate or "cure" the tongue-tie. No stitches are required. The earlier this is done, the better, as it can help newborns establish healthy breastfeeding habits. If you have any questions, don't hesitate to talk to your doctor.

Other Surgeries

Other surgeries are also available, which are usually a bit more invasive than a frenotomy. Typically, if surgery is necessary, a frenotomy is sufficient. Otherwise, your doctor may recommend a frenectomy (removal of the frenulum) or a frenuloplasty (a frenotomy that requires general anesthesia).

Long-Term Prognosis of Babies with Tongue-Tie

Generally, if your baby has a tongue-tie, it's not usually a cause for concern. It's pretty common and can be easily managed with early intervention. No current evidence suggests that a baby born with tongue-tie is more likely to have sleep apnea or speech disorders caused by language development problems. However, a few different complications can occur if severe cases are left untreated.

Difficulties with Breastfeeding

One of the most common challenges associated with tongue-tie is difficulty breastfeeding. Babies with tongue ties often struggle to achieve a secure latch because their restricted tongue movement limits their ability to draw milk effectively. This can lead to prolonged or inefficient feeding sessions, frustration for both mother and baby and issues like poor weight gain in the infant.

For mothers, improper latching may result in nipple pain, nipple dryness, and, in some cases, reduced milk supply over time due to inconsistent feeding.

Working with a lactation consultant can help you overcome breastfeeding difficulties and the emotional challenges that may be associated with them, so it's best to seek help if you notice any signs of tongue-tie. If issues persist, using a breast pump and bottle-feeding your newborn breast milk can be a safe and effective alternative to nursing with many benefits.

Challenges with Speech and Pronunciation

Tongue-tie can contribute to speech challenges because the restricted tongue movement makes it harder to produce certain sounds that require precise tongue placement and flexibility. For example, sounds like "d," "l," "t," "th," "r," and "s" require the tongue to move fluidly to different parts of the mouth, like the roof or behind the teeth. When the frenulum is too tight or short, the tongue’s range of motion is limited, making these sounds more difficult to pronounce clearly. However, a tongue-tie does not affect language development or problems with learning.

Specific tongue exercises and practice can usually address pronunciation challenges caused by a child's tongue position, but it's important to discuss your options with your doctor or pediatrician.

Potential Issues with Oral Hygiene

As a child grows, a restrictive tongue-tie may also impact oral hygiene. Limited tongue mobility can make it harder to sweep away food particles naturally, increasing the risk of dental issues like plaque buildup and cavities. This is particularly true if the tongue can't easily reach certain areas in the mouth. Addressing tongue-tie early can help prevent these potential hygiene-related issues, supporting healthier dental habits as the child develops.

To help you supplement feedings in case of any breastfeeding problems, or if you don't plan to nurse exclusively for the first six months, order your insurance-covered breast pump from Byram Healthcare. Connect with one of our specialists today to find lactation support or get started with your order.