A baby is born with a tongue tie.  That means, the band of tissue that connects the bottom of the tongue to the floor of the mouth is too short and tight, causing the movement of the tongue to be restricted as you can see from the photos above.

The medical name is ankyloglossia and is present in 10% of births – more in boys then in girls.  Tongue ties or lip ties (where the upper lip is attached to the jaw tissue) can be hereditary as well.

One way to check for a tie, is to have your baby on your lap legs facing away from you and take out your tongue. A baby will try to imitate. If it can’t go  far out, becomes heart shaped or seems to make a ‘pool’ at the middle of it, you should do further evaluations with a health care professional.

The most obvious problem with tongue ties, is not being able to feed well from the breast (and to some extent from a bottle as well). Tongue ties though can have much more implications, depending on the severity of the tie.

Immediate problems one might notice in the baby:

• Poor latch which results in:
• Difficulty or unable to breastfeed
• Colic & excessive gas
• Reflux
•  Difficulty with adequate milk intake
•  Poor weight gain.
•  Falling asleep on the breast
• Extended nursing episodes.
• Unable to sustain a latch
• Unable to develop a deep enough latch
•  Unable to hold a pacifier
•  Early weaning from the breast

When it comes to the mother, she might experience:

•  Low milk supply
• Bleeding, cracked and flattened nipple
• Early cession of lactation
• Post-partum depression
• Anxiety , stress & fatigue
• Vasospasm
• Painful compression of nipples
• Mastitis, engorgement, thrush
• Feelings of guilt if it results in early cession of lactation

Long term, apart for the fact that if not breastfed children will have increased risk of sickness and so on, there can also be:

• Orthodontic problems & facial development
• Increased risk of dental decay
• Speech defects
• Increased risk of SIDS

When an infant has a lip tie, they may be unable to sustain the seal that is needed to breastfeed. They can also experience:

• Orthodontic problems: large gaps between from teeth, relapse after orthodontic care
• Painful latch once upper front teeth erupt
• Dental decay on upper from teeth when still nursing
• Speech problems
• Esthetic problems

Long term, lip ties can result in:

• Periodontal disease
• Esthetic problems with smile lines
• Poor oral hygiene

As already mentioned, not all ties will result in these long term problems. It will largely depend how tight the frenulum is.  A good health care practitioner will be able to assess and advise if they feel, the severity needs a cut or let it be and give extra support through different feeding positions etc. If with extensive help, there are still difficulties in breastfeeding, weight gain and more, a cut would be necessary.

The procedure is very simple and normally done within 5 minutes. In Malta this is usually done by an ENT.  Despite the procedure of clipping the frenulum is quick and safe, it can prove very difficult to find a doctor willing to perform it.  A long time ago, frenotomy (the medical term for clipping the tie) was done routinely.  However, because not all ties can result in long term problems, doctors became less open to do the cuts. At the same time, breastfeeding was not the norm any more and babies taking the bottle were not effected as much hence it fell out of routine.  So much so, that it is not mentioned much to medical students.

If you suspect a tongue or lip tie, contact a breastfeeding specialist to help you with further evaluation and find a health care professional that is open to do frenotomy.