My baby has 'tongue-tie'. Should I be worried?

Congratulations on your new bundle of joy! Is it joyful? What if your baby cries, fusses and isn’t feeding well? Perhaps you’ve tried breast and bottle-feeding without success.

After talking to family, friends and searching social media, someone mentions your baby may have a tongue-tie. Could this be the answer?

Read more: Essays on health: Australia is failing new parents with conflicting advice – it's urgent we get it right

What is tongue-tie?

Tongue-tie (or ankyloglossia) is when the tissue under the tongue is short, thick or tight. This can restrict how the tongue moves.

Babies, children and adults can have tongue-tie, with 4-10% of the population affected. This means 12,000-32,000 Australian children are born with a tongue-tie each year.

We don’t know the precise cause of tongue-tie. But it can run in some families and occurs more in males than females.

How is it diagnosed?

The diagnosis includes a health professional looking at the tongue’s structure and appearance, and thoroughly testing how the tongue moves and works (known as a “functional assessment”).

Your child health nurse or lactation consultant may suspect your baby has tongue-tie. For older children or adults, a speech pathologist may notice tongue restriction affecting eating, drinking and speech.

Will it affect my baby’s feeding or speech?

Impact on breastfeeding

Tongue-tie can make it hard for babies to breastfeed. In some babies, it can cause problems latching to the breast, pain for the mother, and more frequent feeds due to inadequate intake.

The Australian Breastfeeding Association outlines the following signs that may relate to tongue-tie:

• baby is not gaining enough weight
• breastfeeding is painful
• the nipple is damaged or flattened after breastfeeding.

Tongue-tie in older children and adults can also restrict tongue movements, causing difficulties eating.

Impact on speech

Occasionally tongue-tie causes significant restriction where a child cannot produce sounds correctly. This is particularly the case with sounds that require the tongue to elevate, such as “t”, “s” and “r”.

Read more: Common myths about speech problems in children

How is it treated?

If a tongue-tie is not causing problems with breastfeeding, eating, drinking or speech production, then treatment is not recommended. But when treatment is warranted, there are non-surgical and surgical approaches.

Non-surgical approaches

Non-surgical management might include seeing a lactation consultant who can provide breastfeeding advice, preferably one certified as an International Board Certified Lactation Consultant.

A speech pathologist can assess and treat your baby or child’s feeding, eating, drinking and speech. If non-surgical methods don’t work or are not suitable, surgery may be warranted.

Surgery

Surgical options include snipping the tissue under the tongue with scissors or a scalpel, laser frenotomy (dividing the tissue under the tongue, called the frenum), frenuloplasty (dividing the frenum and using stitches), and frenectomy (removal of the frenum). A paediatrician, ear, nose and throat surgeon, dentist or surgeon can perform the surgery on infants, children or adults.

Some experts are concerned about the large increase in the number of children surgically treated for tongue-tie globally. In Australia, surgery rates for frenotomy increased by 420% from 2006 to 2016.

This prompted a group of health professionals from a number of disciplines to recently warn against unnecessary surgery for tongue-tie, before a comprehensive assessment of tongue structure and function.

Does surgery work? Are there risks?

A small study shows parents of preschool children reported improvements in their child’s speech after surgery.

A larger study of children aged two to four found no difference between the speech or tongue movement of tongue-tied children who had surgery as an infant and those who didn’t.

Therefore, surgery is not recommended for babies with tongue-tie during infancy, with the sole aim of improving speech later in life.

A large study of 215 babies under three months old reported improvements in breastfeeding following surgery. In a more recent review, mothers reported improvements in breastfeeding and nipple pain.

The Australian Breastfeeding Association recommends surgery to release a tight frenum for babies with a tongue-tie having difficulties breastfeeding.

Read more: Deep cuts under babies' tongues are unlikely to solve breastfeeding problems

As with any surgical procedure, there are potential risks. Babies can experience pain, bleeding, breathing problems, weight loss and poor feeding after minor surgery for tongue-tie.

Your dentist or surgeon will be able to discuss these potential complications, as they apply to your particular situation.

Where to go for help?

It can be a challenging for parents to know which health professional to see with any concerns about your child’s breastfeeding, eating, drinking or speech. Different professions differ in how they assess and manage tongue-tie.

A lactation consultant, child health nurse, or speech pathologist are good places to start to assess how the tongue looks and works during feeding and talking.

The Australian Dental Association recommends a multidisciplinary approach, including lactation consultants, speech pathologists, paediatricians, speech pathologists, and dentists or surgeons.

Whichever health professional you see, they will still need to properly assess how the tongue works to guide any future treatment.

For more information about tongue-tie, see websites from the Australian Breastfeeding Association, Australian Dental Association and Speech Pathology Australia.