How to tell if child has tongue tie
4 Ways To Tell If Your Child Has A Tongue-Tie And What To Do About It - Alabama Tongue-Tie Center | Dr. Richard Baxter
It seems that everywhere you read online, a tongue-tie seems to be one of the first issues suggested when babies can’t eat or kids can’t speak well. Let’s go through some easy ways that parents can tell if their baby or child might be affected by this condition.
1. The Obvious
If your child has a heart-shaped tongue, a short tongue, can’t lift or stick out their tongue, there might be a problem. Sticking the tongue out is not a great test. Instead, ask your child to lift their tongue (or do it for them). If you can see an obvious string attaching near the top of the tongue, then there is very likely a restriction present that could be affecting your child. Go on to point #3.
2. The Not-So-Obvious
Many times a parent will think their child has some or all of the symptoms of a tongue-tie, but when they lift the tongue the string (frenum) isn’t attached to the tip or even near it. It’s 50% of the way back, or maybe even 25% visible or there might be no appearance of a frenum at all. A posterior tongue tie is a term that describes a less obvious variant of tongue restriction that is more common than the classic to-the-tip variety but is less easy to identify. Healthcare providers have not been taught about its existence in medical or dental school, or in continuing education courses.
The posterior tie is most easily identified by coming from behind the patient and lifting the tongue with both index fingers on either side of the tongue. The fascia or connective tissue bunches up and forms the appearance of a string or frenum, and often there is a good bit of tension as well. But the presence of this appearance alone does not mean the baby or child has a tie. They must be having symptoms in addition to the tight string of tissue in order to qualify as a tongue-tie.
You gotta lift it up to see it!
Notice the restrictive lip-tie and not obvious (at first) tongue-tie, until tension is applied.
3. The Symptoms
Regardless of the appearance under the tongue, it’s the symptoms that count. No symptoms, no treatment. If it ain’t broke, don’t fix it! Common infant and child symptoms are listed below. Contrary to popular opinion, none of these symptoms are required or the absence of a symptom doesn’t rule out a tongue-tie. Sometimes a tongue-tied infant has poor weight gain, other times they can be chunky and the mother is compensating for the inefficient feeding, or has a large milk supply. Sometimes nursing hurts worse than labor, other times there is moderate pain, and sometimes there is zero pain from a tongue-tied baby. (And very often, the painful latch happens in babies with a not-so-obvious posterior tongue-tie.)
Some kids with a tongue-tie have perfect speech, others have a significant speech delay or speech issues with mumbling, clarity, sounds (R, L, S, etc.) and confidence. Same with feeding (slow and picky eating, especially with meat), and with sleep (restless sleep, snoring, teeth grinding, etc.
). So it’s the overall picture of the child’s limitations that are important. Look at all of the issues together, or check off a form like ours, the Infant Assessment Sheet or the Child Assessment Sheet. If you have more than a few checkmarks on there, there is likely a problem.
Infant’s Issues
- Poor latch
- Poor weight gain
- Reflux or spitting up often
- Clicking or smacking noises
- Gassy or fussy often
- Milk leaking out of the mouth
- Frustration with eating
- Prolonged nursing or feeding sessions
- Constantly hungry
Mother’s Issues
- Painful nursing
- Creased, flattened, blanched nipples
- Blistered or cut nipples
- Poor breast Drainage
- Plugged ducts or mastitis
- Nipple shield required for nursing
Child’s Issues
- Frustration with communication
- Trouble with speech sounds, hard to understand, mumbling
- Speech delay
- Slow eater
- Picky eater, especially with textures (meat, mashed potatoes)
- Choking or gagging on liquids or foods
- Spitting out food or packing food in cheeks
- Restless sleep (kicking or moving while asleep)
- Grinds teeth at night
- Sleeps with mouth open
- Snores (quiet or loud)
- Frequent headaches or neck pain
4.
Trust Your Mother’s Instinct
Sometimes you have to go with your gut. If you think something is “off” with your child, 99% of the time, something IS wrong. Even in the face of professionals telling you “it’s fine we see this sometimes,” or “all babies are fussy, gassy, colicky, etc.,” or “his siblings talk for him,” trust your instincts. It’s common for babies to be gassy and fussy, and not eat well, because frankly, tongue-ties ARE common (25% at our best current estimates). Because these symptoms are so common, they are confused for being normal.
Dental cavities are common, but not normal. If a baby is spitting up all the time, “toots” like a grown man, and milk leaks out everywhere when eating, those are common symptoms, but not normal symptoms. There is very likely a physical reason to explain those. And very often, it’s a lip or tongue-tie.
So What Should You Do About It?
It’s helpful to see a lactation consultant or feeding therapist if you are concerned with your infant or child’s feeding, but make sure they have contemporary knowledge of tongue or lip ties.
Ask if they have taken a course recently because it’s not taught in schools yet (even though it’s been around since Biblical times).
It’s also helpful to rule out other issues, so see the speech therapist, or a myofunctional therapist, and initiate therapy. But if the tongue-tie is obvious, no amount of therapy will correct a structural problem. If it is less obvious, then maybe therapy can help the issue, but if you hit a wall, or your child has symptoms in multiple domains (speech and feeding and sleep) then have the tongue-tie treated as part of a comprehensive therapy plan, working alongside your therapist’s recommendations.
That’s why it’s so critical to find a therapist who has gone out of their way to gain knowledge (or here, or here, or here, lots of options for education!) in this emerging field of tongue and lip-ties, or tethered oral tissues (TOTs). At the same time, we have seen children who have been in therapy for years, or even over a decade, that had a significant to-the-tip or close to the tip tongue-tie! The dentist, pediatrician, therapist, no one even mentioned it to the parent.
Make sure you have your child evaluated by a knowledgable provider, who has taken additional CE courses, attended recent conferences on tongue-ties, treats them routinely (several a week at least), and assesses for all the symptoms and possible presentations (anterior and posterior tongue-tie). It’s a spectrum of restriction, and some are obvious, other tongue restrictions are barely visible. Ensure they recommend stretches and exercises in addition to treatment, and ask what method they use to release.
Educate yourself on the effects a tongue restriction can have on an infant, child, or adult, and spread the word. We have some additional information on our webpage, The Facts.
We’re trying to spread the word with our recent book, Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More (download PDF sample here) as well as our latest article published in Clinical Pediatrics on the functional improvements after a proper tongue-tie release.
In our study (download the PDF here!), 89% of the children had improved speech after the procedure, 83% had better feeding, and 83% had better sleep. So it’s not every child has improvements in every area, but many do. When combined with therapy, those numbers are even better.
If you are a parent and concerned your child might have a tongue-tie, we’d be happy to chat with you or schedule a consultation. Just call us at 205-419-4333 or send us a message.
If you are a provider and have any questions about this post, or want to learn more, check out our recent course, Tongue-Tied Academy designed to help providers learn the procedure and Tongue-Tied Academy LITE for therapists who want to learn more. There is even a free preview of the course available. You can use the coupon code BLOG to save $250 off the full version or save $50 off the LITE version.
How to Tell if Your Baby is Tongue-Tied – Children’s Health
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When you have a newborn in the house, your whole world suddenly revolves around the baby.
Naturally, you search for the latest information to make sure your little one is eating right, sleeping right, and is happy and healthy. Keeping them fed is a priority, and sometimes it can be surprisingly challenging.
One issue that new parents might hear about is tongue-tie, especially if their baby is having trouble breastfeeding.
So what is tongue-tie, and do you need to worry? Read on to learn about how to tell if your baby is tongue-tied.
What does it mean when a baby is tongue-tied?
Everyone is born with a bit of tissue under the tongue, called a frenum or frenulum. It connects the bottom of the tongue to the floor of the mouth. Tongue-tie is when the tissue under the tongue is too short or too thick and restricts the tongue's range of motion. The medical term for tongue-tie is ankyloglossia.
"In some cases, the central part of the tongue cannot elevate, which is why people say it is 'tied' to the floor of the mouth," explains Felicity Lenes-Voit, M.
D., Pediatric Otolaryngologist with Children's Health℠ and Assistant Professor of UT Southwestern. "When looking for tongue-tie, we also examine several other factors related to the tongue's movement, which include how well it moves side to side, how well the tongue 'cups' while sucking and if there is a wavelike motion from the front to the back of the tongue."
How common is tongue-tie?
Tongue-tie may affect 4-11% of newborns and infants, though an exact number is not known.
"It could be that even up to 25% of babies have some degree of tissue under their tongues, but we see a wide variety and severity, and not every baby needs corrective surgery or treatment," says Dr. Lenes-Voit.
What does tongue-tie look like?
To check for tongue-tie, you can look at the shape of your baby's tongue. If your baby is tongue-tied, the tip of the tongue may look like a little heart. That's because the tissue that attaches the baby's tongue to the bottom of the mouth is too short or too thick.
It tethers or pulls down the tongue in one area, causing the tip of the tongue to form a heart shape.
You might see this heart shape when the baby is crying or lifting the tongue. If you don't see it, you might notice other signs or symptoms of tongue-tie.
What are tongue-tie symptoms in babies?
Typically, parents first notice signs of tongue-tie in babies during breastfeeding. Babies with tongue-tie might:
- Cause pain with breastfeeding
- Compress the breast rather than suck
- Have noisy feeding sessions as they swallow lots of air (this can also be related to positioning issues or reflux)
- Have trouble latching when breastfeeding
- Not make enough wet or dirty diapers
- Require long feeding times
Other signs that a baby might have tongue-tie include if the baby cannot:
- Lift the tongue to the roof of the mouth
- Keep a pacifier in the mouth (though many babies without tongue-tie also refuse pacifiers)
- Move the tongue from side to side
- Move the tongue past the gumline where teeth will grow
As children get older, parents often worry about a tongue-tie causing speech problems, but there is no scientific evidence to support this.
Not all symptoms mean your baby is tongue-tied
If your baby has trouble taking a pacifier or nursing, this doesn't necessarily mean your baby has tongue-tie.
"Breastfeeding can take a lot of work. Teaching a baby to develop a good latch takes time and patience," says Kandi Trevino, SLP, a Speech-Language Pathologist at Children's Health who cares for babies with tongue-tie.
To improve breastfeeding, the mother and baby may need to try another position. If feeding issues continue, your baby may need a thorough evaluation to check other physical factors that can affect feeding.
"Sometimes the baby's inability to generate good suction while feeding is an issue with the overall oral motor function or the coordination of the suck, swallow, breathe reflex," says Dr. Lenes-Voit. "Maybe the baby has issues with muscle tone or strength. If a baby is having to take frequent breaks to breathe while eating, or ever stops breathing or turns blue, they need to be evaluated.
"
What should you do if you think your baby has tongue-tie?
If you're concerned about tongue-tie symptoms in your baby such as feeding issues, start by talking with your pediatrician or a lactation consultant.
"Go to someone who is very knowledgeable and will consider the big picture, and not recommend a tongue-tie procedure unnecessarily," advises Trevino.
Your pediatrician may refer you to a pediatric ear, nose and throat (ENT) specialist for further evaluation.
"It's important that we perform a comprehensive evaluation and make sure nothing more serious than tongue-tie is going on," says Dr. Lenes-Voit. "Certainly, if a mother experiences pain every time a baby feeds, and no matter what she tries, the baby cannot latch properly, that's concerning. If tongue-tie is the reason for the pain and feeding problems, we can intervene. The ability to nurse is incredibly precious for many parents, and we support that.
"
How is tongue-tie treated?
If treatment is needed, your pediatrician or ENT specialist can perform a frenotomy, removing part of the tissue that restricts the baby's tongue movement. If your baby is less than 3 months old, the procedure can be performed in the physician's office. If the baby is older than 3 months, the doctor will treat the baby in a hospital setting. Typically, babies do very well after treatment.
See more advice for feeding a baby with a tongue-tie, including after a frenotomy.
Learn more
The Pediatric Ear, Nose and Throat program at Children's Health provides convenient, accessible ENT care to families. If you're concerned about tongue-tie in babies, contact us for a comprehensive evaluation or second opinion in our Multidisciplinary Tongue-Tie Clinic.
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Tongue tie in a child | Description of the disease
Short frenulum of the tongue in a child, or ankyloglossia, is not a disease, but a common physiological feature characterized by insufficient length of the hyoid ligament. However, this feature prevents the free movement of the tongue, makes it difficult for the child to suck on the mother's breast, and later causes problems with speech, the formation of malocclusion, and even the development of certain diseases. nine0005
What causes frenulopia?
As a rule, the causes of tongue tie in a child are genetic. This feature is inherited from the father or mother. However, its occurrence may be due to violations of intrauterine development of the fetus.
Risk factors
In addition to hereditary predisposition, factors affecting the formation of a short frenulum of the tongue in a child include:
- negative impact on the embryo at 2-3 months of pregnancy; nine0016
- severe toxicosis in expectant mother;
- viral diseases transmitted by the mother during pregnancy;
- Pregnancy taking strong drugs such as antibiotics.
Symptoms and clinical picture of a child with a short frenulum of the tongue
Parents who are inexperienced or unaware of this pathology may not notice the signs of a short frenulum, usually the problem is detected by nurses and doctors in the maternity hospital. The characteristic manifestations of ankyloglossia are as follows:
- when trying to stick out the tongue, it takes an arched position;
- when the tongue is raised, the frenulum is pulled, as a result of which the body of the organ takes on the shape of a heart;
- The tongue is fixed at the bottom of the mouth and cannot fully "go out".
Since the symptoms of tongue tie in a child are not obvious, therefore, you should pay attention to the following nuances.
In the first year of life there are problems with breastfeeding. The child cannot properly clasp the nipple with his lips, squeezes it excessively with his gums or bites. This leads to malnutrition, hence anxiety and frequent crying.
nine0005
Later, malocclusion may occur, with misalignment or initial malocclusion.
Difficulties are also noted at the time of speech formation, the child hardly pronounces hissing and upper articulation sounds, may burr.
At a later age, the described troubles are accompanied by frequent and very painful tears of the shortened ligament.
Methods of diagnosis
Diagnosis of a short frenulum of the tongue in a child is carried out mainly visually, by examining the oral cavity, but can also be based on the described symptoms and history taking. In most cases, the pathology is detected by the medical staff in the maternity hospital. nine0005
In an older child, the defect is identified by a specialist. Often, its presence is indicated by functional deviations, for example, the inability to lick lips, pronounce certain words or syllables.
Which doctor treats a frenulum breve?
A child's tongue tie is treated by a neonatologist or pediatric surgeon. However, a pediatrician can notice an anomaly. A dentist, an orthodontist, and in cases of minor deviations in length, even a speech therapist are able to assist in its elimination.
Treatment regimen for a child's tongue tie
The treatment for a child's tongue tie is to cut it, which ensures freedom of movement of the tongue. However, the complexity of this operation depending on age is different.
Main treatments and contraindications
Ideally, frenulum incision should be performed in the first days of a child's life, but there are 2 scenarios.
In infancy, the incision is made by a surgeon using scissors, which is absolutely painless at this stage of life, since there are no nerve endings in this area yet. After this, the baby is applied to the chest in order to calm and prevent the development of bleeding. nine0005
How to treat tongue tie in older children? Also, only the operation will be more painful, as the membrane thickens over the years. Frenuloplasty is usually performed - transfer of the fusion site of the frenulum, followed by suturing.
Possible complications
Complications with a short frenulum of the tongue in a child occur when the pathology is ignored. It can be:
- incorrect jaw formation;
- gap between teeth;
- violation of the development of speech and diction;
- excessive salivation;
- gingivitis or periodontitis - inflammatory diseases of the gums;
- snoring;
- apnea.
Tongue tie in a child: what to do, treatment
Tongue tie (ankyloglossia) is one of the most common small anomalies in the development of the oral organs.
Frenulum of the tongue is a fold of the oral mucosa that runs along the midline and connects the floor of the mouth with the lower surface of the tongue. nine0005
The function of the frenulum of the tongue is to fix the tongue to the soft tissues of the oral cavity, to prevent retraction of the tongue (glossoptosis), especially during the neonatal period.
Causes
Quite often, ankyloglossia is inherited from one of the parents, that is, it is a congenital developmental anomaly. Another (non-hereditary) cause of the pathology is intrauterine trauma to the frenulum of the tongue (during thumb sucking).
Clinical manifestations
Ankyloglossia is usually detected in the maternity hospital (neonatologists and pediatricians). Correction of the frenulum of the tongue (if there is such a need) can be performed in the same place. Recently, however, children with this pathology are referred to dental surgeons. nine0005
Symptoms
When crying, the tip of the child's tongue splits into a stylized heart.
The baby cannot stick his tongue out of his mouth. To test this reflex, you can run your finger over the lips of the baby. Normally, the baby sticks out the tongue far enough, moving it around the lips in search of mother's milk.
Breastfeeding takes a long time, the baby is naughty, nervous, clattering sounds are heard when sucking.
The infant is not gaining weight well. nine0005
A child with a short frenulum cannot reach the palate with his tongue.
There is a noticeable violation of the pronunciation of some sounds during the formation of speech.
With a short frenulum (less than 1.5 cm), if it is attached to the soft tissues of the floor of the mouth, functional disorders do not always occur. These include difficulty sucking during breastfeeding and impaired sound pronunciation in the formation of phrasal speech.
Consequences of an anomaly of the frenulum
Hypotrophy due to impaired sucking, poor weight gain in infants. nine0005
Violation of occlusion, the first signs of which during the period of temporary occlusion is the turn of the central lower incisors to the lingual side.
Violation of the development of the lower jaw, as a result, the formation of distal occlusion.
Local gingivitis, periodontitis up to the exposure of the roots of the teeth in the area of the incisors of the lower jaw.
Violation of the pronunciation of sounds that require raising the tongue up: “sh”, “g”, “u”.
Impaired language development due to asymmetric growth. Small mobility of the tongue disrupts the articulation of some sounds. nine0133 Violation of diction (clarity, intelligibility of pronunciation).
Treatment of a short frenulum of the tongue
The best way to eliminate the anomaly of the frenulum is surgical correction.
Important:
- during breastfeeding, the decision on surgical treatment is made only after examination by a neonatologist, pediatrician and dental surgeon;
- for older children (from 5 years old), indications for surgical treatment are jointly determined by a dental surgeon, speech therapist, orthodontist. nine0016
Types of surgery
Frenulotomy - cutting the frenulum of the tongue (often referred to as "cutting the frenulum"). Immediately after the correction of the frenulum, it is necessary to attach the baby to the breast or give a bottle of formula.
