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My Baby Was Tongue-Tied

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No, it isn't a cute way to say she's silent. It's a common abnormality that can affect nursing and speech unless the problem is resolved.

baby holding mother's hand

Bethany Sanders: "Oh," the pediatrician said with a note of surprise in her voice, "She's tongue-tied."

I looked over at my fat, buttery newborn lying in the hospital bassinet next to me. Tongue-tied? What a weird word to call my perfect baby. I peeked inside her mouth as she squawked, trying to determine what was going on.

"It means she has ankyloglossia," she said reassuringly, "or a 'close frenulum.'"

In laymama's terms, my baby had a minor, common, congenital anomaly that affected that little thing at the base of her tongue, the lingual frenulum. Hers was attached, too short, meaning she was unable to lift her tongue much or stick it out past her lips.

"One of my kids had that," my grandma told me later over the phone. "It might have even been your mom, I can't remember." That she couldn't recall actually made me feel better, because that meant it was a nonissue. My aunt offered that one of her kids, too, had been tongue-tied, and just six weeks later, my cousin gave birth to a baby with the same condition.

Ankyloglossia runs in families, and best estimates put the incidence of tongue-tied babies at anywhere from 1.7 to 4.8 percent. It's more common in boys than girls. And it's far more common in kids than it is in adults, suggesting that -- even without treatment -- the condition often resolves on its own.

Whether or not mild ankyloglossia interferes with breastfeeding is something experts don't always agree on. Decades ago, when formula feeding was the norm, it was common to let ankyloglossia resolve on its own. But some breastfeeding advocates believe these babies might be better off getting "clipped" before problems begin. In fact, at least three separate studies have found that mothers report nipple-pain relief and greater ease in nursing after clipping of the frenulum -- a quick and relatively painless procedure often done before the baby even leaves the hospital.

Ankyloglossia's effect on a child can range from mild to severe, says Jessica Nappi-Silletti, speech pathologist and author of the book "Building Better Speech Manual." "The issue of whether or not to clip the tongue in an infant truly depends on the extent of the situation," she says. "Sometimes the term 'tongue-tied' is used too freely -- when in fact the movement of the tongue may be slightly restrictive, but surgery may not be necessary. If a child can suck on a bottle or breast, is gaining weight and babbling appropriately, then I feel waiting is fine."

But, Nappi-Silletti added, "If sucking, eating and speech are impacted, then surgery is a necessity."

In the past -- as far back as the 1600s, in fact -- midwives clipped tongue-ties with a clean, sharp fingernail. But today's treatments include snipping (not with a fingernail!), surgical revision of the frenulum and even laser surgery, depending on the severity of the condition and the child's needs.

Our baby's case was relatively mild. My doctor recommended the wait-and-see approach, and my daughter nursed happily, getting fatter and fatter, until about the fourth month. But it was when -- I believe -- she started needing those longer feeds and that rich, fatty hind milk to stay full that we started having problems. There were shorter, more frequent feeds, a frustrated baby beating at my breast and, finally, refusing it completely. My pediatrician used  my baby's healthy weight as evidence that there were no feeding issues, but she didn't see what I saw while nursing.

In our case, supplementing with formula got us over the hump. At about six months, my daughter's tongue seemed to "pop," and she could finally stick it out past her lips. She did so again and again for days, like it was a newly discovered toy. We were able to gradually get back onto a part-time nursing schedule (though she really preferred the bottle by then).

Today, a doctor might note her short frenulum on exam and say she's perfectly normal -- no feeding or speech issues, and she has no trouble sticking her tongue out at her big sister (who was not born tongue-tied, incidentally).

If we had to do it again, I might consider snipping to avoid our minor breastfeeding issues. But in 50 years, when one of my great-grandchildren is born tongue-tied, I'll probably be just like my grandma: I'll remember that it happened to us, and that it wasn't really any big deal at all.



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7 comments so far | Post a comment now
Tiona March 11, 2010, 4:14 PM

I was tongue-tied. My mom said I no problems with feeding, but I had problems speaking. I got it clipped at 5, but had to go through speech therapy to learn to speak properly.

suep March 11, 2010, 7:25 PM

As you have related, a tongue tie like your daughter had can be minor. Unfortunately, I have seen moms and newborns who have clear feeding issues: lack of weight gain because the baby can’t remove milk from his mom’s breast…except for what comes with her milk ejection reflex; a frustrated baby who can’t raise his tongue enough to get a good latch and tries to compensate by clamping down with his jaw…mom’s nipples get so sore she can’t bear the thought of breastfeeding.
A wait and see approach by these babies’ doctors means those babies get less breastmilk and their moms quit breastfeeding. Why is it pediatricians withhold such a minor procedure that can make such a huge difference to a mom and baby?
suep
www.bosombuddies.com

ellen March 13, 2010, 4:03 PM

I’m glad that your baby’s tongue tie was not a big deal for you, but it would have been a very big deal to someone who did not want to wean prematurely to formula (or supplement with the same).

And many tongue ties do not reverse so early. Even if there are no later speech problems, children and grown ups with tongue ties can have oral hygiene issues, because without normal tongue movement they cannot sweep across their moths with their tongue to clean up food debris. In addition, tongue tie often causes a misshapen palate.

In my experience as an IBCLC, most mothers and babies do benefit from early diagnosis and treatment of tongue tie. I’m glad that your baby’s case was so easy, for both of you.

Anonymous March 18, 2010, 8:03 PM

tongue-tie is an archaic and derogatory term. Two of my 3 boys had tight frenulums and neither needed clipped/lasered—they were able to breastfeed fine and they have not developed speech problems or any other problem related to the frenum. do your research and make sure there’s really a problem before you have an elective surgery performed on your child.

Misti April 20, 2010, 2:50 PM

Anonymous, if it’s causing problems, then it is neither archaic nor derogatory to name and resolve the issue.

Obviously it isn’t always a problem — in which case there would be no need for diagnosis or treatment. (Also the case with two of my sons.) But where is does cause trouble, and sometimes it does, then it’s wise to treat it. That requires knowing what the problem is (naming or diagnosing.)

Charita Hard July 25, 2010, 10:20 PM

@Michael Can you elaborate on your point?

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