So, let’s start off today talking about tongue-tie. This is a topic that is full of old-wives’ tales and urban myth. So, let’s cut straight to facts:
What is tongue-tie? Interestingly, there isn’t really a standard definition. And that is RARE in medicine. As a profession, we are very big on definitions and “diagnostic criteria”. Tongue-tie is also called “ankyloglossia”. It usually refers to problems with the “frenulum”, which is the thin piece of skin that connects that underside of your tongue to the floor of your mouth. It is usually very thin, but in some children is thicker. It can be attached all the way to the tip of the tongue or just at the back of the tongue. There are lots of normal variations in the frenulum, but tongue-tie usually refers to those variations that limit the mobility of the tongue to the point that it causes problems in feeding or speech. Occasionally, “tongue-tie” also refers to problems with muscles of the tongue.
How common is it? It may be as high as 10%, though some experts think that number might be a little high. But diagnosis and treatment has doubled in last 20 years internationally, for many reasons.
Is tongue-tie really a problem? Not always, but when it is, it can cause 3 main problems:
1) Infant feeding: Some, but not all, infants with tongue tie may have trouble with breast-feeding. All medical professionals agree that a consultation with a qualified lactation expert is your first step here. Full stop. Ask your midwife or GP for referral. Tongue-tie does not usually impair bottle feedings. There are many, many reasons for feeding problems in babies, and tongue-tie is only one. Read more: https://www.hse.ie/eng/
2) Speech: Tongue-tie may cause pronunciation problems in young children, but doesn’t effect making sounds (normal babbling) or delay the onset of speech. Speech sounds that may be affected usually include “t,” “d,” “z,” “s,” “th,” “n,” “l”. If your child isn’t speaking or has delayed speech, it isn’t tongue tie. If you are concerned about your child’s speech, for whatever reason, always request GP referral to a qualified speech and language therapist. If going privately, find a list of properly qualified therapists here: https://isti.ie/
3) Mechanics – Older children with tongue tie may have trouble with a few common movements: licking lips, licking ice cream/lollies, or later on, playing wind instruments like flute or trumpet. Adolescents may report difficulty with kissing (really) — but probably not to their parents. At this age, it can also cause dental problems so may be diagnosed by a qualified dentist.
What if you think your child has tongue tie? Talk to your GP. You should obtain a referral to a qualified lactation consultant or speech therapist, depending on your concern, as first line of treatment.
Safe and correct diagnosis and treatment of tongue tie in an infants/children is a coordinated “multi-disciplinary” effort among midwives, lactation consultants, speech and language therapists (SLT), dentists, GP’s, dentists, consultant paeditricians, and consultant specialists surgeons. If you are looking for private therapy, what qualifications should you be asking for? For speech and language therapist, s/he should be registered with CORU and listed on https://isti.ie/. For choosing a lactation consultant, your first best step is asking for a recommendation from your midwife. More general information on a lactation consultant’s qualifications here: http://www.alcireland.ie/
What if your child needs to have surgery to correct tongue-tie? Do NOT let unqualified or alternative practitioners do any procedure on your infant. Full Stop. “Frenotomy” is the simple cutting of the short frenulum to free up tongue movement. It is very safe. However, it should be done by a qualified and certified medical practitioner (usually doctor or specialist trained midwife) to prevent complications such as bleeding, infection, mouth ulcers, pain, damage to the tongue and saliva ducts, and scar formation (that can lead to further tongue tie). These complications are rare in the hands of someone who is qualified. If you would like an alternative to HSE service, ask your GP for referral to any of the highly qualified private consultant paediatricians/surgeons who specialise in this area and run dedicated multi-disciplinary clinics for assessment and treatment. Occasionally, after expert consultant assessment, the tongue tie is more complicated than simple shortening of the frenulum. A simple operation called a “frenuloplasty” is needed, but this will be done in a hospital by a specialist surgeon under anaesthesia.
https://www2.hse.ie/
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