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Understanding Tongue-Tie: Causes, Symptoms, and Treatment Options

Tongue-tie, also known as ankyloglossia, is a condition some babies are born with that limits their tongue movements. The tongue is attached to the floor of the mouth by a thin stretch of tissue called the lingual frenulum. In tongue-tie, this frenulum is unusually short, thick, or tight, restricting the tongue's range of motion.

What Causes Tongue-Tie?

During fetal development, the lingual frenulum is stuck to the tongue. Normally, the membrane thins and separates from the tongue before birth, allowing free range of motion. In some cases, this separation doesn't occur, leading to tongue-tie. The exact cause is unknown, but it may run in families. Male infants are about twice as likely to be tongue-tied as female ones, and it's more common in first-born babies.

Symptoms of Tongue-Tie

Tongue-tie is often discovered due to breastfeeding problems. Signs of tongue-tie in babies include:

  • Difficulty latching

  • Chewing instead of sucking

  • Poor weight gain

  • Prolonged feeding sessions

  • Fussiness during feeding

  • Clicking sounds while feeding

  • Seeming constantly hungry

Mothers may experience painful breastfeeding, sore or cracked nipples, mastitis, and low milk supply.

In children, tongue-tie may cause:

  • Difficulty pronouncing certain sounds (t, th, d, r, l, and s)

  • Trouble swallowing or moving the tongue from side to side

  • Difficulty licking an ice cream cone or playing a wind instrument

Diagnosing Tongue-Tie

A physical exam is sufficient to diagnose tongue-tie. The doctor will ask about feeding, check the baby's tongue, mouth, and teeth, and use a tongue depressor to assess the range of motion. In older children, the doctor may ask them to move their tongue and make certain sounds.

Treatment Options for Tongue-Tie

Treatment for tongue-tie depends on the severity and the child's age. Some doctors prefer a wait-and-see approach, as the frenulum may loosen on its own. Others recommend immediate treatment. Surgical options include:

  • Frenotomy: A simple procedure where the frenulum is clipped using scissors.

  • Frenectomy: Similar to a frenotomy, but the frenulum is completely removed.

  • Frenuloplasty: A more complex procedure for thicker frenulums or when additional repair is needed.

In some cases, doctors may recommend speech therapy or lactation consultation before considering surgery.

Risks and Complications

Surgical treatments for tongue-tie are generally successful, with rare complications such as bleeding, infection, or damage to the tongue or salivary glands. Untreated tongue-tie may lead to dental problems, excessive drooling, gagging or choking on foods, difficulty with basic activities like licking an ice cream cone or kissing, and speech issues.

When to Seek Help

If you suspect your baby has tongue-tie or are experiencing breastfeeding difficulties, consult your pediatrician. They can assess your child's condition and recommend the appropriate treatment. Remember, each case is unique, and not all instances of tongue-tie require correction.

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