Your questions answered: Tongue Tie

To go along with this weeks Blog Post on Tongue Tie what you need to know, Dr Vanessa has also answered some of the questions you sent in all about tongue tie. I hope to make this a regular section on the blog so stay tuned for more 'Your questions answered' coming soon.

Any tips on upper lip tie? This is a brilliant question as there's a lot of misinformation regarding upper lip ties. I see daily pictures of babies upper lip frenula posted by mums on facebook asking "is this a lip tie?" (and the answers given from other mums is invariably yes). A lip frenulum is not a tie unless restricted and causing issues with function. The misinformation starts with the classification most doctors use when describing this tissue. This classification system just describes anatomy. A class 2 upper lip frenula is actually normal and what most babies have, and a Class 3 upper lip frenula with no restriction is not a tie. Lip tie can occasionally cause problems with feeding (both breast and bottle), but it most often as a result of a co-existent tongue tie. Later on in life, it can cause dental decay of the two top front teeth - this is mainly the "hooded" type if tie- and a gap in between the two front teeth called a diastema. A diastema can happen without a lip tie. With lip tie, if a baby has no symptoms, my advice is don't get it released. Some infants with tie do not experience these problems so its best to wait, be well informed, and if an issue arises get it released. Why is it not routinely checked for after birth? Again, a brilliant question - it should be! In Brazil, every baby is screened for tongue tie before discharge and if a frenotomy is indicated for breast-feeding problems it is performed before they leave the hospital- this is defined by law! I think that including tongue frenulum assessment in the paediatric check before leaving the hospital is a great idea. The difficulty lies in part to the fact that we're all using different assessments, and no one will agree on which is best. Also, although the evidence base for performing release for feeding difficulties is strong, more research is needed to enact such a change. Can it affect speech delay? There is no evidence that tongue tie causes speech delay. However, there is lots of evidence that is causes difficulty in articulation of sounds, particularly S, Z, SH, CH, J and sometimes L & R. Sometimes tongue-tied adults and children will describe getting "tired" when talking quickly, mumbling, having to reduce the volume of their speech or getting pain on the underside of their tongue. How to decide if you should get it released? It's really important to get assessed by a health professional confident in diagnosing ties. I was 11 years qualified as a doctor before i could say that i was able to diagnose ties! This assessment must involve a discussion around symptoms and an examination of your baby's mouth with a gloved finger. A discussion can then take place regarding need for release. What can you do to stop it reattaching post revision? How common is reattachment? This is a contentious issue. The rate of reattachment is around 3-10%. Some seem to reattach no matter what you do, and some reattach in part, but not enough to cause the original problem. Some tie specialists advocate for wound massages to prevent reattachment. As yet there is not enough evidence to support this. It also places huge stress on parents and babies and guilt if they're finding the stretches difficult. When is the best time to get it revised? If its for a feeding issue, ASAP! Although i strongly recommend that breastfeeding dyads see a lactation consultant prior to review. Sometimes bodywork or other therapy forms will be recommended pre-release. The younger a baby is the less compensations they have picked up that need to be undone. Once a baby gets to 9-12 months, sedation or a general anaesthetic is needed to perform release. If it doesn’t impact breastfeeding and weight gain - should you still get it revised? Ties don't always cause problems with breastfeeding or weight gain. My advice is to be mindful of the symptoms it can cause and be see specialist early if needed. Can tongue tie impact weaning / solid intake? Yes, it can cause difficulties moving on through the textures, gagging choking and food refusal. Why is it so expensive privately? The fee reflects the provider's expertise, knowledge base, experience, clinical risk, and overheads including medical insurance, staff, premises, medications, equipment etc. If you’re no longer breastfeeding but you suspect baby has it should you still get it treated? This is an individual parents decision. If its not currently causing an issue the decision is more complicated. The tongue is really important for airway development so when there is a significant restriction there, sometimes a parent will opt to release it. How to tell if there is posterior tongue tie? Posterior or Class 3 and 4 ties are tight lingual frenulae at the back of the mouth, rather than the tip. The only way to examine for posterior tie is with a gloved finger in the baby's mouth. How do you know if your newborn has it? Obvious ties sometimes have tell tell signs like heart-shaped tongue or tongue tip notching, and might be picked up by parents, PHNS, doctors, midwives or lactation consultants. If you're concerned get an assessment with a health professional who is confident with ties. Any need to keep an eye on it as they get older? Yes, this is important to look out for problems - feeding, speech, dental, airway, sleep or posture can all be affected by tongue tie. Will there be any adverse effects of not having it snipped? There are always potential risks with surgical procedures - there is a 1:300 risk of bleeding, a 3-10% risk of reattachment, pain, fussiness after the procedure or difficulty feeing for the 24 hours following the procedure. These risks can be minimised and i discuss this at clinic. Any link between tongue tie and reflux / colic? Yes - there is a link which has been studied in recent scientific papers. It mainly results from aerophagia, or swallowing air, when swallowing milk. Incidence of it happening to subsequent children? There are no studies done on the incidence in subsequent children but from my own experience, i would say around 20% of siblings are affected. What is the best way to treat it? Laser? It is not the tool but the skill of the provider. Is it more common now? No. It's been around forever (and was even mentioned in The Bible!). But awareness has grown significantly. Duty of care to diagnose it? Health professionals have a duty of care to diagnose ties, or if they cannot, refer you to someone who can. Why does it seem to be such a controversial / contentious issue for medics? Tongue tie has been around forever. Evidence-based medicine has not. The large body of evidence support to use of frenotomy to help resolve feeding issue and for non-feeding related issues is growing every day.As with any pioneering research, it can invoke strong, polarised opinion. The main thing is we are talking about it. Tongue Tie Galway has compiled a page of important research articles from the past and emerging articles for your interest.

Is it linked to other medical problems? Yes, is is linked to dental, speech, feeding, sleep, posture and airway issues.

Dr Vanessa Stitt of Tongue Tie Galway is a GP, and a member of IATP (International Affiliation of Tongue Tie Professionals), ICAP (International Consortium of Oral Ankylofrenula Professionals), and ALCI (Association of Lactation Consultants Ireland). Vanessa developed an interest in tongue-tie after my own son was diagnosed with a tongue-tie and i was having difficulty breastfeeding. He underwent a frenotomy procedure and there was a marked improvement in his latch when breastfeeding- they happily breastfed for another 8 months.

Contact Dr Vanessa on her website, by email at or phone 085 7642095

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