Tongue Ties in Babies
About
When a baby has a tongue, lip, or cheek ties, they are unable to move parts of their mouth that need freedom and flexibility in order to achieve a good latch and seal on a bottle or breast. When the tongue is unable to lift properly, babies often resort to compensations to allow them to still eat. These compensations often cause symptoms in both the baby and the mother.
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What is a tongue tie?
The medical term for the condition known as tongue tie is ankyloglossia. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short or tight, causing the movement of the tongue to be restricted. Tongue tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 4-10% of babies are born with tight frenulums. Tongue ties can create functional deficits at all ages, from infants to adults.
When a baby is tongue tied, one of two things may happen. Either the baby's tongue blocks the nipple from fully entering the mouth (thrusting it towards the front of the mouth), or the nipple fully enters the mouth but the baby clamps down and bites the base of the nipple. In the first scenario, the tongue is not able to move upward and can only move forward - these babies often have trouble holding a pacifier in their mouths, as well. In the second scenario, the nipple is properly positioned, but the baby's inability to move the tongue results in compensation by the gums and lips.
What is a lip tie?
A lip tie occurs when the frenulum that attaches the upper and/or lower lip to the gums on the upper jaw bone. Sometimes the frenulum can wrap all the way around the gums and attach on the palate. The degree of attachment does not always correlate with decreased function - the need for treatment is based solely on symptoms, not thickness of the frenulum or where it attaches. A severe tie may cause a notch to form on the upper gum line. This is due to the tension from the frenum pulling on the bone. In a battle between muscle and bone, muscle will always win - in this case, the muscle is causing the jaw bone to pull upwards, which can affect the child's erupting teeth.The term "Tethered Oral Tissues" (TOTs) refers to all types of ties - lingual (tongue), labial (lip), and buccal (cheek).
How do tongue and lip ties affect breastfeeding?
A normal suckle begins with a flanging of the lips to create a seal around the areolar tissue of the breast - much like a suction cup on a piece of glass. A lip tie prevents the lips from being able to create a seal on the breast. The baby often compensates for this poor seal by clamping down on the breast to try to stay latched. The lips often rub on the breast, creating friction that is both painful for the mother and results in lip calluses/blisters for the baby.
As the baby latches on, the breast (nipple and areola) gets drawn into the mouth and the nipple extends to the junction of the hard and soft palate. The middle of the tongue elevates to the palate, and then drops, creating a buildup of negative pressure in the baby's mouth, which draws milk from the breast. In normal breastfeeding in a baby without a tie, there is minimal compression of the nipple or compensations from the lips and jaws.
How do ties affect bottle feeding?
In order to get milk out of a bottle, the baby must still create a vacuum in their mouth. Just like with breast feeding, this vacuum is generated by the up-and-down motion of the middle of the tongue, and when the tongue is unable to lift to the palate, the vacuum is weak and inefficient. In order to compensate for limited movement of the tongue, tied babies will often bite on the nipple to compress the milk out (much like milking a cow). Biting the nipple not only slows the flow of milk, but it often causes fatigue while feeding, leading to babies falling asleep before they are full.Parents and caregivers often increase the nipple size to allow for a faster milk flow, thinking that this will make it easier for the baby to eat. However, the faster flow combined with a tongue that cannot easily lift for a normal suck/swallow motion often leads to choking, coughing, gasping, and reflux-like symptoms.
Symptoms of Tongue and Lip Ties
Baby's Symptoms
Tongue tie symptoms may include:
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Falling asleep on the breast
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Lip calluses or blisters
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White coating on the tongue
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Frequent unlatching
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Clicking, coughing, and choking
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Gulping
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Reflux-like symptoms (arching the back, hands in fists, spitting up)
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Gassiness, grunting, constipation
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Frustration at the bottle or breast, often worsening around 2 months
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Snoring, noisy breathing, mouth breathing
Mom's Symptoms
Symptoms in the nursing parent may include:
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Painful latching
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Flattened, creased, lipstick-shaped nipples
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Scabbing or bleeding nipples
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Clogged ducts, milk blebs
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Poor milk supply
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Thrush
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Mastitis
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Stress related to breastfeeding