Tongue Ties in Children
After a child weans, many of the symptoms of tongue tie are no longer obvious. As they get older, their restrictions lead to the need for compensations to regain function. Many times, these symptoms are overlooked or ignored and treatment is delayed until the issues worsen as they get older. See below to learn more about how tongue and lip ties can affect childrens' feeding, sleeping, speech, and other functions.
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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.
The tongue needs to move freely in all directions in order to move food around the mouth, chew, swallow, speak, and stabilize the jaw. Toddlers with tongue ties need to compensate in order to achieve the movements needed for these tasks, and many times they struggle.
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 ties affect feeding?
The tongue is responsible for moving food around the mouth and clearing the cheeks. Children with tongue ties often have a hard time chewing larger pieces of food, they frequently stick their fingers in their mouth to pull impacted food from their cheeks, and they are prone to gagging on different textures due to limited tongue movement combined with high palates. While gagging is a normal part of child development during feeding, oral restrictions make it difficult to move past the gagging stage, and food/texture aversions often remain.
Tongue tied children are frequently called "messy face eaters" due to their inability to lick their lips and the restricted movement of the tongue when trying to clear food off a fork or spoon.
Children with tongue ties often have a hard time using straw cups and swallowing liquids, and they also struggle with swallowing pills.
How do ties affect speech?
Several studies suggest that the restricted range of lingual motion inherent in a tongue tie condition can present issues with speech articulation in children.
As a child with tongue tie tries to mimic certain sounds, for example, they may face difficulties such as with pronouncing “t”, “d”, “l”, and “r”, as they may struggle with putting the tongue to the lips and sticking out the tongue completely.
In some cases, the tongue tie can impact the development of the airway, leading to enlarged adenoids and fluid in the ears, which can cause difficulty hearing. When a child can't hear sounds well, it is harder for them to learn to make those sounds themselves! It is important to rule out hearing loss when a child has a speech delay, as this is the cause in many cases, regardless of whether the tongue is restricted or not.
How do ties affect sleep and breathing?
In order to sleep well, children need to be able to breathe. And if the tongue is not able to elevate and rest along the palate, it negatively affects the development of the airway, causing airway obstruction, which leads to sleep disordered breathing.
Some ways that a tongue tie might affect one’s ability to sleep may include:
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Breathing difficulties
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A tongue tie may impede or inhibit airflow, especially when you’re sleeping. Due to restricted motion, the tongue may become partially blocked in its normal position, which can cause snoring, mouth breathing, and even sleep apnea.
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Disrupted sleep patterns
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The effects of tongue tie on sleep include frequent nighttime awakenings, tossing and turning, and usually interrupted sleep. These interruptions can prevent you from reaching deep, restorative sleep stages, leaving you feeling tired and groggy during the day
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Inadequate tongue posture
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When the tongue is restricted and sits low in the mouth, the mouth usually falls open during sleep. This can cause dry lips, dry mouth, irritation in the airway from cold air entering through the mouth, and can often lead to enlarged tonsils and adenoids
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How do ties affect growth and development?
The tongue is responsible for supporting the palate during development. As the tongue rests along the palate, the pressure helps grow the jaw in a way that provides adequate space to fit all the teeth. If the tongue does not rest naturally against the palate, the jaw often remains too narrow to fit the teeth, as well as the tongue.
The resulting high, narrow palate often causes teeth to erupt in the wrong position (or not at all), as well as significant dental crowding. Many adults with tongue ties have had teeth extracted because their tongues did not grow their palates wide enough, and the treatment of choice for crowding used to be extractions instead of expansion.
We now understand the importance of having the tongue in the correct position during a child's growing years. Not only does the mouth need to grow properly to fit the teeth, but it also needs to grow wide enough to allow for proper airflow through the nose. When the palate is narrow, the nasal passage is also narrow, often causing a deviated septum that worsens nasal airflow.
Thankfully, there is now lots of research that supports the idea that we need to get kids' jaws to grow early in life to support healthy function into their teen years and adulthood. Allowing the tongue to sit in the proper position against the palate is one way to support this proper growth.