Written by: Nicky Barker, Founder of Little Ones & Paediatric Sleep Specialist
Who knew a tiny piece of attached skin could cause so many issues! And yet, there is still quite a lot of misinformation out there about tongue ties and a whole lot of poor advice being given to mothers around this sometimes-complicated condition.
Because it's not just all about how a child is feeding. Tongue ties can also affect a child's sleep, cause massive discomfort from wind, create speech difficulties, inhibit sinus development, prevent a natural release of endorphins... the list goes on.
In this article we want to shed some light on tongue ties, symptoms and effects of a tongue tie and how you can seek help if you think your baby's tongue tie requires it.
Historically, tongue ties have been recorded as being “snipped” by midwives as early as 1697. Midwives were still performing this procedure, with surgical scissors or sometimes with a swift nick of a finger nail, up until the 1940’s, however, this soon wasn’t so much of an issue as formula became very popular in the 50s, especially in America. A bottle teat resembles a nipple but a baby doesn’t have to work for a let down so it masks some of the issues a breastfeeding woman has to contend with in regards to tongue ties affecting feeding. The once common recognition and treatment of tongue ties slipped under the radar with the massive rise in bottle feeding. It was only when breast milk started being pushed again as a more natural option that the word “fad” started coming into play, in relation to tongue ties. The problem was that by now society had spent decades not needing to worry about tongue ties and so the information and knowledge around them had receded. Suddenly tongue ties were being ignored or unnoticed and it was unpopular or even difficult to get a baby's tongue tie seen to or treated.
Most people are aware that tongue and lip ties can cause issues with breastfeeding including:
- poor latch
- aggravating reflux
- causing excess wind due to gulping, making settling and sleeping difficult, especially overnight
- clicking noises whilst feeding
- causing reoccurring bouts of mastitis for the mother
- bleeding and cracked nipples
- the baby's suck isn’t strong enough to get a let down
- the baby tiring easily
- fussiness and arching away from the breast because it isn’t easy for the baby to feed
- inadequate weight gain or that horrible term “failure to thrive” (but this isn't always an indication and many babies with tongue ties can still gain weight)
- long long feeds where they still don’t seem to be full…(excessive cluster feeding)
But feeding is not all a tie affects.
Because the tongue is unable to effectively reach the roof of the mouth when tied, which is where it should naturally sit when in a “resting” position, it can’t release natural endorphins that come from a tongue resting on the palate (roof of the mouth). As a result, babies can be hard to settle or constantly want something to suck - a breast, a pacifier or a thumb - because having something in their mouth replaces the action the tongue should be doing but can't. Not being able to get your tongue into it's natural position also affects how airways develop; they stay narrow and that's when you start seeing sleep issues such as:
- sleep apnea
- teeth grinding
- constant wake ups
- hard to settle without a feed/pacifier/thumb
- mouth breathing
- can be a cause of SIDS
Severe tongue ties can also cause narrow jaws and faces, which is the main cause of crowded teeth. Enduring a quick procedure when a baby is small to have the tie released could mean that braces won't be needed later on. Speech issues are also common with ties and can be life-long, even with speech therapy.
(a tongue tie)
Lip ties cause a gap between the two front teeth as well as a poor latch and cheek ties can cause you to constantly bite your cheeks or even get food stuck in odd places. These little bits of skin are responsible for a lot of on-going issues and they are very easy to fix, and depending on the method used to fix them, pretty painless!
There are 4 different types of tongue tie which are measured in grades. This is the same for lip ties, but they, confusingly, are graded the opposite way around.
Grade 1 - these are the most restrictive of ties and the tongue is attached at the very tip to the floor of the mouth. This causes a forked or heart shaped tongue and it is rare that the tongue will be able to reach past the lips. The tongue also can’t sit on the roof of the mouth in a natural resting position at all.
Grade 2 - the tie is attached a little further down the underside of the tongue but many of the symptoms are the same as Grade 1.
Grade 3 - these ties are closer to the base of the tongue.
Grade 4 - These are posterior ties, also known as submucosal, these are actually under the mucous membrane covering and are often misdiagnosed as a ”short tongue”. They must be felt to be diagnosed.
Grade 4 - the tie (labial frenum) comes down from the top of the membrane in the inside of the upper lip, all the way down between the teeth or where the two middle teeth will be when they come through. It can wrap round to the underside of the gum which forces the teeth apart and doesn’t allow them to come together.
Grade 3 - the tie is nearly down to the where the teeth would sit then they come through.
Grade 2 and 1 - often these ties are left alone but it depends on how the upper lip is behaving when feeding.
There are a couple of different methods to deal with a tongue/lip/cheek tie. Some GPs, Paediatricians and midwifes will snip them with surgical scissors depending on the grade. Having surgery under anaesthetic is also an option but isn't usually done till after 6 months of age. Another option is having it done with a water laser. This procedure takes less than a minute and there will be minimal bleeding or bruising. Exercises will need to be done with a parents finger, under the tongue to ensure the tissue stretches out and doesn't scar, no matter what procedure is used.
If you suspect a tie and recognise some of the symptoms above in your young one, regardless of age, contacting a Lactation Consultant, experienced midwife, dentist or other health professional is well worth it. Disappointingly, sometimes it can take seeing a couple of health professionals to actually get a diagnosis because not everyone believes ties have any effect or that the effects stretch beyond weight gain.
We have had a lot of experience with customers whose babies turned out to have tongue or lip ties. By first aiming for the most age-appropriate sleeping and feeding patterns, we were quickly able to see that something else was going on for these babies, inhibiting their ability to feed, settle or sleep well.
"If it were not for this Sleep Program and the amazing support from Little Ones, my baby would STILL be suffering with a bad tongue tie. Several times we took him to the doctor for his tongue tie to be looked at and we were told repeatedly that it was fine because he was still gaining weight. Little did I know that there are other areas a tongue tie affects too - causing extreme windiness, very unsettled behaviour and poor sleep. It's not just about weight gain.
By trying to follow the Sleep Program we were able to really see that it was in fact the tongue tie affecting him. If we didn’t know what to aim for sleep-wise, we would have assumed my baby’s bouts of crying and wakeful periods all through the night were “normal” as we were being constantly told by others. Through the support and guidance of the Little Ones Village we were urged to have his tongue tie reassessed and we booked to see a private lactation consultant. She immediately saw that it was causing problems with his feeding - his latch was only lasting about 40 seconds then he was struggling to feed effectively after that, resulting in a big build-up of wind throughout the day, causing his screaming fits in the evening and his waking all through the night. She referred us immediately to get the tie lasered.
I honestly cannot thank Little Ones and their staff enough for encouraging me to trust my instincts as a mother and pursue a diagnosis because I *knew* his behaviour wasn’t “normal” and the effects of his tongue tie kept getting brushed off as “newborn behaviour”. If we hadn’t had the Sleep Program to guide us in terms of knowing what his sleep patterns should be like for his age, we would have been in the dark and probably would have continued to believe there was nothing wrong.
This has been an absolute lifesaver for our baby and our whole family." - Tammy from New Zealand
Always trust your gut if you suspect your little one isn't feeding or settling as they should be and don't brush off a babies continued unsettled behaviour and poor sleep as being "normal", especially if your instinct tells you otherwise.