Congratulations on your new bundle of joy! Is it joyful? What if your baby cries, fusses and isn't feeding well? Perhaps you've tried breast and bottle-feeding without success.
After talking to family, friends and searching social media, someone mentions your baby may have a tongue-tie. Could this be the answer?
What is tongue-tie?
Tongue-tie (or ankyloglossia) is when the tissue under the tongue is short, thick or tight. This can restrict how the tongue moves.
We don't know the precise cause of tongue-tie. But it can run in some families and occurs more in males than females.
How is it diagnosed?
The diagnosis includes a health professional looking at the tongue's structure and appearance, and thoroughly testing how the tongue moves and works (known as a "functional assessment").
Your child health nurse or lactation consultant may suspect your baby has tongue-tie. For older children or adults, a speech pathologist may notice tongue restriction affecting eating, drinking and speech.
Will it affect my baby's feeding or speech?
Impact on breastfeeding
The Australian Breastfeeding Association outlines the following signs that may relate to tongue-tie:
- baby is not gaining enough weight
- breastfeeding is painful
- the nipple is damaged or flattened after breastfeeding.
Impact on speech
Occasionally tongue-tie causes significant restriction where a child cannot produce sounds correctly. This is particularly the case with sounds that require the tongue to elevate, such as "t", "s" and "r".
How is it treated?
If a tongue-tie is not causing problems with breastfeeding, eating, drinking or speech production, then treatment is not recommended. But when treatment is warranted, there are non-surgical and surgical approaches.
Non-surgical management might include seeing a lactation consultant who can provide breastfeeding advice, preferably one certified as an International Board Certified Lactation Consultant.
A speech pathologist can assess and treat your baby or child's feeding, eating, drinking and speech. If non-surgical methods don't work or are not suitable, surgery may be warranted.
Surgical options include snipping the tissue under the tongue with scissors or a scalpel, laser frenotomy (dividing the tissue under the tongue, called the frenum), frenuloplasty (dividing the frenum and using stitches), and frenectomy (removal of the frenum). A paediatrician, ear, nose and throat surgeon, dentist or surgeon can perform the surgery on infants, children or adults.
Some experts are concerned about the large increase in the number of children surgically treated for tongue-tie globally. In Australia, surgery rates for frenotomy increased by 420 per cent from 2006 to 2016.
This prompted a group of health professionals from a number of disciplines to recently warn against unnecessary surgery for tongue-tie, before a comprehensive assessment of tongue structure and function.
Does surgery work? Are there risks?
A small study shows parents of preschool children reported improvements in their child's speech after surgery.
A larger study of children aged two to four found no difference between the speech or tongue movement of tongue-tied children who had surgery as an infant and those who didn't.
The Australian Breastfeeding Association recommends surgery to release a tight frenum for babies with a tongue-tie having difficulties breastfeeding.
Your dentist or surgeon will be able to discuss these potential complications, as they apply to your particular situation.
Where to go for help?
It can be a challenging for parents to know which health professional to see with any concerns about your child's breastfeeding, eating, drinking or speech. Different professions differ in how they assess and manage tongue-tie.
A lactation consultant, child health nurse, or speech pathologist are good places to start to assess how the tongue looks and works during feeding and talking.
The Australian Dental Association recommends a multidisciplinary approach, including lactation consultants, speech pathologists, paediatricians, and dentists or surgeons.
Whichever health professional you see, they will still need to properly assess how the tongue works to guide any future treatment.
Sharon Smart is Lecturer, School of Occupational Therapy, Social Work and Speech Pathology and Speech Pathologist, Curtin University. Mary Claessen is Senior Lecturer, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University.
This article was first published on The Conversation, you can read it here.