Frequently Asked Questions
We know that there are many adults who also struggle with a restrictive tongue-tie. Usually by adulthood though they have 'learnt' to function their tongue in a compensatory way, many of these adults are absolutely fine and unaware they even have a restriction (or that it is the root cause of any potential symptoms they may have).
We know that there can be potential issues later on but these are poorly researched, and we don't have a crystal ball to say that it will or wont affect your infant years down the line. But in essence speech, oral cleanliness, tension aches/ migraines, breathing/sleeping/snoring and dental implications have links to a restrictive frenulum but nothing is 100% definitive as yet but research is being done all of the time.
Generally, especially in the early days a tongue-tied infant can also gain weight. Many people seem to understand that they can loose weight but if they are an inefficient feeder, they may have long or frequent breastfeeds. Or, if bottle fed; either down a bottle too quickly (so you think they're ravenous but its more that they are not in control of the flow and you over feed them) or feeds are so long they end up taking in more calories than what they need. They tend to be branded as 'lazy', 'snackers' or 'grazing'.
Some even believe that it will 'snap' of its own accord. Can you imagine how that may feel in an uncontrolled environment? And, even then it may/may not 'tear' all of the restrictive element. Infection risk, bleeding management and potential pain come to mind as things to consider too, especially if older.
A restrictive frenulum affects tongue motility and efficacy. The tongue tie itself is not particular how you feed to 'decide' if it will affect your chosen feeding method or not!
This one really baffles me! Using ambiguous terms not only confuses parents or gives the wrong 'impression', they are also terms that just do not give us much information.
I see many parents who are told "it wont cause any issue because its a mild one" and yet the infant is clearly struggling. Similarly, the opposite is true-parents being told its severe. Or ones 'at the front' need doing-yet they have a long stretchy frenulum and are feeding fine.
It really is not about what it looks like-its all about what it can or can not do which is why an assessment with an experienced practitioner is important.
And again, not all healthcare professionals say the same thing!
And thats really annoying.
Training to diagnose and assess for a tongue tie restriction is NOT part of any healthcare professionals routine medical or otherwise training. It is a separate specialist course. Sure, many midwives, health visitors, paediatricians and doctors all have their opinion on it-but unless they have been trained in it, then it is just that. An opinion.
There is a wealth of research to support tongue function which is continuously growing. Ask your healthcare professional for their 'opinion' by all means, many are usually correct anyway as they have a wealth of experience, but unfortunately there will always be someone whose 'opinion' is mistaken for fact.
Everyone seems to have a tongue-tie these days! Having a release is just a new-age fad!
Yes, I have been told this too. As if someone would do a cut for no reason? unethical. Its not new at all-there is reference to it in the bible, Medieval texts> In the Victorian era we know that midwives would grow their little fingernail and do a division as the baby is being born. So no, not new. We did progress with medical advances in hygiene and in some cases formula/bottle companies would pay or sponsor healthcare providers to promote their formula milks over breastfeeding (check out 'the nestle boycott') so a division became less known about. But it is not new. Certainly past generations would understand it with differing terminology, such as a 'short tongue.'
Will having a tongue-tie divided hurt my baby? or cause discomfort?
NICE (2005) Division of ankyloglossia (tongue tie) for breastfeeding is a recognised and long established document discussing the benefits and risks of a division. This document is freely available via an internet search should you wish to check it out. The document refers to a study that concludes that 1 in 8 infants will sleep through the whole procedure. The problem is that although we believe this is the case-they cant tell us. The remaining 7/8 would cry - but they are in a strange environment with an unknown adult doing a procedure whilst being gently restrained so it is also possible that they are just unsure/discombobulated/in shock because it is so super-duper quick they haven't really had chance to get their bearings yet. However, some babies do become very fussy at feeding afterwards, which I can understand, but again short lived and unlikely pain related.
If I choose for my baby NOT to have a release, does this mean they will have a speech impediment?
Nope, not necessarily. Researchers are looking into this. We know that there is a potential that it may, this is true, but it is not conclusive. The current studies that we have though look at children with a short anterior (to the tip of the tongue and attached to the lower gum ridge) and conclude its possible-but it doesn't look at all of the other types of restriction, and there are many other reasons a child may have speech issues separate to a tongue tie restriction.
Speech articulation is also linked to a high palate (roof of the mouth) which happens in embryology particularly if theres a tongue-tie restriction.
Is having a tongue-tie restriction hereditary?
Again, there is no definitive research on this one but it is believed to have an hereditary element to it, but no one really knows. It is also marginally more common in males too-but again we do not know why
I can see a vertical 'stringy' bit under my baby's tongue. Does this mean my baby has a tongue-tie restriction?
No. Everyone has a lingual frenulum. That is oral anatomy. It is only considered restrictive in infancy if there are feeding implications hindering efficacy. This, coupled with a tongue function test assessing the parent-baby dyad holistically is used to suggest if there is a restriction or not.
Here is a video of an assessment conducted by my colleague Sarah Oakley:
Do you also provide division of lip-ties?
No, a division of a lip-tie in the UK can only be performed by specialist oral surgeons and dentists. It is not something that is considered necessary in infancy as there is no robust evidence to suggest it affects infant feeding-but it can later on in life but more so dentally.
please refer to ATP position statement on Lip-ties and also my blog "What is a lip tie?"
What are the risks involved with a surgical release?
Please refer to the page on this website for more detailed information (Tongue-tie tab above).
My baby was diagnosed with a tongue-tie restriction, we didnt opt for a release-and they were fine
I would question who and how the diagnosis was made. If your infant has a true tongue tie restriction, they will have been symptomatic. If they were/are 'fine' and have no issues-whilst thats great-they were not tongue tie restricted.
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