There are two types of frenula in the mouth, one under the tongue and one between the lips and gums. A lingual frenulum is a band of tissue that connects the tongue to the floor of the mouth; if it is too short, it can cause tongue-tie which is called ankyloglossia. A labial frenulum is the band of tissue that connects the lips to the gums on both the top and bottom. A short labial frenulum can cause lip-tie.
Some babies are born with ankyloglossia in which the frenulum under their tongue is too short causing them to be tongue-tied. This can greatly impair a baby's ability to nurse and if left untreated, can eventually lead to a failure to gain weight and malnutrition. Once they are older, they may also have difficulty speaking.
Ankyloglossia and Breastfeeding
The limited tongue motion caused by tongue-tie can prevent the baby from latching onto the breast properly. When a baby nurses, the tongue extends and curls into a U-shaped on the underside of the mother’s breast. The nipple is drawn deep into the baby's mouth, near the back of the throat so the nipple is not pinched against the roof of the baby’s mouth.
Not all tongue-tied babies have a hard time nursing. Some babies who appear to have a significant tongue-tie are able to breast-feed successfully while others who appear to have only a mild degree of tongue-tie have extreme difficulty nursing. Preterm babies may also have difficulty latching even though they are not tongue-tied.
Ankyloglossia Signs and Symptoms
Some symptoms to be on the lookout for if you suspect your baby is tongue-tied include:
- Inability to latch onto the breast during feeding; sliding off
- Sucking the cheeks in while nursing
- A (upside down) heart-shaped tongue: the tip of the tongue will have a dent or divot, especially evident when crying
- Nipple pain during feeding, accompanied by bruising, scabbing, or cracking nipples
- Mastitis or low milk supply, due to infrequent or incomplete emptying of the breast during feedings
- Failure to gain weight
Treating Ankyloglossia In Infants
A labial frenectomy on a newborn is a simple procedure and is performed in the hospital by an otolaryngologist or in an oral surgeon’s office. The frenulum under the tongue is very thin and has few nerves so there is very little pain associated with a frenectomy. While the baby is swaddled, the doctor will gently lift the tongue and snip the frenulum with sterile surgical scissors.
It is possible for a lingual frenulum to stretch on its own and for breast-feeding to improve with time and practice. For babies who are having trouble nursing, a labial frenectomy may help. Tongue-tie is not the only reason a baby may have difficulty feeding but if your baby is not gaining weight or exhibits any of the signs mentioned above, visit their pediatrician to see if they are tongue-tied and if a labial frenectomy is the best treatment.