Tongue tie is a condition in which the tongue is attached to the bottom of the mouth by a tight piece of tissue. This condition, which is seen after birth, restricts the movement of tongue in the affected children.
Back in 2022, Christie George discovered that her younger daughter Noelle had a tongue tie which was making her restless. “I knew my elder daughter struggled with tongue tie, hence, we speculated that it was possible this might be the issue,” says the 29-year-old mother from Dubai. Despite knowing that Noelle had a tongue tie, the family did not prefer medical intervention as she was bottle fed.
“Over the first five weeks, Noelle used to be unsettled during and after her feeds. She would pop on and off her bottle, make clicking noises or not be able to properly seal her mouth around the teat,” says George. Noelle would cry and pull her legs in even after feeding. She seemed generally unhappy with her milk, she adds.
Reason behind the issue
A consultation with a tongue tie specialist revealed that Noelle had a severe tongue tie. Soon, she underwent a surgery, and the tightness in the tongue was removed successfully.
“She started feeding better straight away. She got a good grip around the bottle and finished a full feed before we even left the clinic,” says George. Cut to present, Noelle is one year old and is a happy and healthy girl. It was the timely management of tongue tie that helped in a positive outcome.
Tongue tightness
“The location of tongue tie may vary for each person. If the tip of the tongue is attached to the bottom of the mouth, it is difficult for the child to suckle the milk,” Dr Babu Salam, periodontist from Chennai, Tamil Nadu.
Feeding struggles
A 2021 study says that tongue tie in infants may cause painful, inflamed breast and cracked nipples in the mother which results in reduced milk production. Moreover, the infants face difficulty in latching and require prolonged feeding. They show symptoms like deviation in the mouth when opened and the inability of the tongue to stick out beyond the lips.
It is important to consult a lactation professional when there is difficulty in feeding. They teach about the positioning of the infant to aid in a good latch. If necessary, they may recommend tools like nipple shields or breast pumps to assist in the feeding process.
Speech difficulty
“Sounds like /ta/, /da/, /sa/, /la/, /ra/ requires movement of the tongue. These articulations may alter in children with tongue ties,” says Vaishnavi S, speech language pathologist from Andhaadhi Rehab from Chennai. Trills which involve multiple /r/ sounds are difficult to pronounce, she adds.
“If the tongue tie is prominent, instead of /ta/, they might pronounce /tha/; instead of /da/, they might pronounce /dha/,” says Vaishnavi. She adds that the articulation of an adult with tongue tie lacks precision and sounds childlike. This may affect their self-esteem and limit their social interactions.
Medical approach
The management of tongue tie involves operating the tight tissue beneath the tongue by the surgeon. “Tongue tie release can be done as early as in children who are three to six months. The factors to consider for the surgery include weight, fitness, and blood count,” says Dr Salam.
If the child is premature and requires artificial breathing support, then the parents should consider delaying the surgery, he adds. In such cases, if breastfeeding is difficult then artificial way of feeding like intubation can be considered.
Speech therapy
If the speech is affected due to tongue tie, then speech therapy is required after the removal of tongue tie. However, not all children with tongue tie require surgery or speech therapy.
If tongue tie is operated before the child turns one, it does not affect speech. However, if the surgery is performed at a later age, then speech therapy is recommended. “After the surgery, the child may struggle to correct the pronunciation on their own due to muscle memory,” says Vaishnavi. In such scenarios, speech therapist guides the child to improve the articulation from sounds to words and sentences.
Early intervention
“If the tongue tie is not corrected, it can affect the growth of the jaw and positioning of the teeth,” says Dr Salam. Early intervention before the child turns 10 or 13 prevents the possibility of facial deformity, he adds. Other oral health issues include delay in tooth eruption, recurrent teeth cavities and gum infections.
Read more – Significance of early intervention for milk teeth cavities.
A 2020 study published in Clinical Paediatrics says that the comprehensive approach of tongue tie release surgery with consistent tongue exercises showed improvements in speech, eating habits, and sleep patterns of children.
