Newborn Tongue Tied Baby

Tongue Tie (Ankyloglossia)

Tongue tie is where a baby's tongue is held down by tissue underneath the tongue which has not separated from the floor of the mouth and tongue during growth as an embryo.

This can cause problems with breast feeding, bottle feeding, swallowing and licking.  It can even interfere with development of the bottom jaw and create dental and speech problems.

While a lower lip tongue tie is more common, some babies will have an upper lip tie which needs to be treated.

Additional reading regarding tongue ties:

http://www.birthingmagazine.ca/breastfeeding/159-tongue-and-lip-ties-best-evidence.html

7lrbIqjUrDiZ-aZt9d7QT8q4ctADlCEk5OdxskzQUoo,LpbwRfFCZEVBaAJbocD8XOwMdF94Fhvp9PvKPdaKgV8.jpg

Diagnosis & Treatment

How is tongue tie diagnosed?

I have been treating this condition for 30 plus years, but it seems to have become more common in recent years.  This is most likely due to midwives and lactation consultants being aware of it and looking for it when assessing feeding issues with mother and baby.

There is a spectrum of severity based on how much of the tongue is held down, so a minor tongue tie may not cause any issues at all.

Speech therapists sometimes refer older children to me for assessment and treatment if needed, but the incidence of this has not really increased.

Adults also sometimes book an appointment for assessment of licking problems which they have had all of their lives.

What happens when a baby has tongue tie?

Babies need a mobile tongue so they can effectively latch  on and suck when being fed.  The extent of the tie will determine the degree of the problems arising.

The baby's tongue needs to elevate, collect the nipple and surrounding breast tissue and push it against the roof of their mouth.  The baby will slip off the nipple easily if their sucking is impaired.  They will make clicking noises and their tongue may rasp against the mother's nipple and cause her pain.

Feeding this way will take up a lot of energy so the baby will get tired easily and take  longer to feed.

Eventually an impaired suck will result in decreased milk production, poor weight gains, a hungry, irritable baby and a worn out tired mother with sore nipples is not a happy situation.  Sometimes the first sign of something not being right happens after the first few weeks when the mother feels her supply has decreased and her baby's weight gain slows down.

In past years this situation would almost always result in the abandoning of breast feeding.  Some of these babies still had problems with teats and much time and effort went in to trials of various shapes and sizes of teats.  However tongue tie is now easily treated.

Treating a newborn tongue tied baby

When you bring your baby to an appointment I will ask for a description of the problem and will examine your baby to determine the extent of the physical problem.  If I assess that it would be helpful to separate the tissue between the tongue and floor of the mouth to remove the tie, I will then proceed with the operation.  You will not need to book a separate appointment as the operation can take place there and then.

I use a scalpel to give a quick clean cut and avoid damaging surrounding tissues, which is especially a risk in the Type 3 and Type 4 ties, the so-called posterior ties.

Some babies feel very little pain, while some do appear upset for several minutes.  Most babies don't like having large adult fingers in their mouths or being held during the procedure, which is quite understandable.  There is some bleeding but this usually stops within five minutes.

The baby can be, and is encouraged to be fed straight away.

Recovery

What happens after the operation?

Some ties grow back.  I encourage mum or dad to put their index finger under the baby's tongue and lift it up to the roof of the mouth after every feed for three to four weeks afterwards, starting two days after the operation, however this is not a guarantee the tie will not grow back.  I have seen ties grow back in a week.  Some babies need the procedure repeated, sometimes several times if they heal quickly.

Bleeding some hours after the operation is very rare but should this occur, apply pressure to the floor of the baby's mouth with a gauze swab. This is all that is needed, but the baby understandably hates it.

For additional information on after-care: http://vimeo.com/55658345   or visit:  http://www.lunalactation.com/

1z7o8RswRbp_IBFIDSc3MqtAC6HxTDhlDzw9bEEd33M,3cVfEnYRdFOLKlnMqBIj-x0hWErTpJZIIOQVozJHoWU.jpg

Upper Lip Tie

What is upper lip tie (Maxillary Frenulum) in babies?

Lots of babies have this condition and it is rarely an issue.  An upper lip-tie is where a piece of skin under the baby's upper lip (the labial frenulum) is very short or thick and is pinned too tightly to the upper gum. This can restrict movement of the upper lip preventing it from being able to flange or 'pull out'. This can make it difficult for babies to attach to the breast correctly as it is harder for them to maintain a good seal.  In older children and adolescents, an upper lip-tie can be associated with a gap between the front teeth.  Generally this is only a cosmetic issue. However, it can make it difficult for a baby to breastfeed.

Treating a baby with upper lip tie

The upper lip tie is cut with a scalpel. It bleeds for a short time so pressure is applied to the upper lip, pushed against the upper jaw. 

Recovery from an upper lip tie operation

I have never needed to do anything else to treat a baby with upper lip tie.  A review of overseas studies suggest that ongoing bleeding requiring treatment has not been needed.  If it was, treatment would involve applying silver nitrate to the bleeding site.

 

Costs

The cost of the consultation is $10 for New Zealand Citizens.  You will need to provide us with a copy of either of the baby's parents elligible Passport, Birth Certificate or Community Services Card.  Please check with reception when making an appointment.  If we do not have the correct documents on the day of the procedure the cost is $45.

* Older children and adults will incur a higher fee.

Booking

Please phone reception at Broadway Medical Centre  to enquire about booking.

Phone:   03 477 4335

Fax:       03 477 4337

E-mail: enquries@broadwaymed.co.nz