Tongue and lip ties are common congenital variations that can affect infants. These conditions involve restrictive oral tissues that may impact a baby’s ability to feed and develop properly. While the presence of these tissues is normal, their abnormal tightness or shortness can sometimes lead to functional challenges.
Understanding Tongue and Lip Ties
A tongue tie, medically known as ankyloglossia, occurs when the lingual frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth, is unusually short, thick, or tight. This restriction limits the tongue’s range of motion, affecting its ability to lift, extend, or move side-to-side. Tongue ties can be categorized as anterior or posterior. An anterior tongue tie is visible closer to the tip of the tongue. In contrast, a posterior tongue tie is located deeper under the tongue but potentially just as restrictive.
A lip tie occurs when the labial frenulum, the tissue attaching the upper lip to the gums, is overly tight or extends too far down. This can hinder the upper lip’s movement, affecting its ability to flange or seal properly during feeding. A lip tie is diagnosed when it causes functional issues. The severity of both tongue and lip ties can vary, and not all instances cause problems requiring intervention.
Recognizing the Indicators
Potential indicators include a baby’s feeding patterns and behaviors. Infants may struggle with latching onto the breast or bottle, often resulting in a shallow latch, causing them to frequently unlatch or slip off. Clicking sounds during feeding are common, indicating a loss of suction due to restricted oral movement. Affected babies might experience prolonged feeding times, poor weight gain, or appear fussy and unsatisfied after feeds. Other signs in the baby can include excessive gassiness, reflux symptoms, or milk dribbling from the mouth due to an incomplete seal.
Mothers of babies with these conditions may also experience discomfort. Common maternal indicators include nipple pain, soreness, or cracked nipples during or after feeds. The nipples might appear blanched, flattened, or misshapen after nursing. If the baby is not effectively draining the breast, the mother may develop issues such as breast engorgement, blocked milk ducts, or mastitis, and can also experience a reduced milk supply over time.
Diagnosis and Pathways to Care
Diagnosing tongue and lip ties involves a comprehensive assessment by healthcare professionals. This evaluation typically includes a review of the baby’s feeding history and any related symptoms experienced by the parent. A visual inspection of the oral tissues is performed to observe the frenulum’s appearance and attachment points. Clinicians also use palpation to assess its thickness and tension.
A functional assessment of the baby’s oral movements is conducted, checking the tongue’s ability to lift, extend, and move side-to-side, and the lip’s ability to flange. Observing a feeding session can show how the oral restrictions impact milk transfer and latch effectiveness. Healthcare professionals who can diagnose these conditions include pediatricians, International Board Certified Lactation Consultants (IBCLCs), pediatric dentists, and ear, nose, and throat (ENT) specialists. A diagnosis is made when a restrictive frenulum is found to be causing functional difficulties, rather than solely based on its appearance.
Treatment Approaches
When tongue or lip ties cause significant functional issues, a common intervention is a frenotomy. This minor surgical procedure involves releasing the restrictive frenulum to improve oral mobility, by cutting the lingual frenulum for tongue ties or the labial frenulum for lip ties.
Frenotomies are often performed in an office setting using sterile scissors or a laser. The procedure is typically quick and often requires no anesthesia for infants. Following the procedure, babies can often breastfeed immediately.
Parents are typically instructed on specific oral exercises or “stretches” to prevent reattachment of the tissues during the healing process. Follow-up care with a lactation consultant or other feeding specialists is often recommended to support optimal feeding outcomes and the baby’s adjustment to improved oral function. In some complex cases, a more extensive procedure called a frenuloplasty might be considered, which reshapes or repositions the tissue and may require sutures.