For a new mother, it can be a frustrating question — why isn’t my baby breastfeeding? The answer may lie under the newborn’s tongue.
Ankyloglossia, more commonly known as “tongue-tie,” is a condition where extra tissue is attached to the tongue and limits its mobility. And it can be a primary reason why infants aren’t latching on to their mother and breastfeeding as they should be.
“Basically, it’s extra tissue under the tongue that can restrict movement of the tongue. It can be more thickened in some kids, where it tethers the tongue,” says Dr. Mark Ghegan of Charleston ENT & Allergy. “That mostly affects feeding, and specifically breastfeeding, and that’s primarily where we address things.”
Tongue-tie is a condition some children are born with, although it may not present itself as a problem until later in life — when it can impede eating, make speech difficult, or even cause oral problems. But issues with breastfeeding are a primary concern; between 25 and 80 percent of newborns with tongue-tie have problems breastfeeding, according to the American Academy of Otolaryngology.
“Often we’ll receive a referral from a lactation consultant who’s started working with a mother either in the hospital, or shortly after leaving,” Dr. Ghegan says. “They’ve evaluated, and feel like the tongue being tethered is playing a role in the poor feeding or the pain that the mom is experiencing.”
A Simple Fix
Thankfully, it’s a problem with a simple fix: a procedure called a frenotomy that can be performed in the doctor’s office, and requires no local anesthesia. After applying some drops of topical anesthetic, doctors remove the additional tissue and free the tongue. At Charleston ENT & Allergy, Dr. Ghegan performs the procedure with a small instrument that snips the extra tissue and cauterizes all at the same time.
“It is a pretty easy fix,” he says. “The hard part is determining whether or not the baby needs the procedure. There are always children that seem to do fine, whose tongue may look the same as another child who’s having difficulty feeding. Why does one have trouble and undergo the procedure versus the other? I don’t think there’s enough good evidence out there to know that. But being a fairly minimal, noninvasive procedure, it seems to get really good results and keep infants breastfeeding.”
Tongue-tie can become an issue for older children who didn’t have problems breastfeeding, but whose speech becomes impeded later on. A speech pathologist may discover the problem, and refer the child to an ENT for treatment. Correcting the problem in older children does sometime require the use of anesthesia, Dr. Ghegan says.
According to experts, tongue-tie in older children can cause issues such as drooling, problems licking foods or playing wind instruments, and even a loss of self-esteem. But the main concerns center on speech problems and oral health issues such as tooth decay and inflammation of gum tissue.
“There are multiple things that have been linked to it. The hard part is that there aren’t many good studies on it,” Dr. Ghegan says. “So a lot of it is anecdotal evidence. But the thought is, if you don’t have good tongue mobility, it can cause problems with gums or cavities down the road.”
How common is tongue-tie? It’s difficult to say, Dr. Ghegan says, although the incidence has increased significantly over the past two decades. That surge is likely due in part to the renewed focus on the importance of breastfeeding, and increased awareness of how tongue-tie may impede a newborn from latching on or feeding properly.
“As the pendulum has shifted toward the importance of breastfeeding, I think people are more cognizant of it,” Dr. Ghegan says. “But it’s hard to come up with good numbers.”
Suspect that your child may be suffering from tongue-tie due to breastfeeding, speech problems, or other issues? Request an appointment at Charleston ENT & Allergy by calling (843) 766-7103, contact them via their online form, or visit their website at CharlestonENT.com.