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What is Tongue-Tie? Understanding Ankyloglossia

Recently, there seems to be an increase in the number of newborns being diagnosed with tongue-tie or ankyloglossia. With the increase in tongue-tie, there is an increase in the number of parents asking about tongue-tie clipping. Parents are often told that their child needs a tongue-tie clipping before they are even discharged home with their newborns. Often they are advised to ask the pediatrician about it by the nursery nurses or the lactation specialists because a tongue-tie can make breastfeeding difficult.

Having a tongue-tie means the tongue's ability to move is restricted because of a tight connection of tissue between the tongue and the bottom of the mouth. Often it's so tight that the baby cannot extend their tongue past the lower lip, or if they do, it makes them look like they have a forked tongue like a snake.

Frenotomy for Tongue-Tie

There have not been consistent diagnostic criteria for when tongue-tie needs to be clipped. But the diagnosis and frequency of babies getting a frenotomy, which is where the tongue-tie is clipped, has recently increased. From 1997 to 2012, there was a tenfold increase in the United States, and then from 2012 to 2016, that level doubled again. Some of the increase in procedures to clip tongue-tie may be from increased awareness of tongue-tie and doing the procedure to make breastfeeding easier. However, tongue-tie clipping doesn't always fix that issue, and sometimes it can make it worse.

Tools for determining the severity of tongue-tie have been published but not validated according to recent studies. Scoring symptoms are subjective. The other problem is that these scoring symptoms only focus on the baby and the degree of tongue-tie, not necessarily the mom's anatomy. Does she have flat or insufficient nipples, such that even if the baby did not have tongue-tie there would be nursing issues?

When Clipping May Not Be Necessary

One thing we look at before referring a baby for tongue-tie clipping is can the baby stick out their tongue past their lower lip and whether there is any forking of the tongue. If there is no forking and the baby can stick their tongue out past their lower lip, then clipping is not recommended. Same with posterior tongue-ties, where the tight tissue band is at the back of the tongue and not at the front. Those are normally not clipped because that band of tissue will stretch more as the baby gets older.

Some parents have told me that they were advised to ask about tongue-tie clipping because it will prevent speech issues and sleep apnea if it's not clipped. That's not necessarily true. If the baby is otherwise feeding well, then clipping is normally not recommended.

Your pediatrician can help you figure out if your baby has tongue-tie and if their tongue-tie is severe enough to require a frenotomy. If they do, your pediatrician will refer them to an ear, nose, and throat provider to do that procedure.