All of us have a membrane under the tongue that attaches it to the floor of the mouth and allows it to move. Generally, the growth of this frenulum is consistent with that of the tongue, but it may happen that this is not the case, leaving the sublingual frenulum short. It is known as tongue tie , and many parents wonder what happens if my child has a frenulum of the tongue that is too short?
According to the Spanish Association of Pediatrics (AEP), this pathology affects between 1.7 and 4.8 percent of newborns, being three times more frequent in boys than in girls. As a consequence of this shortening, babies have difficulty moving their tongues and it can cause problems in breastfeeding by not being able to suck properly. However, not all children with a short frenulum have difficulty breastfeeding. It can also show diction problems when starting to speak.
There are different types of sublingual frenulum, the most common being the one that reaches the tip of the tongue. There is also the submucous frenulum, which is not visible to the naked eye, but anchors the tongue to the floor of the mouth giving it a spoon shape.
We can check if our little one has a short lingual frenulum (or ankyloglossia) if we observe that it is difficult for him to push the lingual apex out of the teeth or if when he succeeds, the tongue curves.
Symptoms of short frenulum in babies
Not all babies with a short frenulum have difficulty breastfeeding, since in some the elasticity of the frenulum or the characteristics of the mouth allow them to suck and express milk properly. However, depending on the severity of the anchorage, for others breastfeeding becomes very difficult.
Babies with a short tongue tie often have problems with breastfeeding such as:
- You can’t keep a good grip on the chest; comes loose frequently.
- The feedings are very long and the baby gets tired: he asks a lot and spends a long time at the breast.
- Inability to eat enough milk; slow weight gain.
- Sometimes, while the child is breastfeeding, a tongue click can be heard, due to the loss of vacuum.
For the breastfeeding mother:
Among the different problems suffered by mothers who breastfeed, the AEP stands out:
- It can cause cracks in the mother’s nipple due to the friction and excessive pressure that will be inside the baby’s mouth.
- Cracks can lead to mastitis.
- Feeling of low milk production, as the child suckles for a long time.
- Hypogalactia: poor milk production
- Wean early.
Solutions can be sought such as modifying the posture when breastfeeding, placing the baby’s head back or with the mother semi-reclined. There are women who have succeeded in breastfeeding despite tongue-tie.
Consequences of the short frenulum in the medium and long term
In the medium and long term, tongue tie can also cause other problems. For example, problems in tongue mobility will have a negative influence on the correct development of the maxillofacial structure (such as the palate or teeth), being able to make them breathe through the mouth continuously.
When the baby learns to speak, it will also present problems in the articulation of the different phonemes, since the existence of a lingual frenulum that is too short will lead to dysglossia that will affect the correct pronunciation of sounds, one of the most common being rotacism .
How is it solved?
The first thing is to assess the degree of anchorage suffered by the baby to determine if the operation is really necessary , and it cannot be solved with other breastfeeding support strategies.
When there is a clear diagnosis and it is decided that it is the best option, to solve the problem, a surgical procedure called a frenectomy (also called a frenulotomy, frenotomy, frenilectomy or frenulectomy) is performed. It consists of cutting the frenulum with a scalpel or scissors (conventional surgery) or laser.
It is a very simple procedure and the results are immediate. In infants it is usually performed with spray anesthesia in the sublingual area, but from 10-12 months it is performed in the operating room with inhalation anesthesia.
However, there are opinions against frenectomy . A new scientific study from the University of Western Australia, presented at the XIII International Breastfeeding Symposium, promoted by Medela, concluded that 36% of operated babies abandon breastfeeding before six months of age.
According to the research, the babies studied did not show a significant improvement in tongue mobility after frenotomy. In addition, they can suffer pain, bleeding, infections and refusal to drink breast milk because of the discomfort.
It is important to assess each case, and that the breastfeeding mother is offered options so that her baby can feed properly and avoid pain.
