What is tongue tie?

Open your mouth and curl your tongue up. Underneath your tongue you will see a thin strip of tissue. This is called the frenulum. Everyone has one. You will notice that it runs from the tongue to the floor of the mouth. Now it does not control the movement of the tongue but being positioned where it is, it does, to a certain degree, anchor it. Imagine if it was very short and thick or if it came right up to the tip of the tongue. What do you think would happen to the movement of the tongue? It would be restricted. That is a tongue tie, when the frenulum is so short and thick or comes so far up the tongue that it limits its motion.

Now the tongue is a useful structure. It does lots of things. It helps us to speak, allows us to swallow, contributes to dental hygiene and can be part of facial expression. When we are babies the tongue is vital for feeding, being instrumental in the latch and the co-ordination of the suck-breath-swallow sequence. It is therefore important that it is fully functional. If the frenulum is tight and restrictive, the tongue cannot work properly and feeding is problematic. The infant is often fussy. They may splutter, cough, chomp, slip or lose their latch. They often take in air and so suffer from wind and possibly reflux. They exhaust themselves trying to compensate and, nine times out of ten, fall asleep, even after short feeds. The mother may experience squashed, sore and cracked nipples and her supply might dwindle as she dreads every feed, stress hormones inhibiting let-down and, eventually, reducing milk production.

Were this not valuable enough, the tongue has another function that is important for the growing infant, that of facial development. Put your hand behind your ear and slide down onto a large bony protuberance. This is the mastoid process. The mastoid process is not present at birth. It develops as the baby learns to lift their head. Why? There is a muscle attached to it, the sternocleidomastoid. This is a neck muscle that acts to lift the head by pulling on the bone. As it does so it draws the bone out into a process. So, muscles pull on bones and change their shape. The tongue is a muscle. It is part of a team, a team that controls and co-ordinates feeding. These muscles attach to the bones of the head and face and, as such, have an influence on their growth. A restricted tongue means a different head and face shape. Does that matter? Well, one of the noted consequences of a tongue tie is a flatter face. Sinuses are spaces that are found within the bones of the face. Flatter faces have narrower sinuses.  Narrower sinuses don’t drain well and, as such, predispose sinusitis and other associated issues such as migraines. Another thing that is pertinent with respect to tongue tie and face shape, is the fact that in the womb the tongue, jaw and palate all develop together. Consequently, a restricted tongue is often accompanied with a small jaw and high palate. Now what does that mean for the life of the baby, child and adult? Usually dental issues, such as crowded teeth or cross-bites. So, tongue restriction or tongue tie has the potential to create much more than just feeding issues.

So, what can be done? If you suspect your baby is tongue tied please seek advice from a lactation consultant, mid-wife or appropriately trained paediatric cranial osteopath, such as the Osteopath Clapham. It may be that a frenulotomy is thought necessary. This is a procedure that involves cutting or lasering the frenulum to release the tongue. But don’t panic. This may not be necessary. The problem may be biomechanical. There are many structural and functional reasons for a restricted tongue. Have a look at my blog: When is a tongue tie not a tongue tie? As a lecturer in breast feeding mechanics and once tutor at the Osteopathic Centre for Children, I am very happy to advise. If you do choose to see me at the Osteopath Clapham, I will carry out a thorough case history and examination before concluding that there is a tongue tie and even then, may, depending on the severity, suggest a course of osteopathic treatment before considering a frenulotomy. So, don’t worry. Equally don’t suffer alone. Help is only an email or phone call away.