When is tongue tie not a tongue tie?

When is a tongue tie not a tongue tie? In a nutshell? When it is a biomechanical problem often of intrauterine (within the womb) or birth-related origin. So, what do I mean by that?

Firstly, what is a tongue tie? Open your mouth and curl your tongue up. Underneath your tongue you will see a thin strip of tissue. This is the frenulum. Everyone has one. You will notice that it runs from the floor of the mouth to the tongue. Now, it does not control the movement of the tongue but being positioned as 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. Some tongues ties are very obvious being easily seen on examination. Some are less so. Sometimes the tongue acts like it is tied but doesn’t look it. So, what’s going on there?

The tongue is a muscle. It is attached to the various bones of the head and face. If those bones are out of kilter then the tongue will, likewise, be out of kilter and its function will be compromised. The tongue doesn’t act alone. It works alongside other muscles. Together they control and co-ordinate feeding. These muscles are also attached to the bones of the head and face. The same applies. If the bones of the head and face are out of place then so are the attachments of these muscles and their function is altered. But what causes the bones of a baby’s head to be out of alignment?

There are many reasons. Firstly, the intrauterine position. Some children are breech, bottom or feet down. In these cases, the head is squashed up against the rib cage and the bones are easily put out of place. Others spend much of the pregnancy head down, low in the pelvis. This is often the case with second or third children, the pelvis being more flexible. Again, this position can contort the bones of the head and face. Then there is the labour. Many aspects of the labour can displace these bones: forceps; ventouse; births prolonged by slow dilatation or the child getting stuck; oxytocin, a medication that increases the frequency and force of the uterine contractions; emergency caesarean sections; and many more. Whatever the cause, out of place head and face bones alter local muscle function and as a result the child may struggle to feed as if they had a tongue tie.

So, what can be done? Here at the Osteopath Clapham I take time to listen, searching the pregnancy and labour history for clues to the presenting difficulties. A careful, primary-care level examination follows, in which I upturn as many biomechanical stones as I can, searching for the true cause of the problem. At the end of the day, it may be that there is a tongue tie and a frenulotomy is the best course of action, or there may not be, in which case a series of osteopathic treatments may help to solve the issue. Whichever it is don’t suffer alone. If your child has or is acting as if they have a tongue tie do give me, Julieann, the Osteopath Clapham a call.