Addressing Tongue Ties And Lip Ties In Infants

Introduction

Lip ties and tongue ties can be very common in infants; however, some parents do not know about their existence.

Lip tie is a condition that involves a piece of flesh connecting the upper lip and gums, while tongue ties involve flesh under the tongue of young children, these little pieces of flesh can be long, which makes it challenging for your baby to receive the right nutrition and can lead to a loss in weight when not addressed correctly.

So, parents, do you know how to identify a lip tie and a tongue tie? And how to address it?

In this article, we will discuss lip and tongue ties, what they are, and how to identify and treat them.

Understanding tongue ties and lip ties

Definition and types of tongue tie

A tongue tie, also called ankyloglossia, is a short, thick, or tight tissue band that attaches the bottom of the tongue to the mouth floor, interfering with baby feeding time. A tongue tie forms when this tissue called the frenulum doesn’t form well, as in some children the frenulum is too short or tight while in others it may attach to the tip of the tongue, making any movement impossible. This condition is usually present in newborns at birth.^1,2

Tongue ties are different for every child and can be categorised based on how well the tongue can move. There are 4 levels of severity:

• Class 1 is a mild tongue tie
• Class 2 is moderate tongue tie
• Class 3 is severe tongue tie
• Class 4 is when the tongue can hardly move²

Definition and types of lip ties

A lip tie is a piece of tissue attaching the upper inner lip to your gums, also called the maxillary labial frenulum.

Just like the tongue tie, this piece of flesh can be short and tight, limiting the movement of your upper lip. Lip ties combined with tongue ties can lead to difficulty latching or eating solid foods after breastfeeding.

This lip attachment can be classified into 4 types:

• Class 1 or mucosal type, where the frenulum is attached to the topmost part, where gums and tissue meet
• Class 2 or gingival type, where the frenulum is attached deeply to the gum
• Class 3 or papillary type, where the tissue is attached between the front teeth
• Class 4 or papilla penetrating, when the frenulum is extended in the bone³

Causes and prevalence of tongue and lip ties in infants

The causes of tongue and lip ties are unknown; however, they are associated with genetic factors. They are usually more common in boys than girls, and these conditions can sometimes run in families. This means that your family history might play an important role in the presence of tongue ties at birth.¹

Potential impacts on breastfeeding, speech, and overall development 

Tongue and lip ties can lead to different difficulties in the development of your child, and while in some children it may not cause problems, in others it might necessitate correction.

These two conditions can impact breastfeeding, nutritional issues, and speech problems by interfering with your child’s ability to make certain sounds such as t, d, z, s, th, r and l.

They can also interfere with oral hygiene both in childhood and adulthood, contributing to tooth decay and gum inflammation (gingivitis), the formation of gaps in upper front teeth (lip toe) and in bottom front teeth (tongue tie), gum recession, loss of gum between teeth and crooked or crowded teeth.³

Tongue and lip ties can also make activities such as licking ice cream, playing wind instruments, and kissing more challenging.¹

Signs and symptoms in infants

What are the signs and symptoms in infants?

When breastfeeding your baby might:

• Seems constantly hungry
• Seem frustrated unsettled, and irritable during or after feeding; Not gain enough weight or not be able to maintain a certain weight
• Have a hard time latching, and staying attached during feeding (additionally causing damage to the mother's nipple)
• Make clicking or smacking sounds during feeding (this might indicate their inability to get a tight latch)⁴

Tongue and lip ties can also affect mothers. A mother might experience:

• Pain when feeding the baby
• Engorgement and/or blocked milk ducts
• Low milk production or oversupply

Blockage of the milk ducts and low milk production is mainly due to the lack of milk removal, while oversupply can happen when the baby is nursed frequently as a result of inadequate feeding.

These experiences can often lead parents to frustration discouragement and a premature end to breastfeeding.⁵

Diagnosis methods: clinical assessment, assessment tools, and professional evaluation 

How can we diagnose tongue and lip ties?

Tongue and lip ties can sometimes be diagnosed during a newborn examination, but they can be difficult to identify until the baby shows clear difficulty during feeding.⁴

During the diagnosis, the healthcare practitioner will check the child's health history and assess it through a physical exam. During the exam, your child’s tongue will be checked as well as its range of movement.²

Treatment options

How can tongue and lip ties be treated?

There can be many approaches to the treatment of each condition, and while some doctors and lactation consultants might suggest immediate correction, others might prefer waiting before proceeding surgically.

Surgical treatment is mainly suggested in cases in which tongue ties or lip ties cause problems.

Lip tie treatments

As a first intervention, after determining that your child has a lip tie, alternative methods might be suggested. They can vary from manual therapy methods to lose the frenulum to special nipple shields for the mother.

In more significant cases of lip tie, surgical intervention is a valid option. In this quick procedure, the doctor will sever the tight frenum.⁶

Tongue tie treatments

A tongue tie might loosen over time, resolving the issues. In other cases, it may remain but not cause issues.

Just like in the case of lip ties, mothers might be connected with lactation consultants to assist in breastfeeding, and further speech therapy might be suggested to correct any speech difficulties.

Conservative treatment options

Lactation support and positioning techniques

Breastfeeding a baby with a tongue or lip tie can be challenging. However, there are methods which can help your baby latch better before proceeding to surgical options

Softening the breast

• Breastfeeding often makes your breast softer, helping your baby latch more easily
• To help your baby latch, follow their natural movements (i.e. head bobbing and licking nipple)

Reverse pressure softening technique

• Use this technique to move fluids away from your nipple and facilitate latching
• Place your fingertips at the base of the nipple, applying gentle pressure for a minute
• Express a little bit of milk, if needed, by applying pressure with your thumb and fingers on your nipple⁵

Biological nurturing

• This is a natural and gentle technique that allows a more comfortable approach to breastfeeding
• Recline letting your baby recline on your body with their chest and tummy against you
• Gravity will help your baby keep their tongue forward, improving both feeding and milk production
• This particular type of breastfeeding can be done skin-to-skin or with light clothing^5,7 

Help your baby get a deep latch

• This is needed to maximise milk intake and minimise pain
• If your baby withdraws their tongue, move their chin further from your nipple
• Gently press your finger into the edge of the areola to guide the baby's latch⁵

Assisting latch

• Try placing your finger at the base of your breast, where the baby's top lip will position, presenting the breast instead of the nipple
• As your baby opens mouth wide, use your fingers to guide your nipple⁵
• A lactation expert might be suggested before proceeding with surgical methods

Surgical options

Correctional surgical procedures are called frenotomy and frenuloplasty. These procedures are usually employed in severe cases, in which movement is severely compromised as the symptoms are less likely to be solved naturally.

• Frenotomy
• Frenectomy
• Frenuloplasty²

Frenotomy

A frenotomy is a quick and simple surgical procedure, usually conducted without anaesthesia.

During the procedure, the doctor uses sterile scissors to cut the frenulum free. The discomfort is minimal in infants because of the few nerve endings in that area.

After the procedure, there might be minimal bleeding (a drop or two), and babies can be breastfed right after.

Frenotomy is the only procedure performed on infants, while the other procedures can be performed on both children and adults.¹

Frenectomy

This is a slightly more complex procedure, in which there is a complete removal of the frenulum.² 

Frenuloplasty

In certain cases, the frenulum might be too thick for frenotomy. This procedure is made under anaesthesia with surgical tools, and the wound is closed with sutures.¹

Risks and benefits associated with surgical intervention

Complications in surgical interventions are incredibly rare, but there can be:

• Bleeding
• Infection
• Tongue damage
• Salivary gland damage
• Scarring
• Reattachment of the frenulum
• Reactions to anestesia (in frenulopasty)¹

Post-surgery

After surgery, tongue exercises might be suggested to ease tongue movements and reduce the scarring.¹

These stretch exercises will be given by your doctor to help the baby’s healing process.

Healing for lip and tongue ties is relatively quick. Complications are rare, so babies usually recover quickly from this process.

If you suspect your infant has a tongue or lip tie or notice a loss of weight, contact your paediatrician and lactation consultant, they will help assess the problem and decide on the next steps.

Lip and tongue ties can cause other problems in time and should be investigated early on.

Summary

Lip and tongue ties are common in babies and can negatively influence your baby’s nutrition and your breastfeeding experience.

Parents should be aware of the signs and symptoms of both conditions and seek professional help and treatment when necessary.

When properly diagnosed and treated, children with lip and tongue ties can thrive and fully develop into healthy children.

Recap of key points

• Tongue tie is a problem related to the tongue present at birth
• Lip tie is a problem related to the gum and upper inner lip
• These occur when the frenulum on both sides is too short and tight
• Every child shows different symptoms; some never suffer any symptom
• They can lead to breastfeeding problems in infants and be painful to breastfeeding mothers.
• As your child grows, it can lead to speech problems and other oral problems
• Not all children need surgery, as in some cases it can be solved spontaneously
• If the symptoms are more severe and seriously interfere with your child's nutrition, a frenotomy might be suggested
• Other methods and therapies should be explored before surgery
• Frenotomy is usually the first surgical procedure suggested
• If the frenulum attaches to the back frenotomy, the doctor might proceed with a more extensive procedure
• Parents should always consult their paediatrician and lactation expert to explore their options