Posterior Tongue Ties

By Marina Macleod

June 18, 2019

Marina is a Registered Nurse with over 14 yrs of experience, a Mama Coach in Calgary, AB and area and a Mama to 2! She offers prenatal education, newborn and post-partum support, lactation counseling, infant & child CPR/Choking workshops, as well as sleep education programs based on science, empathy & support.

What is a Tongue Tie?

Medically it is called Ankyloglossia. The Canadian Pediatric Society describes it as a relatively common congenital anomaly which is characterized by an abnormally short lingual frenulum which can cause decreased tongue mobility. What is a Lingual frenulum? This is a small section of tissue that connects the floor of the mouth to the underside of the tongue. With a tongue tie the frenulum can be uncharacteristically thick, tight or short. There are different degrees and classifications of ankyloglossia including anterior and posterior tongue ties. With an anterior tongue tie the frenulum is attached at or near the tip of the tongue. With a posterior tongue tie the frenulum can be attached midway or deeper along the underside of the tongue, it is thickened and appears as a flat mound or white line at the base of the tongue.

 

 

Breastfeeding and Tongue Ties

Tongue ties restrict movement and do not allow the tongue to function properly. This is significant especially in babies and young children as it can affect breastfeeding and eventually speech. Babies with a posterior tongue tie may have difficulty extending their tongue beyond their lower gums. This can contribute to a problematic latch and sore nipples as well as cause continued breastfeeding and developmental problems. When babies breastfeed they have a specific suck pattern including a wave-like tongue movement that helps transfer the milk from moms milk ducts to their mouth to swallow. If babies do not have that free tongue movement, that can happen with a posterior tongue tie, proper milk transfer can be very difficult. Some red flags that may occur when breastfeeding include:

  • Very painful latch (initiating breastfeeding may be occasionally uncomfortable, but should not be painful)
  • Baby is not gaining weight properly
  • Baby is not following their developmental curve
  • Baby is unsettled at the breast or after a feed or fussy in between feeds
  • Baby has decreased wet/dirty diapers
  • Mom has a decreased milk supply (which can happen in the first couple weeks or up to 3-4m post partum)

If you are having difficulties with breastfeeding and are noticing any of the above points, your baby should be assessed for a tongue tie. This can be done by a doctor, or lactation professional that has experience in assessing for Ankyloglossia they will look in your babies mouth and complete a thorough assessment.

 

 

Treatment and Diagnosis

There are varying degrees of tongue ties which can make diagnosis difficult. The tongue and surrounding oral cavity appearance, the movement of the tongue, physical examination and baby’s symptoms are all used to help make a diagnosis. Not all tongue ties need to be treated, some babies with a tongue tie show little to no symptoms and are able to latch and breast feed sufficiently.  Thus, treatment of a tongue tie is somewhat controversial. Some health care professionals prefer to treat it in the immediate postpartum stage and others prefer a more conservative approach to wait and see if problems persist. Treatments for tongue ties can include frenotomy (clipping the frenulum), frenuloplasty (a more in depth repair done under anesthesia), Lactation support, speech pathology and suck training.

 

If you are concerned or have questions it is best to have your child assessed. You can reach out to any Mama Coach, your physician or lactation professional.

 

For more information on this topic Check out our More Than Sleep Show Podcast!

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