Accoy Ankyloglossia

You have a two month old son. You try to breastfeed but it is difficult for him to latch on. In fact, breastfeeding is a painful experience. Your pediatrician says that your son is tongue-tied or has ankyloglossia.

Ankyloglossia is a relatively common, congenital condition in which the membrane that attaches the tongue to the floor of the mouth is too short or is attached too close to the tip of the tongue. The membrane is known as the lingual frenulum. An abnormal lingual frenulum limits the range of movement of the tongue.

This limited range of movement can affect swallowing, speech and feeding, especially breastfeeding. It can also impair mechanical actions such as the ability to play a wind instrument, to lick one’s lips, to stick out the tongue or to elevate the tongue.

The degree of tightness of the lingual frenulum in tongue-tie varies greatly and so does the impact of that tightness on the functioning of the tongue.

Often times, infants are evaluated for tongue-tie if the nursing parent reports pain or other feeding difficulties.

Your doctor could suggest a frenotomy—a procedure to cut the tissue under the tongue, often with a laser.

There likely are some cases in which the tongue-tie revision would improve eating. But it is wise to consult with various medical professionals like your pediatrician, lactation consultant, dentist, or speech and language pathologist, to carefully consider whether having this procedure done is truly necessary. Lactation consultants and speech and language pathologists can weigh in whether your child has a tongue-tie and whether or not it is severe.

Ankyloglossia can cause challenges beyond breastfeeding including speech problems, orthodontic issues and trouble with the tongue sweeping through the mouth to keep the teeth clean. There are other mild impacts, like not being able to lick an ice cream cone with the tip of the tongue.

If breastfeeding is the primary reason for considering a frenotomy then consider trying other options first. A specialist might advise you to alter your position and technique when breastfeeding.

But there are some children who will benefit from a frenotomy. It is important to note that ankyloglossia can affect any baby though it can be hereditary. Ankyloglossia tends to be more common in males than females.

Frenotomies can be performed with surgical scissors, as well as lasers and electrosurgical instruments. Some risks associated with frenotomies are bleeding, poor feeding, airway obstruction, scarring and damage to the saliva ducts.

Surgery should be considered if the tongue-tie appears to be severe enough to limit proper tongue function and if the treating specialists feel that surgery will lead to an improvement in this function.

Frenotomies are usually done by dentists, pediatricians, otolaryngologists (ear, nose and throat doctors) and other specialists. Some believe that more procedures are needed to spare mothers and infants from unnecessary frustration and discomfort. Others say too many surgeries are being done because of the view it can’t hurt and might help.

The decision to proceed with a frenotomy should be made on a case-by-case basis, in consultation with a healthcare professional who understands your child’s needs.