Newborn Ankyloglossia

Ankyloglossia (commonly-known as tongue tie or tongue-tied) occurs when the lingual frenulum (membrane connecting the tongue with the bottom of the mouth) is either positioned incorrectly or is too tight.

Ankyloglossia is most visible when baby is crying

Look at your tongue in the mirror. You will see that the frenulum attaches in the middle of the tongue. This normal condition prevents the tongue from falling out of the mouth or being swallowed.

In tongue-tied babies the frenulum “ties” the tongue to the bottom of the mouth and restricts its movement. Depending on the structure and the position of lingual frenulum, ankyloglossia can vary in severity.

The easiest tongue tie to diagnose and correct is the one where the frenulum attaches close to the tip or on the very tip of the tongue.

The hardest tongue tie to deal with is the hidden one, when the frenulum attaches properly in the middle of the tongue or to the very base of the tongue, but is too tight and inflexible. It is called posterior. This one is hard to see, because it occurs deeper in the mouth.

My son had the visible ankyloglossia. When he first latched on, it felt fine. He breastfed from the first hours of life.

Next day a hospital lactation consultant came to check on us. I asked her to look at my son’s latching on. By then I thought it looked and felt different from what I expected it to be. His latch felt very shallow and his mouth could hardly embrace the nipple, let alone the areola.

The consultant watched, made adjustments and told us to keep trying till her next visit. By the time of her next visit my nipples were already sore and cracking. My son seemed to be pressing on them with his gums with all the strength he had.

Before the consultant’s visit we were struggling through another feeding session and after a couple of attempts my son pushed away from the breast, arched and started screaming.

Eureka!

Right then in his tiny mouth I saw this tissue uncomfortably holding his tongue still. It was as if he screamed, but his tongue didn’t!

When the consultant arrived she examined my baby’s mouth and tongue and said he was tongue-tied, which was the reason for his shallow latch and restless nursing.

You may suspect ankyloglossia in your newborn if:

The latch looks shallow. Even if you use correct latching on technique, your baby grasps your nipple and the areola, but then lets it slip out when sucking starts. This may cause severe nipple trauma.
The sucking sounds loose and clicking and feels more like licking. This is caused by the break in suction during sucking. Try “latching” on the back of your hand as if to suck on it. Do you feel what happens to your tongue? Right - it is placed between your lower lip and the hand to ensure good suction. Tongue-tied babied can’t protrude their tongues that far and, therefore, can’t latch on effectively.
Your baby’s tongue doesn’t stick beyond his/her lips, especially visible during crying. With posterior tongue tie you won’t see the membrane underneath the tongue, as you will with the regular one, but you will see that the tongue doesn’t come out of the mouth.
With front (visible) ankyloglossia when stuck out, the tongue looks heart-shaped, rolled under, flattened, or rolled up.
When the baby tries to stick the tongue out or move it around in the mouth it may look twisted to the side.
You may also notice that the baby spends a lot of time at the breast, but your breasts remain near full, become sore, the baby can’t wait 2 hours between the feedings and fails to gain weight well. This combination of symptoms tells you that there is either something wrong with your milk composition or your baby is not sucking effectively. Before concluding tongue tie, first check latching and positioning.
After a couple of stressful nursing sessions, your baby refuses the breast. You shouldn’t, however, conclude tongue tie condition based on this alone. Check for other signs of ankyloglossia. Otherwise, visit Nursing Strike section to find out why babies may refuse the breast.
Assess general nursing behavior of your baby. Breastfeeding is the most desired process for a newborn. Tongue-tied babies, however, may latch and nurse, but arch and fuss around and be unable to relax due to the hard work sucking is for them.

It is important to correct tongue tie as early in baby's life as possible. The procedure is called frenotomy. It is fairly easy and done in doctor's office. Read more about frenotomy.

There are many ways to show your love and devotion to your kids and to win their trust. Breastfeeding is the most natural one.

Yours,

Viktoriya