This article is courtesy of Mr. Ng Chee Eng, Paediatric Surgeon of a private hospital in Penang.

TONGUE TIE & NURSING

QUESTION

Mothers of babies with this condition have difficulties in breastfeeding because of sore nipples. This condition is diagnosed by lactation consultant and paediatrician. Currently, are paediatric surgeons still performing the procedure to snip the part of the tongue to enable breastfeeding? What are involves? Does the baby has to go under general anaesthesia (GA)? Other than breastfeeding problems, will the baby have problems with his speech later on?

ANSWER

Whether a tongue tie needs to be released / snipped depends on its severity and whether it is causing any problems.

Latching on to the nipple/breast and breast feeding can be difficult if not impossible with a severe tongue tie. Release is then clearly justified and during the first few weeks of life, it can be done without any anesthesia and without any distress to the baby. However if the membrane (frenulum) that holds the tongue down is thick, then release will need to be under GA because of the risk of bleeding. All older children are done under GA.

Regarding speech, again it depends on the severity of the tongue tie. Some of these children may mispronounce certain syllables. However it must be said that the vast majority of children with tongue ties speak normally. Tongue tie that is detected very early but did not cause any problems like breast feeding, should not be released until he/she is much older, maybe even at 2 to 3 years old. The tip of the tongue does become longer and the underlying membrane / frenulum may recede with the child’s growth. If there is still a speech problem, release is indicated but even then I always caution the parents that the speech may not improve. They are always advised to seek a Speech Therapist’s assessment and advice.

There is also another indication for release of a severe tongue tie even when there are no problems with feeding or speech and that is to allow the tongue greater movement and mobility within the mouth. This is important for purposes of mouth hygiene as they are able to sweep the inside of the mouth of food debris.

The Japanese / Koreans / Chinese – I think what is happening is that the the parents want their children to speak better English by lengthening the children’s tongues. These children have normal tongues to start with. I am very doubful if it works and I will certainly not do it even at the request of the parents.

In summary, release of tongue tie is only justified in severe cases especially if there are difficulties with it. Generally a severe tongue tie is one that the tongue is unable to protrude beyond the lips. In newborns, some of them can’t even protrude beyond the gum margin.

I hope I have answered your queries about this fascinating subject.

Ng C.E.