Lack Of Awareness About Tongue-tie In Babies

Meera (name changed) was devastated when her newborn was unable to sustain breastfeeding and on seeing her baby unsatisfied and fussy all the time. Luckily enough, her lactation consultant, referred to by her pediatrician, diagnosed her baby with tongue-tie at the right time and was able to intervene right. 

But unlike Meera, there are umpteen such cases where the mothers are so desperate to find out what was wrong with their babies. Such obscurity surrounds a lot of young parents most of whom are at their wit’s end. 

A severe lack of awareness, of specialized education surrounding tongue-ties & breastfeeding for pediatricians and lactation consultants, has been fuelling this.

What is tongue-tie?

Tongue Tie aka Ankyloglossia is a congenital condition marked by an unusually short band of tissue that anchors the babies’ tongue to the floor of the mouth. Tongue ties have been around since times immemorial. In fact, there have been several references including that of The Bible and several medical texts from the middle ages. Moreso, several midwives used to nip their nails and snip off the tongue ties whenever they saw mothers experiencing breastfeeding issues.

How prevalent is tongue-tie in babies?

While its occurrence ranges from 3 per cent to 16 per cent worldwide, tongue-tie is an overlooked complication in the Indian scenario. Per a 2016 study conducted by Cloudnine Hospital, Bangalore, an estimated 0.52 per cent among 25,786 babies born across three different hospitals in the city were diagnosed with tongue-tie. 

The seemingly low incidence rate in India, compared to the western countries, seems to be due to the lack of timely diagnosis by trained professionals. Tongue tie’s relation to breastfeeding issues has always been disputed, and the effectiveness of its only solution is in question. It is believed that the debate lies due to the fact that research hasn’t caught up, but that isn’t true. Moreover, several cases of tongue-tie actually slip under the radar due to the lack of clinical support particularly due to lack of specialized education amongst pediatricians and from lactation consultants. 

How to spot tongue-ties in babies?

Strongly associated with breastfeeding difficulties, tongue-ties are diagnosable at birth, given the role of the tongue in latching and suckling. The early symptoms of tongue-tie in infants range from difficulty latching,  feeding continuously and inadequate weight gain. 

As mothers, there are some early symptoms and red flags to look for, when they think their baby is fussy, unhappy, or notice breastfeeding issues. 

Red flags to look for in babies

●restricted tongue movement

●inability to open mouth wide when attaching to the breast

●coughing on the milk flow

●difficulty staying latched

●clicking noises and dribbling of milk during feeds

●colic and vomiting after feeds

Symptoms of tongue-tie in babies

1.Poor latching: The baby slips off the nipple and in an attempt to maintain the latch, chews on the nipples more than sucks. The baby feeds for an extended period of time or for a very short duration and still feels unsatisfied after the feed. 

2.Fussy feeding time: The baby barely hangs on the nipple and often pulls and moves his/her head in an attempt to pull out the milk

3.Doesn’t gain the expected weight: Weight loss of over 7 per cent in the initial week, growth stagnation even after weeks or months when production decreases, and very few poop diapers 

4.Disturbed sleep patterns: snoring, tossing and turning in bed, and mouth breathing

Symptoms exhibited by mothers

1.Painful nipples 

2.Breast pain post-feeding 

3.Sore and cracked nipples that look misshapen 

4.Exhaustion from frequent feeding

5.Distress, low or oversupply of milk

Despite the above-mentioned difficulties, tongue-tie’s association with breastfeeding troubles has always been disputed and ignored and what’s worrisome is that the effectiveness of the condition’s only solution is always questioned.

What are the complications of untreated tongue-tie?

If left undiagnosed, tongue-tie might lead to fussy eating, mouth breathing, snoring, recurrent tonsils, adenoids, disturbed sleep, slouching posture with forwarding neck & shoulders, oral problems like speech issues, incorrect jaw and teeth development during childhood and complications like neck, shoulder, back pain and temporomandibular disorders in the later stages of life.

Are all breastfeeding issues because of tongue-tie?

There are many other reasons why a child cannot breastfeed properly. In fact, due to birth trauma, babies could go through some changes in the head shape or have a tight neck. As a result, they are likely to keep turning their head to one side- which could also make breastfeeding difficult. 

A craniosacral therapist, a tongue-tie specialist, and a lactation consultant together are more likely to diagnose issues like these. That’s why a careful and complete assessment with a multidisciplinary team approach of pediatric dentists who are trained tongue-tie specialists, lactation consultants, and craniosacral therapists is required to make the right diagnosis. 

Putting all the pieces of the puzzle in place

At present, experts leading the field of neonatal tongue tie are from the periphery of a core medical team that consists of lactation consultants, pediatric dentists who are trained tongue-tie specialists, and craniosacral therapists. A holistic, multidisciplinary approach to diagnosis is thus crucial to diagnosis and guidance.  

Bottomline

If you are a new mother who thinks there’s something wrong with your child or if you are concerned with your child’s feeding, it might be really helpful to consult an internationally trained lactation consultant (IBCLC) and a pediatric dentist who is also a trained tongue-tie specialist. A balanced approach is key to diagnosing tongue-tie in children and eradicating the lack of awareness that has been fueling it.

Dr Ankita Shah

Guest Author The author is Founder of Dentician and The Tongue Tie & Sleep Institute