Ankyloglossia

What is ankyloglossia?

Ankyloglossia (ang-ki-low-GLOS-ee-ah) is also known as tongue tie. It is a condition where your child's tongue does not move as freely as it should. The tongue is made up of muscle tissues that help your child during feeding, swallowing, and talking. It is connected to the floor of the mouth through a thin piece of tissue called the frenulum. The frenulum is attached to the middle part of the tongue, allowing the front part to move freely. With ankyloglossia, your child's frenulum may be shorter, thicker, or tighter than it should be. His tongue is held tighter to the floor of his mouth, reducing movement. Ankyloglossia can range from mild to severe (very bad) in decreasing the movement of the tongue. The condition can change over time to improve or get worse.

What causes ankyloglossia?

Ankyloglossia is a congenital condition, which means that your child was born with it. It may run in families, and is more common in males than in females. Mothers with history of cocaine abuse have a higher risk of having a child with tongue tie. It is also seen in children with certain genetic problems.

What signs and symptoms may come with ankyloglossia?

• Babies: Your baby may have a hard time getting milk from the breast during breastfeeding. Mothers may also feel breast pain or soreness when the baby suckles hard for milk. Bottle fed babies may also have some problems with getting milk from the rubber nipple.
  
  
• Children: Your child may have any of the following:
  
  
  • With his mouth open, he cannot easily touch the roof of his mouth with the tip of his tonque.
    
    
  • Is not able to extend his tongue much past his lower lip.
    
    
  • Has a heart-shaped tip on the front of his tongue. This may be seen when he tries to extend his tongue out with his mouth open. This happens when the sides of the tongue move forward, but the tip is held back by the tight frenulum.
    
    
  • Has a short chin and a palate that is higher than the normal.

What problems may come when my child has ankyloglossia?

• Feeding:
  
  
  • Babies: Babies may have problems with latching-on to their mother's breast during breast-feeding or with bottle feeding. They may not get enough milk because of the condition. Breastfed babies may suck even harder and this may cause breast pain in mothers. When this happens, mothers may want to stop or limit breast-feeding with the babies being bottle fed instead.
    
    
  • Children: The older child may have problems with swallowing chewed food or clearing food from his mouth.
  
  
• Oral and dental: Ankyloglossia may cause chronic halitosis (mouth odor) when food is not cleared and stays in the mouth. The trapped food can increase the germs that grow inside your child's mouth. This can cause the bad smell and start tooth decay. A child with ankyloglossia may also have other problems with his teeth or gums. Some teeth may not form well and spaces may be seen between his teeth. Ask your child's caregiver about how halitosis, tooth decay and tooth loss may be prevented or treated.
  
  
• Social: Your child may have a hard time coping with having this condition. He may be teased by other children and be sad, angry, or depressed. Your child may have problems doing what other children can easily do. These may include licking an ice cream cone or sticking his tongue out completely. He may also have problems playing wind instruments such as the flute.
  
  
• Speech: Ankyloglossia will not prevent or delay your child's ability to talk. Having this condition may only cause problems in how your child can say or pronounce some words. Words with the tongue sounds T, D, L, TH, and S may be hard for him to say.

How is ankyloglossia diagnosed?

Tell your child's caregiver if other family members have had the same condition.

• Babies: This condition may be noticed during your baby's newborn exam. The front part of your child's tongue will be looked at as he cries. If he is having problems with feeding, you may be asked questions on how your baby suckles milk during breast-feeding. Your caregiver may watch your baby during breast-feeding or bottle feeding.
  
  
• Children: Your child's tongue is checked as he lifts or extends his tongue upwards. The softness and length of his frenulum are also checked.

How is ankyloglossia treated?

Mild ankyloglossia in babies may not be treated unless there are feeding problems. Watchful waiting may be all that is needed as his tongue grows. The inside of his mouth will change in size and shape during the first 4 to 5 years of life. When his teeth start to erupt, his tongue grows and will narrow at the tip. Over time, his frenulum may grow, stretch, and even come loose on its own. When ankyloglossia is severe, your child may need any of the following treatments:

• Babies: The frenulum is clipped with surgical scissors to release the front of the tongue. There is usually little discomfort and little bleeding when this is done. It may be done with or without local anesthesia medicine for pain. This procedure may improve your baby's ability to latch-on correctly to your breast during breast-feeding. This improvement is often seen right after doing the procedure.
  
  
• Children: Your child may need to do tongue exercises or have speech therapy after any of the following:
  
  
  • Frenotomy: This is also called frenulectomy. This surgery is done if the condition is causing speech problems. The thinnest portion of your child's frenulum is cut to release the tongue tip. Local anesthesia may be used to control pain during surgery.
    
    
  • Frenuloplasty: This surgery is also called a frenectomy. It is done if the frenulum is thick and has many blood vessels. Your child may be given local or general anesthesia to control pain during surgery. The frenulum is cut and removed. The wound is then closed with sutures (stitches). Ask your child's caregiver for more information about this surgery.

When do I call my child's caregiver?

Call your child's caregiver if:

• Your baby is having problems with latching-on to your breast during breast-feeding.
  
  
• Your baby is not satisfied after feedings or you are having severe nipple pain when breast-feeding.
  
  
• You are concerned about whether your baby is getting enough breast milk or formula during feedings.
  
  
• You are finding breast-feeding painful and are thinking about switching your baby to formula.
  
  
• Your child has problems swallowing food.
  
  
• Your child has problems saying some words or problems with speaking.
  
  
• You have more questions about your child's condition, treatment or care.

When should I seek immediate care for my child?

Seek immediate care if:

• Your child refuses to feed at all.
  
  

Where can I find support and more information?

Having ankyloglossia may be hard for you and your child. Your child may have a hard time feeding or coping with his condition. You may feel angry, sad, or frightened about this. These feelings are normal. Talk to your child's caregiver, family, or friends about these feelings. You may need to see visit a lactation consultant if your baby is having problems with breast-feeding. Contact the following for more information:

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village , IL 60007-1098
  Phone: 1- 847 - 434-4000
  Web Address: http://www.aap.org
  

• La Leche League International
  957 North Plum Grove Road
  Schaumburg , IL 60173
  Phone: 1- 847 - 519-7730
  Phone: 1- 800 - 525-3243
  Web Address: http://www.lalecheleague.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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