The truth about tongue ties…..what, why ,how

Tongue ties can cause some controversy depending on who you speak to. As a paediatric ENT surgeon seeing lots of children with feeding and speech issues, I get asked about tongue ties a lot, so here are my thoughts…….

 What is a tongue tie?

A band of tissue, known as the frenulum,  attaches the tip of the tongue to the floor of the mouth. This frenulum is normal, but when it is particularly tight it can cause problems, particularly with feeding. When the tip of the tongue is unable to move freely, then infants can have problems feeding. This is often most pronounced when breast feeding as the tip of the tongue must massage milk from the nipple, and if it is unable to make this movement , breast feeding may be a challenge. 

Why would you divide a tongue tie?

By dividing the tongue tie the tongue has a better range of movement. The main indication for dividing a tongue tie is to assist with feeding. In my opinion the sooner you do this the better. Before the age of 6 months this can be done in the clinic with a straightforward procedure, using sterile scissors to divide the band of tissue. As there is little in the way of nerves or blood vessels in the frenulum the babies manage this procedure very well. They can feed straight away. There is a small chance of bleeding or reattachment after the release. This is rarely a problem.

Difficulty feeding, especially breast feeding, can be due to a complex set of issues, so dividing a tongue tie does not always resolve the whole problem. However, it does often help, so if the child is struggling it is definitely worth a shot.

 If the child is thriving and feeding well there is really no indication to divide a tongue tie. It rarely gives issues going forward and will often stretch out over time. I often get asked will it affect speech, and in my experience,  this is very rare. 

If you are concerned about your child’s speech, seeing a speech therapist along with an ENT surgeon will help establish the reason for the speech issue. If the tongue tie is felt to be impeding certain anterior sounds then discussion around the benefits and expectations of dividing it can be discussed.

How do you divide a tongue tie?

As described above, I am happy to divide a tongue tie in any child less than 6 months in the clinic setting. Once they are over this age they are a bit too active to do this in the clinic. By 6 months kids are generally thriving so often the indications for tongue tie release over this age are very limited. If children do require it dividing later on then a short general anaesthetic is required. Division of the frenulum with scissors is known as a frenulotomy.