tongue tie

The appearance of the tongue of newborns sometimes may be worrisome to parents because of a common condition ordinarily referred to as "tongue-tie," or technically "ankyloglossia." The tip of the tongue appears to be tied down to the floor of the mouth by a prominent band of tissue that anchors the underside of the tongue to the floor of the mouth to a greater or lesser degree. The tip of the tongue may even appear to be grooved or notched.

This phenomenon, a prominent or short lingual frenulum, actually only rarely interferes with normal eating or speech. We can decide pretty easily whether a prominent tongue-tie will need any kind of medical attention by observing how far out the baby can protrude its tongue between the lips.

If you say the "thuh" sound a few times, you will notice that your tongue goes no farther than just tapping the back of the upper incisor teeth for normal speech. Therefore, if a baby can stick his tongue out and blow raspberries at you, you can be confident the baby will have perfectly good mobility for normal speech.

For this reason it is pretty rare to see a baby undergo a "frenulotomy" (tongue clipping). I certainly would not recommend it without consultation with a pediatric ear-nose-throat specialist and perhaps a speech pathologist. The ENT specialist will want to either do the procedure with a local anesthetic before about 6 months of age, or wait until the child is old enough for a general anesthetic.

I have seen quite a few children over a long span of years as a very busy pediatrician. I have yet to see a school-aged child with a speech problem that was associated in any way with tongue-tie. Perhaps those kids all were clipped by other doctors. If there is ever a truly significant problem with speech caused by tongue-tie, it is a very rare occurrence by my experience.

On the other hand, frenulotomy has become somewhat more in vogue as a cure for breast feeding difficulties. There is some published literature claiming improved nursing outcomes in babies with nursing difficulties who underwent the procedure. A definitive controlled study awaits publication, however. In any case, consultation first with a lactation specialist is perhaps the best advice for serious nursing difficulties. The lactation specialist would be in the best position to advise on whether a frenulotomy would be helpful.

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