TeachMeSpeechMe

An Article From A Mom and Dental Professional.

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Have you ever heard the term tongue tied?   What about the phrase cat got your tongue?  So many catchy phrases but what happens when you realize at such a young age that your child really is tongue tied and if not corrected they could likely have many issues such as malnutrition or speech delays.   We were told early on our oldest was tongue tied and that was the reason why his latch was off when breastfeeding.   There were many options given to us but our family physician said that since he was gaining weight at a good rate and the tongue tie was so slight we should bypass surgery and just wait to see if it turns into a problem later on.   Unfortunately we have been battling for years with a huge speech delay with Carter. He will be turning 5 in a few days and is just not starting to talk where those closest to him can understand.

So how does tongue tie form?

Tongue tie happens when babies are in the womb.   Babies are born with either the frenum attachment to the tongue or lips being too short and tight, or it didn’t move back down the tongue during development and is still attached to the tip of the tongue.  

Our first child was born 6 weeks early weighing just around 4 pounds. Being a first time mom with no experience whatsoever with children I was struggling with massive postpartum on top of trying to figure out how to breast feed a baby in NICU.   I wasn’t able to fully get my son to latch when in the hospital so I primarily pumped and bottle fed him.   I got so comfortable doing it that way that I was positive this was how he was going to be fed. I would pump and then keep bottle feeding him.   My son was 6 weeks old when my sister in law said let’s change this you will love the connection and worked with me till I was fully comfortable with breastfeeding Carter.  By the time I was truly comfortable Carter was almost 8 weeks old and I was noticing a huge difference with him being colicky and spitting up after every feeding.  We decided to bring in a lactation specialist to determine what the problem was and how to fix it.  

Our lactation specialist was the one who determined that tongue tied could be the culprit.   We immediately made a follow up appointment with our doctor to see what she said and what treatments could be done.   Now being a dental hygienist I know that it could be a very simple procedure but the first time mom in me was very skeptical about anyone touching my son.   With the help of our family physician we decided to just let it go because it was so minor and his weight gain was right on point.  She also said with kids being kids and how minor it was most likely at some point he will have a fall and it will cut itself on its own.  

So with that being said I have since had a lot of patients in my practice come to me with similar situations and not know where to start or that there even was a problem.   Listed below are some of the main signs we suggest to look for if you have concerns.

TOP 5 SIGNS to look for that your baby has a tongue or lip frenum attachment…

1. Improper or failure to latch properly when breastfeeding 

When my oldest was born he was so tiny I was completely out of my comfort zone when trying to breast feed him.   First off I realized I knew nothing about babies and second I knew nothing about breastfeeding.  I used the lactation specialist in the hospital every second I could to help me but still felt very out of my element.   I decided for a while to just get comfortable with the pumping method until I felt like I was able to get a good latch.   

I’m a huge fan of medella breast pumps I find them to be the most widely used throughout hospitals and top rated by health professionals.  Also if you aren’t aware, which I was not aware with my first one, you insurance will provide you with a free breast pump you just have to look into which ones are covered.   

It took me a full 6 weeks to finally get comfortable with breastfeeding but by that time I was having so many pains and cracked nipples I thought it was just from the learning curve.   It never once dawned on me that maybe there was something wrong with the latch due to a lip or tongue tie.   This should have been my first sign.  

2. Baby makes a clicking sound when breastfeeding or drinking from a bottle 

My husband and I always noticed that when feeding Carter he made a clicking sound.   It didn’t matter whether he was feeding from a bottle or breast.   At first we thought it was just a cute side sound he made but we always noticed he would dribble some milk out of his mouth and started to research more.   The research didn’t lead us down the right path though.  All it ever talked about was improper latch causing a fussy baby.    This should have been our second clue.  

3. Baby has tons of gas after feeding and fussiness

Carter had always been defined as a “colicky” baby we assumed because he was a premie.   He used to have his feedings and just scream followed by a lot of spit up.  We were introduced to a product call mylicon early on that worked great for a while but he still fussed a lot.   We also tried gripe water but that didn’t seem to do anything for him.   So unfortunately we didn’t think into anything like a tongue tie or lip tie because we were always directed to him just being “colicky.”

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4. Pain during breastfeeding and low milk supply or dip in milk supply 

So one of the biggest things that should have been a red flag was the painful breastfeedings.   I assumed that it was just because I was a first time mom and this was all part of the process.   When I started off I was primarily pumping and noticed my milk supply was outrageous.  I was so proud of myself but then started to notice that when I would breastfeed the flow was to much for my son.  It wound sound like he was guzzling and then he would immediately spit up almost all of the feeding.   When we brought the lactation specialist in she showed me a few different ways to breastfeed my son to slow the flow for him but when I switched from primarily pumping to primarily breastfeeding my milk supply dropped dramatically. 

5. Failure to thrive 

Now luckily we didn’t have an issue with my son he was born a preemie at 4lbs but started packing on the weight immediately.   This was one of the biggest reasons why our pediatrician decided that he was not a candidate for any surgical treatment at that time.   

TREATMENT 

There are a few simple procedures that can be done when you have determined if your child is in fact having an attachment issue. First off if your child doesn’t show major signs of delays or having issues it is ok to not treat them. As children grow the frenulum stretches which ends up giving the tongue enough freedom to move freely.

If surgery is needed you can either contact your ENT, dentist or oral surgeon to do:

• Frenotomy which is where the doctor makes a small cut with a scalpel or laser to the frenulum. I have worked with both in my practice but have found that the laser is the least invasive way. The procedure is quick but may leave your child in pain for a few days. The procedure is very quick and done right in the office. We always encourage parents to hold the child for comfort for both parties. Sometimes when the child is older we suggest anesthesia. It is best to have it diagnosed before the child is 6 months old and starts introducing solids so that it doesn’t interfere with them learning how to eat. If done later on it may cause some delays and issues with the child trying to relearn things such as eating, speech or even latching correctly when breastfeeding.

• Frenuloplasty is done for children who are older or if the frenulum is too thick for a simple frenotomy. Your child will need to be under anesthesia during the surgery where they will divide and lengthen the frenulum to free the tongue.

My son Carter is almost 5 years old and has been in preschool since he was 3 due to delayed speech issues.  A lot of doctors, nurse practitioners and fellow dentists have looked at Carter and said he was not in need of any surgeries but often enough the mom and dental hygienist in me often wonders if maybe we should have tried something when he was younger, even if it was a slight case.  Would we be where we are today with speech delays?  Is he such a picky eater because of something bigger or just because it’s a typical toddler phase? 

Whatever you decide to do is your right as a guardian but never fear asking the questions.   Talk to your child’s primary care physician or take them to your local dentist.