Tongue Tie: Assessment and Management to Improve Breastfeeding Outcomes
Tongue tie, or ankyloglossia, is a congenital condition characterized by a shortened or tight lingual frenulum (thin bend of tissue that connects the tongue to the floor of the mouth) that restricts tongue movement. This can significantly impact breastfeeding and feeding outcomes for infants.
Who is Affected?
Baby tongue tie can affect newborns and infants with varying degrees of severity. It is estimated that approximately 4-11% of infants have some form of newborn tongue-tie. There is occasionally a genetic pattern of inheritance. This condition impacts both breastfeeding parents and their babies, as it often leads to feeding difficulties.
What are the Signs and Symptoms?
For Babies:
- Difficulty latching onto the breast or staying latched.
- Clicking or slurping noises while feeding.
- Inadequate weight gain or slow weight gain.
- Short or prolonged feeding sessions, leading to dissatisfaction.
- Reduced wet and dirty diapers, indicating insufficient milk intake.
- In some cases, reflux can be associated with a tongue-tie.
- In older babies, eating solids can be challenging.
For Parents:
- Pain during breastfeeding, resulting in sore, cracked, or blistered nipples.
- Low milk supply due to an ineffective feeding.
- A misshapen nipple after feeding due to poor latch.
- Feelings of frustration or anxiety related to feeding challenges.
- Mastitis due to ineffective emptying of the breast.
Where is Tongue Tie Assessed?
Assessments typically occur in healthcare settings such as:
- Hospitals
- Breastfeeding and lactation medicine specialists
- Lactation consultant offices
- Pediatric clinics
- General Practice
Assessment can also happen at home. It is crucial that evaluations are conducted by trained professionals who can assess the infant’s feeding ability and the physical characteristics of the tongue. Not every child with a tongue-tie requires treatment; however, early support and appropriate management can help families navigate challenges and safeguard breastfeeding.
When Should Assessment Occur?
- Ideally, assessments should take place within the first week after birth if breastfeeding difficulties are noted.
- Severe feeding problems may warrant an assessment as early as 2 days after birth.
- Early evaluation is critical for timely intervention and prevention of long-term feeding issues.
- However, assessments can be conducted at any time if parents are concerned about a baby tongue-tie or any other breastfeeding or feeding issues.
Why is Assessment Important?
Improved Feeding Outcomes
Proper assessment and timely intervention enhance breastfeeding/feeding success, ensuring adequate infant nutrition.
Prevention of Complications
Early identification and management prevent complications such as poor weight gain and maternal pain during breastfeeding.
Informed Decision-Making
Understanding the severity of tongue tie helps parents and healthcare providers decide on the best treatment options, such as frenotomy.
What to Expect in a Tongue Tie Assessment?
A tongue tie assessment is a crucial evaluation to determine if a child has ankyloglossia (tongue tie) and to gauge its severity. It helps identify potential feeding problems and guides appropriate treatment options. Here’s an overview of what to expect during the assessment:
Preparation for the Assessment
- Positioning: The child may be held by a parent or caregiver, with infants typically placed on the caregiver’s lap or in a position that allows easy access to their mouth.
- Lying Down: For older children, the assessment may take place in a dental chair or on a knee-to-knee board, with the child lying down for better examination access.
- Duration: The assessment is usually quick, taking only a few minutes to evaluate the tongue’s movement and the characteristics of the frenulum.
Tools Used for Assessment
- Visual Inspection: The examiner will check the child’s mouth to identify signs of tongue tie, focusing on the tongue’s shape and movement.
- Lighting: A flashlight or headlamp may be used to enhance visibility of the frenulum and tongue.
- Manual Examination: The examiner may gently lift the tongue with two fingers to assess how high it can elevate, noting any tension in the frenulum and ease of movement.
- Breastfeeding/feeding technique: In case of a breastfeeding dyad, the mother and the feeding should also be assessed.
Assessment Techniques
- Multiple Tools: Various scoring systems may be used to assess the severity of the tongue tie, focusing on:
- Tongue elevation degree
- Frenulum thickness and attachment point
- Functional limitations during feeding
- Observation of Symptoms: The assessor will also consider the child’s feeding history and any symptoms related to breastfeeding or bottle-feeding difficulties, such as poor latch, excessive fussiness during feeds, or insufficient weight gain.
Post-Assessment Recommendations
After the evaluation, if a significant tongue tie is identified, recommendations may include:
- Immediate breastfeeding to check functionality post-assessment
- A possible referral for a frenotomy if deemed necessary.
Assessment Tools for Tongue Tie
Although clinical evaluation is always important, there are multiple tools that are used to assess tongue tie. These are:
Bristol Tongue Assessment Tool (BTAT)
- Overview: An objective tool assessing tongue tip appearance, tongue functionality and sucking.
- Scoring: A higher score indicates increased interference with feeding.
- Reliability: Evidence based validation, strong reliability.
Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF)
- Overview: Evaluates functional and anatomical aspects of the frenulum.
- Scoring: Uses appearance and functional scores to indicate impairment severity.
- Complexity: More detailed but less user-friendly compared to BTAT.
Coryllos Grading System
- Overview: Categorizes tongue tie based on the frenulum’s attachment distance to the tongue tip.
- Categories: Types I-IV, with Type I being least severe and Type IV most restrictive.
TABBY Assessment Tool
- Overview: A pictorial tool illustrating tongue appearance and mobility.
- Scoring: Ranges from 0-8, with lower scores indicating impairments.
How is Tongue Tie Managed?
Breastfeeding Support:
- Lactation consultants can teach techniques to improve latch and feeding positions.
Frenotomy:
- If tongue tie significantly affects feeding and persists despite support, a frenotomy may be recommended.
- This minor surgical procedure involves cutting the frenulum to improve tongue mobility.
Follow-Up Care:
- Ongoing support after intervention ensures successful feeding outcomes.
- Parents are educated on proper breastfeeding techniques and monitored for improvements.
- Multidisciplinary support (osteopathy, craneo sacral therapy and or physiotherapists) may be needed
Parental Education:
- Providing parents with information about tongue tie helps them understand the condition and seek early help if needed.
Key Aspects of Frenotomy
Frenotomy is a quick procedure typically performed without anesthesia for infants. It involves lifting the tongue to stretch the frenulum, then cutting it using sterile scissors or a specialized kit. The procedure lasts seconds , with minimal risk of bleeding, usually limited to a drop or less.
Setting:
Frenotomy can be performed in various settings, including outpatient clinics, hospitals, or, less commonly, at home by trained professionals. For older babies (>8 months), a clinical assessment is needed and a division can be performed, however, sometimes the procedure may require sedation and may be done in an operating room.
Post-Procedure Care:
Mothers are encouraged to breastfeed immediately after the procedure as it helps decrease bleeding. This also allows for an assessment of the baby’s tongue mobility following the procedure. Although the mother may experience an improvement in latch-related pain relatively quickly, overall latch and milk transfer may take longer to improve. A follow-up appointment may be suggested to ensure continuity of care.
Conclusion
Baby tongue tie can pose significant challenges for breastfeeding infants and their parents, but these challenges can often be overcome with proper assessment and management. Early identification using reliable tools ensures that families receive the support they need to improve feeding outcomes and promote successful breastfeeding experiences. For persistent issues, interventions such as frenotomy and ongoing parental education can make a profound difference in both infant and parental well-being.
Disclaimer
Global Breastfeeding Clinic Ltd does not accept any liability for the information or advice provided on this website or any content incorporated by reference. The information shared is intended for general guidance and should not be considered as a substitute for professional medical advice. We encourage all individuals to consult with a healthcare provider regarding their specific health needs. If you have concerns about your health or breastfeeding, please seek personalized advice from your healthcare provider. In case of urgent health issues, please visit the nearest Emergency Department.
While this information provides a helpful overview, we understand that breastfeeding challenges can be complex and unique to each parent-baby pair. At Global Breastfeeding Clinic, we offer personalised consultations to address your specific needs and concerns. Our experienced consultants provide evidence-based guidance and practical support throughout your breastfeeding journey. To learn more about our services or schedule a consultation, visit www.globalbreastfeedingclinic.com! We’re here to support you every step of the way.