Tongue Tie…

Knowing the signs & what may help.

  • Tongue Tie (ankyloglossia) is a congenital abnormality that can restrict the tongue’s movement.  
  • Babies show an unusually thick, tight or short lingual frenulum: the strip of tissue that connects the underside of their tongue to the floor of their mouth.   
  • It is becoming common for babies to have a minor surgical procedure called frenotomy which frees the tied tongue by severing the lingual frenulum.   
  • Frenotomy – clipping the frenulum, in short, a relatively quick and easy procedure.   
Image showing the location for the  frenotomy procedure that relieves tongue tie.

While surgery is becoming routine management once a diagnosis of tongue tie has been made, it should be noted that not all tongue ties may need surgery. The surgery all depends on the severity of the tongue tie. The lingual frenulum can naturally loosen itself off over time & therefore resolve any issues. In other cases, the tongue tie may remain but cause no significant difficulties. However, in severe cases it has been reported that it may effect the way a child: Sucks during feeding as a baby; Speaks as a child/adult; Eats as a child/adult & even impair the function & formation of the palate and jaw.

Consequently, due to the fact there is no definitive diagnostic criteria for tongue tie, there is therefore no consensus in the literature as to whether cutting the tie works to resolve issues. Yet on the other hand, there has been numerous case reports to show significant improvements post cutting.

For instance one particular study at a feeding clinic revealed that 58% still have long term feeding difficulties post-surgery. However, we shall discuss possible reasons for this further on in this blog. 

Possible signs your baby may have a tongue tie: 

Image listing the effects of tongue tie upon mother and infant.

What to Look Out For: 

  • Firstly, when a baby cries, look to see if the front edge of the tongue is at least as high as the corners of the baby’s mouth?  
  • Secondly, if you trace the baby’s bottom gums with a finger, does the tongue turn to follow the finger? 
  • Thirdly, when you tug gently downwards on your baby’s chin & bottom lip, does the tongue extend past the bottom gums?  
  • Finally, if you lift your baby’s tongue towards the roof of the mouth, do you see or feel a membrane that prevents you being able to lift the tongue? Does it blanch?  

Please Note: Simply lifting the tongue to look underneath does not constitute a thorough examination nor will it accurately identify a true tongue-tie.  

Other possible signs to look for:  

  • Lip tie. 
  • Chapped bottom lip.  
  • High palate.  
  • Tongue tip dimple/heart shape.  
  • Retracted tongue. 
  • Narrow gape, tight facial/oral muscle area. 
Image showing severity of tongue tie from none to severe.
What to look for in a tongue tie.

Why tongue tie is more complex than just cutting it? 

Take a moment to look at all the muscles below to fully appreciate just how many muscles are involved in relation to the function of our tongue & mouth.  

Therefore when the discussion on why a high number of babies do not respond after having their tongue tie snipped, we must look at more than just the frenulum in infant feeding disorders.  The surrounding soft tissue could be partially why there is little definitive evidence for long-term effects on improved feeding by simply just the surgery alone. 

Lateral view cross section of muscles in the mouth that are involved with tongue tie.
Lateral View.
Image showing muscles involved with tongue tie.
Muscles involved with tongue tie.
Image showing muscles that may have to compensate due to tongue tie.
Fascial muscular that may have to compensate due to tongue tie.

“Many tongue ties are asymptomatic and cause no problems. Some babies with tongue tie have breastfeeding difficulties. Conservative management includes breastfeeding advice, and careful assessment is important to determine whether the frenulum is interfering with feeding and whether its division is appropriate.”  

NICE Division of ankyloglossia (tongue tie)

Craniosacral/Chiropractic Treatment: 

To date the main research & evidence regarding tongue tie treatment has been observational case study research, however, as a result, this approach looks to have positive outcomes. 

For instance, the role of manual therapy prior to release has shown it can help the surgery by loosening the attachments of the muscles of the tongue. This allow better elevation during the procedure as well as better visual and manual access. 

Following surgical release, manual/cranial therapy can assist in continuing to release & relax the tightened tissues of the mouth & surrounding area. This therefore helps to improve the movement patterns associated with sucking, swallowing, speech & breathing rhythm.  

What to expect: 

Firstly, the treatment involves gentle, slow movements paying close attention to the relaxation response in the body & provides just the right amount of touch to allow the soft tissues to “unwind”.  Secondly, babies will occasionally experience an increase in arousal level & may cry during a session. However, this is natural. 

How many sessions will my baby need? 

This is impossible to say upfront as it varies on each baby’s individual needs. However, the majority of therapists recommend between 2 – 10 sessions. For example, it will depend upon the severity of diagnosis, in addition with how well & how fast baby is improving with mobility & subsequently latch/feeding abilities.  

How long is the appointment? 

Most baby sessions last around 20-30 minutes. 

Some improvements you may notice after a session: 

  • Increased tongue movements & jaw opening. 
  • Increased head & neck turning to both sides. 
  • Improved comfort in baby resting in car seat etc. 
  • Calm & more relaxed appearance, less tense, more interactive. 
  • Improved gastrointestinal function (easier passing gas, stooling, less reflux) 
  • Improved latch & feeding abilities. 

How cranialsacral/bodywork helps: 

Practitioners use hands-on assessment to locate areas of decreased mobility, tightness or restriction. Moreover, they gently help to release the area using gentle experienced touch.

It is important to understand that the whole body plays a part in feeding, not just the tongue & jaw. As a result there are improvements noted in all areas of the body.

In conclusion baby treatment is always gentle & tuned into each baby’s unique needs. 

Please note if you are interested in your baby receiving treatment with Laura at Mern Chiropractic, please call us on:

07469205041 or email mernchiropractic@gmail.com

Image of smiling baby lying on its back with its mouth open showing its tongue.

Further reading – BENEFITS OF BODYWORK ON BREASTFEEDING:  

  • Chiropractic Care for the Breastfeeding Dyad, Sharon Vallone, DC  
  • CranioSacral therapy and other gentle body work for breastfeeding problems, KellyMom 
  • Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants’ Biomechanical Sucking Difficulties. Herzhaft-Le Roy J, et al. J Hum Lact. 2016. 

Dr Laura Nuttall DC

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