Tongue-tie is the lay-term for a condition called "ankyloglossia." It simply means that the frenulum under the tongue (the skinny piece of tissue under the tongue that connects to the bottom of the mouth) is too short and tethers, or "ties," the tongue down. The result can be mild, like Justin's case, or quite extreme resulting in an inability to move the tongue correctly.
When tongue-tie is more severe, a baby can have trouble latching correctly. Despite popular belief that suction is the only way a baby takes milk from a nipple, the tongue plays a vital role in how well a baby nurses. The tongue has a primary function of compressing the nipple against the roof of the mouth during a feeding. When a baby has tongue-tie, the tongue does not reach the roof of the mouth well and the latch on the nipple may be lost easily.
Tongue-tie is diagnosed when the doctor or nurse sees what is commonly called a "heart-shaped" tongue. The frenulum may be attached to the very tip of the tongue instead of directly under it, causing the sides of the tongue to protrude further than the tip when the baby attempts to stick his tongue out. This can be seen when an infant cries or yawns.
The condition is generally diagnosed at birth, but can be recognized when nursing does not appear to be going well. Many lactation consultants and other breastfeeding professionals will suspect tongue-tie when a baby won't latch well or seems to only take part of the nipple. Often the first symptom is not in the baby, but rather in the mother: her nipples become quite sore. Again, a simple peek in the baby's mouth can reveal the malformation.
The treatment of tongue-tie is controversial. Some doctors believe correcting the tongue in infancy is the best choice, while others take a "wait and see" approach. If the tongue is severely tied, and the infant cannot nurse efficiently, many doctors will perform surgery to correct it. There are two forms of correction surgery. Frenotomy is a simple procedure that may be done in the office of an ear, nose and throat doctor (an Otolaryngologist) under local anesthesia. The doctor will numb the baby's tongue with gel or a small injection, then snip the frenulum. Bleeding is minimal and nursing can resume immediately after the procedure.
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