Dr Phil Kieran: Did my baby need tongue-tie surgery?
It can be difficult to get clear and definite answers when looking for information about tongue-tie. This lack of clarity can leave parents feeling anxious and uncomfortable when seeking to make the best decision for their child.
?
It can be difficult to get clear and definite answers when looking for information about tongue-tie. This lack of clarity can leave parents feeling anxious and uncomfortable when seeking to make the best decision for their child. Part of the difficulty is a lack of consensus and clear definitions of tongue-tie and when to treat it. The other part is that it is very challenging to run studies on this age group of patients.
In normal tongue anatomy, the underside of the tongue is attached to the floor of the mouth by a piece of tissue (lingual frenulum), which spreads out to the floor of the mouth. The point at which it attaches to the tongue varies greatly. If this tissue restricts the movement of the tongue, it can lead to issues mainly related to feeding newborns.
Probably the most common reason people look to treat tongue-tie is due to difficulty with breastfeeding. It tends to cause more difficulty with breast than bottle feeding as the mechanics are very different. However, there are so many other variables in breastfeeding that often good support from a lactation consultant can solve issues without the need for surgical intervention.
More severe tongue-ties are easy to see. If the frenulum attaches to the very tip of the tongue or is so tight the tip of the tongue is pulled in, creating a heart-shaped appearance, you can be pretty sure there is restriction in tongue movement. More subtle tongue-ties can be tricky to assess though. Several tools help medics decide which tongue-ties need to be treated. Some of these, like the Coryllos classification, are based purely on the location of the frenulum, and others, like the Bristol Tongue Assessment Tool, look at the attachment and the movement of the tongue.
Releasing a tongue-tie usually involves a small cut on the frenulum to allow the tongue to move more freely. In most cases, this procedure does not cause any significant bleeding or other issues. Some health providers will recommend stretching and mobilising the tongue after the procedure, but there is no compelling evidence that this is needed or helps.
I encourage patients to ask questions until they are happy they fully understand what is involved. This means understanding what tools, evidence, or experience the person providing the service is using to come to their decision, the risks of going ahead, and the risks of not taking action.
If this procedure helped your child and they recovered well, then I wouldn’t worry too much about what you might have done differently.
If you have a question for Dr Phil Kieran, please send it to parenting@examiner.ie
