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Tongue-tie, also called ankyloglossia, is a condition in which the frenulum, which corresponds to the tissue below the tongue, is shorter and tighter than normal, making it difficult for the tongue to move.
Although it does not have any serious implications for he alth, depending on the degree, tongue-tied can interfere with the baby's speech development and breastfeeding, and pediatrician evaluation is important.
Tongue-tie is most easily observed in the infant, but it can also be noticed only in adolescence or adulthood, especially in mild degrees that do not affect daily activities. Treatment is usually through simple surgery to free the tongue and allow it to move more freely.
Depending on the degree, tongue-tie can be easily observed when the baby is crying, for example, as the tongue does not rise in the mouth, appearing to stick to the bottom.
Also, other signs that may be indicative of tongue-tied include:
- Difficulty lifting the tongue to the upper teeth;
- Difficulty moving tongue sideways;
- Difficulty sticking tongue out of lips;
- Tongue in a knot or heart shape when the child puts it out;
- Baby bites mother's nipple instead of suckling;
- Baby feeds poorly and is hungry shortly after feeding;
- Baby fails to gain weight or grows slower than expected.
In addition, when the child can already articulate some words, the pediatrician or speech therapist can also take into account in the diagnosis of tongue-tie the difficulty that the child has to pronounce words with the letters L, R, N or Z, in addition to phonetics.
There are also cases in which tongue-tie can only be observed at older ages, through exercises that assess the mobility of the tongue.
What causes tongue-tied
Tongue-tie is a genetic alteration that happens during the formation of the baby during the gestation period and can be caused by hereditary conditions, that is, due to certain genes that are transmitted from parents to children.
However, sometimes it has no cause and occurs in babies with no other cases in the family. That's why there is the linguinha test, performed on newborns in hospitals and maternity hospitals, which serves to assess the frenulum of the tongue. Learn more about the linguinha test.
Tongue-tie in the baby can cause problems in breastfeeding, as the baby has more difficulty in latching on to the mother's breast correctly, biting the nipple instead of sucking it, which is very painful for the mother.By interfering with breastfeeding, tongue-tie also causes the baby to eat poorly, becoming hungry very quickly after breastfeeding and not gaining the expected weight.
In older children, tongue-tie can cause the child to have difficulty eating solid foods and interfere with dental development, such as the appearance of space between the 2 lower front teeth. This condition also hinders the child to play wind instruments, such as flute or clarinet and, after 3 years old, it impairs speech, as the child tends not to be able to speak the letters l, r, n and z.
How the treatment is done
Treatment for tongue-tied is only necessary when the baby's feeding is affected or when the child has speech problems, and consists of surgery to cut the frenulum of the tongue, in order to allow the movement of the tongue.
Surgery for tongue-tie is quick and discomfort is minimal, since there are few nerve endings or blood vessels in the tongue frenulum, and after surgery, it is possible to feed the baby normally.
Speech therapy for tongue-tied is also recommended when the child has speech difficulties and after surgery, so that exercises adapted to the child's age and problems are performed to improve tongue movement.
Some options for tongue-tie surgery are:
Frenotomy is one of the main surgical procedures to resolve tongue-tie and can be performed at any age, including newborns, since tongue-tie can make it difficult to latch onto the breast and suckle milk. The frenotomy helps to release the tongue quickly and helps the baby to latch better to the mother's breast, making breastfeeding easier. That's why it's done when tongue-tied only presents a risk of affecting breastfeeding.
This procedure is simple and can be done in the pediatrician's office without anesthesia and consists of cutting the frenulum of the tongue with sterile scissors.The results of the frenotomy can be seen almost immediately, between 24 and 72 hours. In some cases, just cutting the frenulum is not enough to solve the baby's feeding problems, and a frenectomy is recommended, which consists of the total removal of the frenulum.
Frenuloplasty is also a surgery to resolve tongue-tie, however its performance is recommended after 6 months of age, since general anesthesia is required. This surgery must be performed in the hospital and is performed with the aim of rebuilding the tongue muscle when it does not develop properly due to the alteration in the frenulum and, therefore, in addition to facilitating breastfeeding, it also prevents speech problems.
3. Laser surgery
Laser surgery is similar to frenotomy, however it is only recommended after 6 months, as the baby must remain still during the procedure.Recovery from laser surgery is quite fast, about 2 hours, and consists of using a laser to cut the tongue brake. It does not need anesthesia, being done only with the application of an anesthetic gel on the tongue.
From laser surgery it is possible to release the tongue and thus help the baby to suckle, being recommended when the tongue interferes with breastfeeding.