Tongue-tie condition can impact nursing infants

All of the positive breast-feeding signs were there for the mother and her nearly 10-pound newborn. There was plenty of mother's milk and an alert and hungry baby.

True, the infant had lost about 3 ounces of weight per day for the first four days of life, but that's a fairly typical pattern for a nursing newborn. On his first office visit at day four, the baby boy seemed to be doing very well, ready to begin the steady 1-ounce-a-day weight gain that would make both his mother and his pediatrician very happy.

As the first few weeks passed, office weigh-ins showed the infant was growing at a frustratingly slow rate. Mom and I discussed various breast-feeding strategies. We also talked about the little guy's tongue, which was tightly tethered to the floor of his mouth by a short, thick piece of tissue called the lingual frenulum.

While many babies with a tight frenulum — a condition known as tongue-tie or ankyloglossia — have no problems eating and gaining weight, some tongue-tied newborns do have a harder time latching on and sucking during breast-feeding.

The mother and baby went off to the otolaryngologist for an evaluation, and the little boy underwent an in-office frenectomy, or snipping of the frenulum. Such frenectomies can be performed with surgical scissors as well as lasers or electrosurgical instruments.

A few days later, the baby was back in the pediatric office for a weight check. Mom reported that the infant could now stick his tongue out past his lips with ease, and the baby proved he could gain weight at the desired rate of 1 ounce per day.

The American Academy of Pediatric Dentistry reports that up to 10 percent of the population has some form of tongue-tie. The group finds limited evidence regarding frenectomy in the medical literature, and notes that specialists including pediatricians, surgeons, dentists, lactation consultants and speech pathologists often offer parents different recommendations about the need for the procedure.

The academy feels that ankyloglossia should be handled on a case-by-case basis. Surgery should be considered if the tongue-tie appears to be severe enough to limit proper tongue function, and if the treating specialists feel that surgery will lead to an improvement in this function.

Just as tongue-tie can negatively affect breast-feeding in some newborns, it can also cause speech articulation problems for some children in the toddler and preschool years. Experts at the American Academy of Otolaryngology — Head and Neck Surgery point out that it is difficult to predict which tongue-tied babies will develop these early speech problems.

The ENT group does, however, see an association between eventual speech difficulties and those children who display a tongue tip with a V-shaped notch, an inability to stick the tongue out past the upper gums, an inability to touch the tongue to the roof of the mouth and difficulty in moving the tongue from side to side.

Ÿ Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.