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Q:

Dear doctor, I would like to know more about lip/tongue tie, which i suspect has been the issue ever since i breastfeed my son, my son who is now 1 year old. i still remember he had problem latching to my breast from the beginning whereby, he will will latched and unlatched intermittently, which resulted i used breast pump in order to continue breastfeed him.  i ran across, an article on lip/tongue tie and found that most of my problem matches against the problem listed in the article.  my questions are, is the procedure to rectify the tie lip or tongue tied common in malaysia? is there any long term effect after the procedure? can any paed identify if your child got the problem? if not rectified, will it be hinder your child development i.e. communication skills. ( katt )

A:

Tongue-tie occur when the thin piece of skin under baby’s tongue (lingual frenulum) is short and restrict the movement of the tongue. It occurs in 3-5% population. It may cause problems in feeding, oral development, swallowing and speech. It often runs in family.

Upper lip-tie is when the piece of skin under the baby’s upper lip (labial frenulum) is too short or thick and pinned tightly to the upper gum. It restrict the movement of the upper lip and prevent it from flanging. It make latching on the breast harder and difficult for baby to maintain a good seal for effective breastfeeding. He may slip off the breast easily. It is often associated with tongue-tie.

During infancy it can cause breastfeeding problems:

Baby need to be able to cup the breast with his tongue to remove milk from the breast well. If the tongue is pinned tightly to the floor of the mouth, he cannot open his mouth wide enough to take in full mouthful of breast, and end up with “nipple feeding”. This causes following problems

Maternal:

  • Nipple trauma and pain
  • Poor milk supply
  • Recurrent blocked duct /mastitis
  • Discouragement with breastfeeding

Infant:

  • Poor latch and suck
  • Losing suction while feeding and suck in air
  • Clicking sound while breastfeeding due to poor suction
  • Poor milk transfer
  • Poor weight gain
  • Fussiness and irritability during feeding

Making a diagnosis

Your Paediatrician or Lactation Consultant will be able to assess your breastfeeding and check your baby’s mouth to see whether he has tongue-tie or lip-tie, looking particularly at the following issues:

  • Appearance of the tongue and movement. Due to lack of lingual mobility it affect speed and accuracy of tongue movement. Baby cannot poke his tongue out beyond gum/lips. Tongue cannot move sideways. Tip of the tongue may be notched or heart-shaped when he cry, or flattened (depending on types of tongue-tie)
               Classic heart shaped tongue caused by restricted central tongue tip elevation. This presentation is actually sometimes less symptomatic than the tighter, shorter frenula that present as flattened (simple) or bunched tongue
Classic heart shaped tongue caused by restricted central tongue tip elevation. This presentation is actually
sometimes less symptomatic than the tighter, shorter frenula that present as flattened (simple) or bunched tongue
  • Swallowing / eating difficulties. Inability to chew age-appropriate solid food. There may be gagging, choking and vomiting during eating.
  • Dribbling of saliva
  • Speech problem. Due to limited range of lingual movement, there is misarticulation and unclear speech ie when pronouncing consonants ‘T’ ‘D’ ‘N’. When talking fast, speech is unclear. They have to undergo prolonged speech therapy, talk carefully and slowly.
  • Dental problems. Poor dental hygiene

If untreated, all the above problems will persist till adulthood. More problems experienced as time passes especially those related to speech & social issue, self esteem, work environment and dental health.

Treatment

Once his doctor identify tongue-tie/ upper lip-tie, he can be referred to dental surgeon for revision of the frenulum. There are few treatment options

  • Snipping of frenulum (frenotomy) without anaesthesia. It is a simple, safe and effective procedure with minimal complications such as slight bleeding and pain. After the procedure, baby can be breastfed immediately.
  • Surgical revision of frenulum (frenuloplasty) under general anaesthesia
  • Revision by laser with local aneasthesia

Generally, these procedures are safe and effective. With timely and appropriate surgical intervention followed by speech therapy, optimum results can be obtained with no significant long term effect.

I hope I have answered your questions and doubt.

( answered by Dr Soong Eileen )

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