Tongue-Tie: Treatment Options for Infants

Ankyloglossia

Hello Dr.
Chen, my daughter is currently seven months old.
The frenulum of her tongue is positioned more towards the front and is slightly short, causing a dip in the middle part of her tongue when she sticks it out.
Do we definitely need to have the frenulum clipped, or are there other treatment options available? Thank you.

feng, 30~39 year old female. Ask Date: 2001/01/10

Dr. Chen Duliang reply Otolaryngology

Hello Ms.
Feng; a short frenulum, along with a depression in the middle part of the tongue when protruding, is indeed a sign of a shorter frenulum.
If the condition is severe, it is advisable to seek treatment early to prevent any impact on future speech function.
The treatment is quite simple and can be resolved in just 10 minutes at our outpatient clinic, and it is very safe.

Reply Date: 2001/01/10

More Info

Tongue-tie, or ankyloglossia, is a condition where the band of tissue (frenulum) that connects the tongue to the floor of the mouth is shorter or tighter than usual. This can restrict the movement of the tongue, potentially leading to difficulties with breastfeeding, speech, and oral hygiene. In infants, tongue-tie can manifest as a limited ability to extend the tongue, which may be observed as a notch or indentation in the tongue when the infant tries to stick it out.

In your case, your seven-month-old daughter exhibits a shorter frenulum, which is causing a slight indentation in the middle of her tongue when she tries to extend it. The decision to treat tongue-tie depends on several factors, including the severity of the condition and the impact it has on feeding, speech development, and overall oral function.

Treatment Options
1. Observation: If your daughter is feeding well, gaining weight appropriately, and there are no significant issues with speech or oral hygiene, a wait-and-see approach may be appropriate. Many children with mild tongue-tie outgrow the condition as they develop.

2. Frenotomy: This is a simple surgical procedure where the frenulum is snipped to release the tongue. It is typically performed in a pediatrician's office or a dentist's office specializing in pediatric care. The procedure is quick, often done without anesthesia for infants, and has a low risk of complications. After the procedure, parents may be advised to perform exercises to prevent reattachment of the frenulum.

3. Frenuloplasty: In cases where the frenulum is thicker or more fibrous, a frenuloplasty may be performed. This procedure involves more extensive surgical intervention and may require anesthesia. It is usually reserved for more severe cases of tongue-tie.

4. Therapy: If the tongue-tie is causing feeding difficulties or speech issues, working with a lactation consultant or a speech therapist may be beneficial. They can provide strategies to improve feeding techniques or speech exercises that can help your child.

Considerations
Before deciding on treatment, it is essential to consult with a healthcare professional who specializes in pediatric care, such as a pediatrician or an ENT specialist. They can assess the severity of the tongue-tie and its impact on your daughter's feeding and development.
In some cases, parents may feel pressured to have the frenulum clipped, especially if they are concerned about potential feeding issues. However, it is crucial to weigh the benefits and risks of the procedure. If your daughter is feeding well and there are no significant concerns, it may be reasonable to monitor her development before proceeding with any surgical intervention.

Conclusion
In summary, while frenotomy is a common treatment for tongue-tie, it is not always necessary, especially if the child is thriving. Consulting with a pediatric specialist will provide you with the best course of action tailored to your daughter's specific situation. If you have further concerns or if her feeding or speech development seems to be affected, do not hesitate to seek a second opinion or further evaluation.

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