All Tied In Knots About Tongue Tie

One doesn’t have to spend very long on various breastfeeding related Facebook pages or groups these days to see the topic of tongue tie being discussed.

On one hand, it can be beneficial for some mothers experiencing breastfeeding problems. The mothers may find out tongue tie is possibly contributing to their problems, and it may encourage them to seek advice from a health professional.

On the other hand, it can create a lot of confusion and anxiety, especially given the strong opposing views on the topic of ‘ties’.

For example, some indicate that ties can cause ‘lifetime ramifications,’ from feeding issues, to speech and dental issues, to airway and behavioural problems. While others indicate that ties are a ‘fad’ and being over-diagnosed and treated.

Indeed, many are all tied in knots about tongue tie.

Inconsistent Use Of Terms For Tongue Tie

One significant contributing factor to the confusion about tongue tie is the lack of consistency with regards to terms used.

If a mother takes her baby to see different health professionals to find out if her baby has a tongue tie or not, she can get told very different things about her baby’s tongue. For example, the mother may be told:

• Your baby has normal oral anatomy and no tongue tie
• Your baby has a tongue tie
• Your baby has a mild, moderate or severe tongue tie
• Your baby has a prominent lingual frenulum
• Your baby’s lingual frenulum is causing a degree of tongue movement restriction

Furthermore, what different health professionals mean by many of the above can be very different.

So, let’s go through the meanings, one by one.

“Your Baby Has Normal Oral Anatomy And No Tongue Tie”

If this is said, there is not really any scope for different health professionals to mean different things. It’s pretty clear. That’s of course not to say that all health professionals will agree that any one baby has ‘normal oral anatomy and no tongue tie.’ But if it’s said, it’s not really open up to any other interpretation.

“Your Baby Has A Tongue Tie”

As per above.

“Your Baby Has A Mild, Moderate Or Severe Tongue Tie”

Now this is where it can get confusing.

Some healthcare professionals will say, “There is no such thing as a mild tongue tie. There is either a tie or there isn’t”.

Some liken this statement to ‘being a little bit pregnant’.

What health professionals who use these terms are likely trying to say is that the degree of restriction they feel the lingual frenulum is causing to the tongue movement is either ‘mild’, ‘moderate’ or ‘severe’.

While any of these tongue ties could cause breastfeeding problems, it’s possible that the more significant the degree of restriction, the more likely it might be contributing to breastfeeding problems.

“Your Baby Has A Prominent Lingual Frenulum”

Sometimes, a lingual frenulum may appear quite prominent, but the health professional might deem it not to be causing a functional problem, hence name it a ‘prominent lingual frenulum’. The confusing thing is that another health professional may call this a tongue tie!

“Your Baby’s Lingual Frenulum Is Causing A Degree Of Tongue Movement Restriction”

Sometimes, health professionals might describe their oral assessment findings in terms of any movement restriction felt.

Confusingly, another health professional may term this a tongue tie.

Furthermore, when a health professional indicates that they feel a ‘degree of restriction’ is present, this doesn’t necessarily mean a problem at all.

Indeed, there is no one range of tongue movement that is normal. There is a wide range of normal tongue movement which is likely different for different individuals. So, if a health professional mentions there is a degree of restriction, this could be within the wide range of normal.

So What Now?

Indeed, the waters parents can travel through with regards to their babies’ oral anatomy can certainly be muddied.

So, what does a parent make of all this?

Well, it comes down to the fact that there is a lack of clear and consistent research and reliable and valid assessment tools on the topic of tongue tie. This is needed before parents can get clear and consistent recommendations. It’s also important to remember that when it comes to the human body, rarely are things black and white. There are many shades of grey.

In the meantime, health professionals need to be evidence based, open-minded and transparent in their communication about this topic with parents, so parents can make their own informed decisions. Until then, many of us will continue to be tied up in knots about tongue tie.

Parents worried that their baby may have a tongue tie would benefit from seeing an IBCLC (one who does an oral examination as part of their assessment) to help work out if their baby's lingual frenulum is or isn't causing a functional problem.