I'm a midwife and these are the signs your baby has tongue tie

Carmelle Gentle is an independent midwife and lactation consultant who specialises in complex feeding challenges and oral dysfunction in infants 0-4 years

27 Mar 2024

The parental awareness around tongue tie has increased in recent years, yet navigating and accessing the right support and treatment can feel like a bit of a minefield for parents in the midst of the early days and weeks postpartum, and throughout infancy and early childhood.

Infant tongue tie in the UK is not routinely assessed for at birth and is not always picked up during routine postnatal appointments. The onus of seeking support around tongue tie can be left up to the parents to figure out what might be going on for their baby.

As such it is important that parents are aware of signs and symptoms that might present in

Parents may wonder if their baby has tongue tie

A tongue tie is where the lingual frenulum (connective tissue under the tongue) is too short or tight and restricts the full range of motion of the tongue, impairing the function of sucking, swallowing and/or breathing during infant feeding.

A thorough assessment of the tongue function requires a physical examination of your baby’s mouth in order to make a diagnosis of tongue tie.

There are ways as a parent that you can begin to observe and recognise if there may be oral restrictions for your infant, symptoms can vary from baby to baby as they learn to compensate in varying ways.

Some common signs that you may notice:

Breastfeeding

· Sore or damaged nipples
· Vasospasm
· Difficulties latching
· Infant weight loss or static weight
· Excessive weight gain (climbing centiles)
· Clicking sounds
· Not seeming satisfied after feeds
· Shallow latching
· Short frequent feeds or long feed duration
· Colic or reflux symptoms

Bottle feeding

· Difficulties latching to a bottle
· Clicking sounds
· Excess air swallowing
· Dribbling milk out of the slides
· Bottle refusal or aversion
· Fussing at the bottle
· Suspected cow's milk protein allergy
· Gagging/coughing/spluttering
· Reflux or colic symptoms
· Lip blisters

Weaning to solid food

· Difficulty transitioning to solid foods
· Unable to move past pureed foods
· Dislikes lumpier textured food
· Persistent gagging
· Persistent tongue thrust
· Coughs, splutters or panics when eating
· Difficulty moving food from front to back
· 'Fussy eater’

Milestone development

· Slow to reach milestones
· Dislikes tummy time
· Seems to have strong head control form birth
· Preference to look/turn/roll to one side
· Unable to sit unaided (at expectant age)
· Bum shuffles
· Army crawler
· Skips crawling stage for walking

Sleep

· Persistent frequent night waking eg. Wakes every 30-60 mins
· Thrashes around in their sleep/restless sleep
· Loud snoring
· Gasping or choking sounds in sleep
· Pauses in breath during sleep
· Mouth breathing
· Open mouth
· Low tongue resting posture
· Nasal congestion

This is not intended to be an exhaustive list, and a baby may experience just one or more of these symptoms where compensation patterns persist.

You may recognise some of these symptoms from the past and see newer symptoms presenting over time. Symptoms can also change as your baby grows and moves through different stages of their development.

The key is to be aware of any signs or symptoms that may be occurring at the present time.

Whilst we cannot predict the outcomes for the future, you can address any persistent challenges that are occurring and seek the right support for your infant.

You can download our TTC symptom tracker to help guide you at any time during the postpartum period.

Sometimes parents are unaware or unable to pinpoint the symptoms that might be contributing to their challenges, but they have a feeling that something isn’t quite right for their baby.

This intuitive gut feeling as a parent is usually right, and I always say to lean into that feeling and find the right support person or service that feels most aligned for you. Seeking the right advice and support is the first step in helping you to help your baby.

When it comes to tongue tie and oral dysfunction a thorough digital oral assessment is needed by a tongue tie specialist; assessing the tongue mobility, function, tension and tone.

We want to assess how your baby is feeding, whether breast or bottle feeding, and incorporate body work such as cranial osteopathy, in addition to helping address any compensation patterns in the body.

A frenulotomy (a tongue tie division) alone is rarely the answer, and a whole-body holistic approach is key for more optimal long-term oral health outcomes.

For more information on Tongue Tie visit https://www.thetonguetiecentre.org/

Carmelle is an independent midwife, tongue tie practitioner & IBCLC specialising in complex feeding challenges and oral dysfunction in infants from birth to 4 years.