“Having successfully breastfed for over a year, I thought it would be a breeze the second time round,” mum Harsha says. “However, my son Akash found latching on very difficult from the start and feeding him was excruciatingly painful. He cried a lot because he was hungry and I started to resent him,” Harsha laments.
Frustrated by the feeding fights, Harsha sought the support of a lactation consultant, who gently felt under Akash’s tongue. She advised Harsha that the frenulum, the string of tissue connecting the underside of Akash’s tongue to the floor of his mouth, was too short and was therefore restricting his tongue movement. Akash had tongue-tie (ankyloglossia), a condition that is caused by incomplete separation of the tongue from the base of the mouth during development.
Causes and complications
According to Dr Linda Ho, a specialist in paediatrics at Matilda International Hospital, tongue-tie, which affects up to ten per cent of babies, is typically “sporadic” – it just happens. Occasionally, tongue-tie may be hereditary and it may be associated with other abnormalities such as a cleft palate.
While some babies with tongue-tie manage to escape the many complications associated with a shorter-than-usual frenulum, others are far less fortunate. Babies may find it difficult to latch on to the breast; toddlers may struggle with swallowing solids; children may find it hard to clear food from the front of their teeth; and teenagers may feel tormented by their first failed kiss. At every life stage, speech delays caused by tongue-tie can cause a person’s confidence to sink.
According to La Leche League leader Jenny Buck, a mother may be offered techniques to increase the comfort and effectiveness of breastfeeding a tongue-tied baby, but if these techniques fail, snipping the frenulum with surgical scissors is a proven solution. “This procedure, called a frenotomy, is simple; it involves no stitches, and can be done in a doctor’s clinic,” she advises. “Because there are few nerves and blood vessels in the frenulum, the procedure results in minimal discomfort or bleeding.”
Children aged six months and above can also undergo a frenotomy to treat their tongue-tie, but it will typically require a general anaesthetic and soluble stitches. A week later, once the wound has healed, speech therapy may be required.
Unfortunately, tongue-tie can often go undiagnosed. As Dr Ho affirms, a distressed mother’s ongoing struggle to breastfeed, a poorly fed baby, and a relationship built on resentment are sufficient reasons to suspect tongue-tie and suggest snipping as a solution.
A controversial cut
But, according to Dr Ho, doctors are divided on whether or not to divide tongue-tie. “Most doctors will take a conservative approach, suggesting lactation support if there are breastfeeding issues and speech therapy if there are speech delays,” she says. “Some doctors will suggest surgery at birth, as babies do not need an anaesthetic; while others advocate waiting until a child is at least four years of age, by which time his tongue may elongate spontaneously, with increased use.”
This may explain why, when Harsha discussed the implications and treatment of tongue-tie with her paediatrician, he dismissed her concerns without checking Akash’s tongue, and suggested she switch to formula.
But as Liz Purnell-Webb, director of A Mother’s Touch and The White Lotus Centre, advises, “Nature provides us with the best nourishment for our babies through breast milk, as well as many hidden benefits such as bonding and pacifying. Let us preserve what is natural through our technology and give mothers and babies our help.”