Tongue Ties

Learn symptoms, causes, management of pediatric tongue ties, and when to contact a pediatric surgeon in Singapore.

What Are Tongue Ties in Children?

Tongue tie, also known as ankyloglossia, is a condition in which the tissue connecting the underside of the tongue to the floor of the mouth (called the frenulum) is tighter or shorter than usual.
The severity of tongue ties varies from mild cases with minimal impact to severe cases that significantly restrict the tongue's range of motion and affect feeding, speech, and oral development in infants and children. Understanding tongue ties and when to seek tongue tie release is important for parents to ensure their child's healthy development.

Common Symptoms of Tongue Ties

Symptoms of tongue ties vary depending on the child's age and the severity of the restriction. A thorough tongue mobility assessment can help identify these signs:

In Infants

Difficulty breastfeeding with poor latch or inability to maintain suction
Prolonged feeding times as the baby struggles to extract milk efficiently
Clicking sounds during feeding indicating the tongue is breaking the seal
Poor weight gain due to inadequate milk intake
Maternal nipple pain or damage from improper latch
Excessive gassiness from swallowing air during feeding
Fatigue during feeding causing the baby to fall asleep before finishing

In Older Children

Difficulty sticking out the tongue past the lower front teeth
Limited side-to-side tongue movement affecting eating and oral hygiene
Heart-shaped tongue tip when the child tries to stick out their tongue
Trouble lifting the tongue to touch the roof of the mouth
Speech difficulties including trouble pronouncing certain sounds like "t," "d," "z," "s," "th," "r," and "l"
Persistent lisp or unclear speech patterns
Difficulty eating certain textures or foods requiring tongue manipulation
Problems with oral hygiene as restricted movement makes it harder to clean the mouth properly
Gap between lower front teeth due to the tight frenulum

If you notice any of these symptoms, a professional pediatric assessment can determine whether tongue tie release is necessary.

What Causes Tongue Ties?

The exact cause of tongue ties is not completely understood, but research suggests several contributing factors.

Genetic Factors

Tongue ties often run in families, suggesting a hereditary component. If one or both parents had tongue ties, their children are more likely to develop the condition. Studies show that boys are approximately three times more likely to have tongue ties than girls, indicating a possible genetic link.

Developmental Factors

During fetal development, the tongue and floor of the mouth form separately and should eventually separate completely. In some cases, this separation doesn't occur fully, resulting in the tongue remaining attached to the floor of the mouth by excess tissue. The exact reason why this developmental process doesn't complete normally remains unclear.

Associated Conditions

While tongue ties usually occur on their own, they may sometimes be associated with certain genetic syndromes or conditions that affect connective tissue development. However, most cases of tongue ties occur in otherwise healthy children without any underlying syndrome.

Consequences of Untreated Tongue Ties

Leaving tongue ties untreated can lead to various complications affecting feeding, speech, oral health, and social development.

Feeding Difficulties

In infants, untreated tongue ties can cause ongoing breastfeeding challenges that affect both baby and mother. Poor milk transfer leads to inadequate nutrition and slow weight gain. The baby may feed frequently but inefficiently, causing exhaustion.
Mothers may experience persistent nipple pain, damage, or reduced milk supply due to inadequate breast emptying. Some mothers may discontinue breastfeeding earlier than desired, missing out on its benefits. A feeding pediatric specialist can identify these issues and recommend appropriate tongue tie release if needed.

Speech and Communication Issues

As children grow, tongue ties can significantly impact speech development. Limited tongue mobility makes it difficult to pronounce certain sounds correctly, and children may develop speech patterns that are hard to correct later.
Speech difficulties can affect communication, academic performance, and social interactions. While speech therapy can help, it may be less effective without addressing the underlying tongue restriction through frenotomy.

Oral Health Problems

Restricted tongue movement affects oral hygiene, making it difficult to clear food particles from around the teeth. This increases the risk of tooth decay, gum disease, and bad breath. The tight frenulum can also cause gaps between lower front teeth or contribute to improper jaw development, potentially requiring orthodontic treatment later.

Social and Emotional Impact

Children with untreated tongue ties may experience frustration with eating, speaking, or participating in activities that their peers can do easily. Speech difficulties can lead to teasing, social withdrawal, or reduced self-confidence. These challenges can affect a child's emotional well-being and social development during critical years.

How to Treat Tongue Ties in Children

Treatment for tongue ties depends on the severity of the condition and its impact on your child. At The Little Surgery, Dr. Ong Lin Yin provides comprehensive care including tongue mobility assessment, tongue tie release procedures, and parent education to ensure the best outcomes.

Initial Assessment

Before recommending treatment, we conduct a thorough evaluation including a detailed tongue mobility assessment to examine the frenulum's thickness, length, and attachment point. We assess how much the tongue restriction affects function.
A feeding evaluation is performed for infants to observe breastfeeding or bottle-feeding and identify specific difficulties related to tongue ties. For older children, we evaluate speech patterns and articulation to determine if tongue ties are contributing to communication difficulties.

Parent Education

We believe that parent education is essential for making informed treatment decisions. During your consultation, we explain what tongue ties are and how they affect your child, discuss treatment options including benefits and risks, demonstrate exercises to improve tongue mobility before and after treatment, and provide guidance on what to expect during recovery. Understanding the condition empowers parents to be active participants in their child's care.

Observation and Monitoring

For mild cases of tongue ties that don't significantly impact feeding or speech, we may recommend observation. Some children adapt well despite mild restriction, and intervention may not be necessary. Regular monitoring ensures that if problems develop as the child grows, we can intervene appropriately.

Frenotomy (Tongue Tie Release)

Frenotomy is a simple, quick procedure to release the tight frenulum and is the most common treatment for tongue ties. This tongue tie release procedure can be performed in our office setting with minimal discomfort.
For young infants, frenotomy may be performed without anesthesia or with only a topical anesthetic, as the frenulum has few nerve endings at this age. For older infants and children, local anesthetic is used to ensure comfort. The procedure involves using sterile scissors or a laser to quickly snip the frenulum, releasing the tongue.
Bleeding is typically minimal and stops quickly. Infants can breastfeed immediately after the procedure, which helps with comfort and healing. We provide parent education regarding wound care and exercises to prevent the frenulum from reattaching. Follow-up appointments ensure proper healing and improved tongue mobility.

Frenuloplasty

Following tongue tie release, some children benefit from speech therapy to help retrain tongue movements and improve articulation. For children who have already developed compensatory speech patterns, therapy helps them learn correct pronunciation. We can refer you to experienced pediatric speech therapists who work closely with children who have had frenotomy or frenuloplasty.

Speech Therapy

Tongue Exercises

For more complex or severe cases of tongue ties where the frenulum is particularly thick or the attachment is extensive, a more involved procedure called frenuloplasty may be necessary. This procedure is typically performed under general anesthesia in a surgical setting.
The frenulum is surgically revised or removed to allow greater freedom of tongue movement. The wound may be closed with dissolvable stitches. Recovery takes longer than simple frenotomy, but the procedure provides more significant release for complex cases.

Why Choose The Little Surgery for Tongue Tie Release

The Little Surgery provides specialized care for tongue ties, including comprehensive tongue mobility assessment, feeding evaluation, expert frenotomy and frenuloplasty procedures, and thorough parent education on tongue ties.

Experienced Pediatric Surgeon

Dr. Ong Lin Yin brings over 20 years of experience in paediatric surgery, including treatment of tongue ties in infants and children. As the former Head of Department of Paediatric Surgery at KK Women's and Children's Hospital, she has successfully performed numerous tongue tie release procedures with excellent outcomes for feeding, speech, and overall development.

Comprehensive Evaluation

We provide thorough assessment before recommending treatment, including detailed tongue mobility assessment, feeding evaluation for infants experiencing breastfeeding difficulties, speech evaluation for older children, and consideration of each child's individual circumstances. This ensures that tongue tie release is performed only when truly beneficial.

Family-centered Care

Understanding that parents may have concerns about their child undergoing a procedure, we prioritize parent education on tongue ties. Dr. Ong takes time to explain the condition, answer questions, discuss expectations, and ensure parents feel confident in their treatment decisions. As a mother herself, she understands the importance of clear communication and supportive care.

Safe and Effective Procedures

Our frenotomy procedures are performed using proven techniques that maximize safety and effectiveness. We use appropriate pain management for your child's age and comfort. The procedure is quick, minimizing stress for both child and parents. We provide clear aftercare instructions and follow-up to ensure optimal healing.

Contact The Little Surgery Today

If you suspect your child has tongue ties, or if you've been told your child may need evaluation, we're here to help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.

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