Frenulum Knot Tying
If you suspect your baby has a tongue tie, there are a few checks you can do at home. Use your findings to compare with tongue tie symptoms your child may display. You may be able to identify whether your kid has a normal tongue vs. tongue tie.
The visual appearance of the tongue tie
The first check is to see if you can see a lingual frenum when your baby lifts their tongue up. Note where it finishes. Does it go to the tip of the tongue? Is it thick? You can palpate the area by pressing two fingers down lightly.
How to feel for a tongue tie: The best way to check for a tongue tie is by running your finger under your baby's tongue.
What is a tongue tie? It's a flap of skin or membrane. It may be very strong and feel like a piece of wire. If you gently push on it, look for a tongue tip folding and a bend of the tongue tip downwards.
What does the normal tongue feel like?
Normal: A normal tongue should allow a smooth, uninterrupted swipe of a finger under the tongue.
Tongue tie symptoms: Most commonly infants will not have breastfeeding or latching problems
The finger swipe tongue-tie test
You can test for normal tongue vs. tongue tie in your child by swiping your finger under their tongue.
A small lump under the tongue may indicate a potential problem. A larger bump usually means more problems with latching and breastfeeding. If you encounter a skin like membrane under the tongue, it's more likely to cause problems.
The 4-Grade Normal Tongue vs. Tongue-Tie Test
Grade I: Slight bump or interference: If your finger finds a smooth but noticeable bump. It can indicate posterior or submucosal tongue tie.
Tongue tie symptoms: Take note of latching and breastfeeding habits as well as the ease and happiness while feeding.
Grade II: Significant bump or interference: Your finger may find a very noticeable bump or tag like extension.
Tongue tie symptoms: Any signs of shallow latch likely associated with posterior tongue tie and swallowing difficulty.
Grade III: 'Skin-like material' or a membrane interfering with the tongue sweep: These thin flaps of skin may catch the finger on the way under the tongue.
Tongue tie symptoms: Latching and breastfeeding will be much more frequent in this type of oral restriction.
Grade IV: Thin or thick flap of skin or membrane that reaches the tip of the tongue: A sign of a more serious anterior tongue tie. The tip of the tongue is involved, and you may not be able to swipe your finger under the tongue at all. These types of tongue ties should be examined by a professional immediately.
Tongue tie symptoms: an infant with this type of tongue-tie may be unable to extend their tongue out of their mouth. Breastfeeding and latching will often be restricted.
How to Spot Untreated Tongue-Tie in Newborns and Kids
For any new parent, the thought of anything being wrong your baby is very worrying.
Fortunately, in most cases, a tongue tie can be easily addressed.
Alongside a finger-swipe test, you should note any of these tongue-tie symptoms:
- Breastfeeding difficulty weakness, or unable to latch
- Recurrent ulcers during teething
- A forked tongue 'or W' shape when child opens mouth
- Unclear speech or lisp and delayed vocal learning
- Unusual tongue shape – should be flat and broad.
- The general feeling of unrest and anxiety mainly associated with feeding.
- A gap between lower front teeth
- Messy eating, dribbling, unable to lick lips or clean teeth with tongue.
- Difficulty playing a wind instrument such as a flute.
Other signs of untreated tongue-tie and development
Breastfeeding, tongue tie and baby bottle feeding
Tongue tie can prevent normal sucking and swallow in newborns. A short lingual frenum or tongue tie anchors the front portion of the tongue to the lower jaw. It's commonly associated with difficulties during breastfeeding for both mother and infant.
It may result in damage to the mother's nipple, breast pain, extreme suction, repeated mastitis, low milk flow.
In the infant, poor weight gain and premature weaning may prevent the development of adult swallowing mechanism
These findings suggest that an exam for tongue tie. Your practitioner will decide whether tongue-tie treatment such as a frenectomy is appropriate.
Can being tongue tied affect speech development?
There are different opinions as to how tongue tie affects speech development in kids. The main problem occurs with the child being unable to make a seal with the palate. This should occur behind upper front teeth. Many sounds in speech are made with this movement.
The consonants t, d, l, n, and r require the tongue to reach to the palate. Speech development is different, and tongue-tie won't always cause speech problems. A speech problem can also be overcome without frenectomy or tongue tie treatment.
Each child's speech development is unique, and all facets of oral function are considered.
Ability to functionally use the tongue
The tongue is a complex muscle system that directs breathing and airway function. Lack of movement may prevent the tongue from reaching teeth.
This may prevent oral cleansing and increase the risk of dental disease. It may also prevent a child from playing a wind instrument. These complex tongue functions could also relate to social problems.
High palate or 'V-shaped' palate
A tongue tie can prevent the tongue sitting in the palate. The palate should be broad and U-shaped. When the tongue isn't able to sit in behind with tip behind the teeth, it may stop this normal growth. It may leave the palate 'high' and V-shaped (narrow). A 'V' shaped palate will often be long, high, narrow, and thin.
Poor palatal growth is the cause of crooked upper teeth. It will also limit a child's ability to breathe through their nose.
Crooked lower teeth
One sign of tongue tie may be crowding of lower front teeth. A tongue-tie that inserts into the gums near these teeth may also cause recession of the gums.
When the tongue sits at the bottom of the mouth, it can cause a tongue-thrust habit. This puts force on the lower front teeth causing them to be crooked.
Recessive lower jaw or 'lack of chin.'
A recessed lower jaw sits back in a child's growing face. It may be seen by a set back, or lack of chin. The tongue acts to anchor the lower jaw against the upper jaw. A tongue tie may restrict the forward posture and growth of the lower jaw. It is known as retrognathia.
From side on the child will look like their chin sits 'behind' their upper lip and nose.
Forward head posture
A child who leans forward when standing may show signs of tongue tie. The posture of the cervical spine or neck is related to muscles attached to the tongue. An upright posture is best supported by a tongue sitting in the palate. Tongue-tie can prevent this normal posture and create a forward tipped cranial posture.
Open mouth and mouth breathing
When a child sits at rest – such as when they are watching television, their lips should be closed. This means they are breathing through their nose. Tongue-ties can contribute to open mouth posture. It may also indicate that your kid will be found sleeping with mouth open. Their lips don't close at rest, and they often breathe through the mouth.
Snoring and sleeping with mouth open
Open mouth posture during the day can translate to sleeping with mouth open. Sleep apnea symptoms are common in kids with tongue-tie. Lack of nasal breathing and snoring may put kids at risk of lack of oxygen. Another sign is children who always sleep on their belly.
TMD and jaw pain
Kids who complain of headaches and jaw pain may have jaw imbalance. Tongue ties prevent normal jaw development causing an imbalance which may be downstream to jaw joint pain and headaches.
Do you suspect an oral restriction in your child? Leave your questions and experiences in the comments below.
For more information on Dr. Lin's clinical protocol that highlights the steps parents can take to prevent dental problems in their children: Click here.
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