Congratulations on your new arrival! There is lots of joy and love and lots of sleepless nights in your near future. The last thing a new parent needs is the added stress of an unexpected medical diagnosis concerning the baby. Luckily, the issues addressed in this piece are relatively easy to fix.
At least a couple times each week, a parent brings a child to see me for evaluation of their tongue or upper lip, and we discover what is called a lip or tongue “tie.” In the case of a tongue-tie, this happens when the tongue and the floor of the mouth remain attached by that vertical band of tissue called the lingual (tongue) frenulum; when we are talking about the upper lip attachment, it is called a labial (lip) frenulum.
With a newborn, these are what we most often call incidental findings, i.e. they do not typically cause symptoms, but happened to get noticed by a physician on exam. The one exception to this is the case of a more severe tongue-tie, because it can truly cause problems for the infant trying to “latch on” during nursing and creates quite a bit of pain for mom.
In these obvious cases, it makes perfect sense to release the tongue-tie and avoid the misery of painful nursing and a cranky baby.
When the tongue- or lip-tie are truly incidental (not causing any symptoms) we have the option to leave it be or release it preventatively.
Release of a tongue-tie in a newborn child is something that I do right in my office. First, I spray a little bit of topical anesthetic right under the tongue – I tell parents to prepare for their baby’s face to look just like theirs did when they took their first tequila shot. The numbing effect happens very quickly and at that point, I use a handheld cautery device to divide and cauterize the tongue-tie while mom or dad holds the baby. The whole thing takes but a few minutes. Half the babies cry for a moment and go back to sleep and the other half stay cranky for another 30-60 minutes. The baby can nurse right away and the area usually heals within a day or two.
When the tongue- or lip-tie are truly incidental (not causing any symptoms) we have the option to leave it be or release it preventatively. But what are we trying to prevent, exactly? In the case of an upper lip-tie, we are trying to prevent the upper frenulum from causing a gap between the two front teeth when they eventually erupt. A lot of older kids are sent to me by the dentist to have this done before getting braces, so I think dental professionals are more aware of this now and suggest that we handle it preventatively if it looks like it will be an issue down the road.
Addressing a mild tongue-tie that isn’t causing a nursing issue is truly optional. The main reason to consider release of it is not so much for nursing issues, but more for the potential to cause speech/pronunciation issues. The attachment to the floor of the mouth impedes the tongue from reaching the roof of the mouth to make sounds like “D” and “T”. Usually, when there is a concern for future issues or a family history of tongue-tie, I recommend erring on the side of releasing it early. The main reason is that when we do it as a baby, it is a simple, in-office procedure and does not require anesthesia in the operating room. The other reason to take care of it early is that newborn kids won’t remember the emotional trauma of having surgery in the hospital!
