Tongue Tied? Could be literally true!

While most of us get tongue tied when we are overawed by a famous personality or when asked to speak in public, or too overcome by emotions, in the case of your infant, it could be due to the fact that the cord of tissue (called the frenulum) that holds the tongue in place against the floor of the mouth is too tight / thick / rigid.

The frenulum is thick and is important in the fetus for proper development of the mouth and gums. It then involutes and becomes thin and elastic. In some fetuses, this does not happen and the child is born with a tongue tie.

Potential problems faced by children with tongue tie:

• Feeding Difficulties: If a mother has difficulty breastfeeding her child due to poor latching on to the breast or who have significant pain while feeding, then the infant must be evaluated for tongue tie.
• Difficulty in Enunciation of certain Syllables: t, d, l, r, n, th, sh, and z and in Hindi ट, ठ, द, ध, थ, ढ require the tip of the tongue to touch the roof of the mouth. These children tend to mispronounce words containing these syllables ever so slightly and while it makes no difference to most people, in some it may preclude some careers like public speaking etc
• Abnormal Shape of the tongue: The tongue is normally conical with a pointed tip with some variations. In these children, the tip of the tongue cannot develop as well as the rest of the tongue as it is held back by the tight frenulum. This results in a rounded tongue initially, and then it becomes bow-shaped.
• Inability to lick a cone: Since the child cannot protrude the tongue, he cannot easily lick a cone. Children being children, compensate by taking the cone, into their mouth. Messy, but effective!
• Improper Oral Hygiene: We use the tongue constantly throughout the day, to keep our oral cavity clean. If the child cannot clean his mouth effectively, it may lead to tooth decay, halitosis and oral infections.

Solution

If the child has a significantly tight frenulum, then it is better to forestall these problems with simple surgery, At the age of nine months (earlier if breastfeeding is an issue), under general anesthesia, we divide the frenulum and suture it back so that extra length is gained.