Thursday, April 22, 2010

Symptoms of Tongue-Tied (Short Frenulum, Ankyloglossia)

Recently I had a friend whose baby was diagnosed with being tongue-tied, also known as ankyloglossia and short frenulum. I wish that her baby boy had been diagnosed sooner, but it took over a month. Although that seems long to me since I work with small babies, I know that some people go even longer before having an answer to their child's feeding and language problems.

My friend's son had poor feeding problems from the beginning and didn't learn how to breastfeed. That should have been the first clue of a problem, because Mom had already successfully breastfed her older son for a year. She said when she attempted to breastfeed him, it hurt really bad, even after she tried to put his lips on the right part of her areola. I only wish she could have gotten together with a lactation consultant (LC) because I think it would have been diagnosed then, but she didn't go to a LC. So, Mom switched her son to a bottle, but not just one bottle, she went through 5 different types of bottles and nipples before she found the "right" one. Even then, he only drank an ounce or two of formula at a time and it took over 20 minutes just for that small amount. He had poor suction on the nipple of his bottle and pacifiers, which lets us know his tongue wasn't working very efficiently. Somehow he was slowly gaining weight and not losing, yet the quality of life was chaotic for Mom because she was practically feeding him most of his waking hours.

After talking to her sister-in-law over the phone who lived far away, but who happens to be a pediatric nurse, my friend realized what it was- ankyloglossia. She was asked to look to see if he could stick his tongue out over the gumline, and he couldn't. She was asked if the tip of his tongue looks like the bottom of a heart because of the skin under the tongue bounding the tongue down, and guess what, it did have a heart shape. My friend was advised to take this information back to her pediatrician, so she did. Once the doctor got a better look, she realized that other symptoms were present. They included: high palate, gags easily, and sometimes has trouble swallowing liquid (would just hold it in the oral cavity). Also noted was that he had tight neck muscles, maybe because he was using every head/neck muscle he had just to drink from a bottle. My friend's son was also diagnosed with GERD (reflux), so I think that the feeding problems were blamed on that, but once the medicine didn't fix everything, it was obvious there was more going on than reflux.
He then got his frenulum (skin under the tongue) clipped. Feeding problems got immediately better, and he has gained weight at a higher rate now. He doesn't even need to do any oral-motor exercises, he just figured it out after a couple of feedings, and he can even drink from more than one type of bottle. So, not only were mealtime problems resolved so were any possible future speech problems! And even better, parents can sleep more at night with less frequent wakings for a feeding!

Every once in a while, I am the one that notices ankyloglossia, but usually it has been identified by the hospital staff, pediatrician, or lactation consultant long before the child was sent to me for a feeding disorder. Sometimes when I catch it, there are other problems as well including delayed gross-motor skills, poor sleeping, and irritability...of course if I couldn't eat and sleep well, I would be grumpy too! So, don't assume that just because no one has ever diagnosed your baby with being tongue-tied that he doesn't have it. If you notice the above-mentioned symptoms, please call your child's physician and have them do a detailed oral exam!


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