The tongue frenulum is the small mucous fold that stretches from the lingual gum to the underside of the tongue.

Consisting of a very dense network of loose connective fibers, the tongue frenulum is useful for the proper development of the tongue, lips and mouth bones in infants.

In particular, it allows the baby to stretch his tongue far enough out of his mouth to latch on to the breast when breastfeeding. The tongue brake plays an important role in tongue mobility and swallowing.

In 10 % of cases, the tongue frenulum is too short, causing babies to have difficulty breastfeeding. Frenectomy is often seen as the solution to the problem. However, it is a surgical procedure that should be considered as a last resort.

Baby's tongue brake: common problems

It is not uncommon for a baby's tongue frenulum to be too short. This abnormality, often benign, is called ankyloglossia. The vast majority of infants with this defect are asymptomatic.

However, in some cases, a restrictive tongue-lock in the baby can lead to complications for both mother and child.

If it is too short, the tongue bridge of the baby can cause difficulties in breastfeeding. Not being able to stick his tongue out far enough, the child will have difficulty grasping the nipple properly to feed.

This extra effort can cause all sorts of problems:

• Lip blisters
• Fatigue related to muscular efforts
• Abundant burps
• Colic
• Aerophagia

As the baby has difficulty suckling properly, weight gain will tend to be slowed.

If the baby's tongue-tie is restricted, the mother may experience pain, cracking or damage to the nipples due to sucking problems.

Because the milk drainage is insufficient, the milk ducts can also become blocked, preventing the milk from being properly drained. A lump can then appear in the breast, which becomes sensitive and even painful.

Short tongue brake: the long-term consequences

In the medium and long term, a short tongue-lock in children can lead to various health problems and discomfort.

Dental implantation and maxillomandibular development

A short tongue-tie can lead to poor tooth implantation and jaw development problems. It can also prevent the child from smiling properly.

Breathing

Because of a short tongue frenulum, the child may have difficulty breathing through the nose. This is caused by the obstruction of the upper airway.

Digestion

Digestion problems are already present in babies and can become more pronounced with age. If the tongue's frenulum is too short, the child may have problems chewing and swallowing. 

Pronunciation

Because the tongue-tie directly affects the proper development of the mouth, jaw and tongue placement, it is not uncommon for children with a short tongue-tie to have problems with pronunciation and speech.

Short tongue brake in babies: what to do?

It is important to detect a short tongue lock as early as possible in the baby.

If you've noticed some of the above symptoms, your baby may have a restrictive tongue-lock.

Consult the pediatrician

It is recommended that the pediatrician be consulted first. Because breastfeeding difficulties can have multiple causes, a visit to the pediatrician will help make the right diagnosis.

If your child's pediatrician notices a short tongue-lock, he or she will refer you to a pedodontist.

Using a midwife

While midwives are generally called upon during pregnancy and at the time of delivery, they can also intervene in the follow-up of childbirth.

Some midwives are certified in lactation and can advise you on good breastfeeding practices. In particular, they check the correct positioning of the baby during breastfeeding.

Get advice from an IBCLC lactation consultant

Also known as a lactation consultant, this professional is IBCLC (International Board Certified Lactation Consultant) certified. This is a certification offered to health professionals or leaders of associations that support breastfeeding mothers.

Lactation consultants work in offices, associations or at home. Their listening skills and advice are of great help to mothers experiencing difficulties during breastfeeding.

Solutions to the short language brake

To avoid frenectomy

Sometimes the symptoms improve or even disappear simply by adjusting positions during breastfeeding with the advice of a midwife or lactation consultant.

However, beyond the positioning of the baby, there are other steps to take:

• Obtain a deep and asymmetrical breast hold,
• Use breast compression to increase milk transfer, especially for babies who tire quickly,
• Supplement baby with compatible breastfeeding aids (a better fed baby has more energy)

More advanced strategies can be provided by an IBCLC lactation consultant who specializes in ankyloglossia. These include exercises or massage to improve tongue positioning.

Because of the position in the uterus, muscular tensions may require an osteopathic consultation since the tongue frenulum is a muscle.

Frenectomy: is it really the solution?

A frenectomy is a surgical procedure to cut the tongue frenulum. If the baby is big enough, the operation can be performed using a cold laser and local anesthesia.

Presented as a solution to breastfeeding problems, the number of frenectomies has exploded worldwide in recent years.

This procedure appeared in France more than twenty years ago and requires the advice of a specialist.

Indeed, frenectomy remains a surgical procedure that involves, like any other act, post-operative risks such as infections or difficult healing.

Therefore, frenectomy should only be considered on the recommendation of a pediatrician or pedodontist. Only they are able to assess whether the tongue frenulum is too short and is the cause of breastfeeding or feeding difficulties.

Do you suspect a problem with your child's tongue-tie? Do not hesitate to call Dr. Agachi's office, pedodontist in Paris.

Based on the symptoms identified by the parents, we will be able to provide you with advice and quickly schedule an appointment in our office.