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MARCH 2021 | FIND MAROONDAH
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Untangling Tongue Ties: Part 1
LACTATION CONSULTANT By Dr. Joanna Strybosh
Ankyloglossia, commonly known as tongue tie, is the name given to the condition where the tongue is tethered (or “tied) to the floor of the mouth by an abnormally short, thick or restrictive frenulum. The frenulum is the thin piece of connective tissue that is found in the midline under the tongue. When considered alongside other tied oral tissue, such as upper lip ties and buccal ties, they are commonly grouped together under the term “tethered oral tissues” (or TOTs). Ankyloglossia has become a topic of much clinical and public discussion, the subject of new research and indeed the cause of considerable contention over the past 20 plus years as breastfeeding rates have been steadily increasing and more tongue ties are being diagnosed and treated. Is important to understand that not all oral frenula are restrictive. The visible presence of a frenulum does not necessarily mean there will be a diagnosis of tongue tie. It is vital when thinking about oral frenulum and assessing for tongue tie, that we
understand this is a functional diagnosis. That means the professional assessing the tongue must understand how it should normally function, in order to be able to accurately recognise when it is not. In effect, tongue tie is a diagnosis of dynamic dysfunction, not a diagnosis of observation only. This is why it cannot be diagnosed from a photograph. In medieval times up and through the early 1900s, tongue-ties were released routinely by either a midwife with a sharpened fingernail, or a surgeon using instruments. In fact, the instruments necessary to clip a tongue-tie appeared in circumcision trays because both procedures were commonly performed before a newborn was sent home from hospital. In the post-war ear of the 1950s, the culture in the United States and Australia changed with the introduction of baby formula and rates of breastfeeding fell dramatically. By the 1960s and 1970s, ankyloglossia was considered to be an outdated topic, and many pediatricians denied that tongue-tie existed or that it caused a problem with feeding in newborns. The natural childbirth movement in the 1970s brought renewed interest in breastfeeding as a first choice
for infants, and with this change came increasing recognition of tongue-tie as a potential road block to successful breastfeeding. A few case reports and observational studies appeared, proposing a link between ankyloglossia and breastfeeding difficulty. In the years since then, ankyloglossia has become a controversial topic in medicine, with many strong opinions held by a diverse group of health professionals, including pediatricians, neonatologists, feeding and speech therapists, lactation consultants, dentists, and ENTs. Stay tuned for part 2 in next month’s edition.
Dr. Joanna Strybosch Osteopath B.App.Sc(Clin.Sc)/B.Osteo.Sc/Grad Dip Paeds
Lactation Consultant CHILDREN’S OSTEOPATHIC CENTRE 9876 3011 www.childrensoteopathiccentre.com
MARCH 2021 | FIND MAROONDAH
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