The Benefits of Childhood Immunizations16/09/2017
Tongue-tie is another mother’s favorite topic for the Paediatricians! Oh yes! You can not be a Paediatrician; no, you cannot say you are a practising doctor in Nigeria, West Africa if at least one mother has not asked you to help check if her newborn or infants has tongue-tie or not!!
An average Nigerian mother believes that the number one cause of speech delay in children is the so-called “tongue-tie”!!! They strongly believe this “tongue-tie” must be cut or else the child will not be able to speak on time or the speech will not be clear. So it is not unusual for us who are Developmental Paediatricians to be asked to check if a child brought to us on account of speech delay has tongue-tie or not! Indeed many would have gone ahead to cut the “tongue-tie” maybe once or twice before coming to you after realizing there is no improvement in the child’s speech despite the tongue-tie surgeries.
This worry is so prevalent that some unscrupulous hospitals have decided to take undue advantage of ignorant and unsuspecting parents by telling them they will “cut” the tongue-tie for a fee! They do this “surgery” routinely which is highly unnecessary in all newborns just for profits. Some parents who want a cheaper option use the untrained “local surgeon” to do the cutting. The latter often use unsterilized instruments putting the baby at risk of infections and tetanus. The cut may also heal with fibrosis leading to more complications.
It takes a lot of efforts to convince the mothers otherwise; some do not even believe you when you tell them the child does not have tongue-tie or that tongue-tie is not the cause of the child’s speech delay. On the Ask The Paediatricians Facebook Group, the tongue-tie issue is one of the most frequently asked questions hence the need to address the issue. This post is to inform parents and deliver them from the unnecessary worry and anxiety about tongue-tie.
The tongue is normally connected to the floor of the mouth by a thin membrane called frenulum in medical jargon. This frenulum is a normal structure in the body and usually very thin and does extend to middle of the back of the tongue. This is to allow the free protusion of the tongue out of the mouth when necessary. However, this is what many interpreted as tongue-tie. It is not a tie….it is normal.
There are rare instances when the frenulum instead of being a thin membrane can be thick, muscular or extend further to the tip of the tongue leading to limitation of the movement of the tongue. This is called anklyoglossia or the true “tongue-tie”. It is only in cases of anklyoglossia that surgery is necessary to free the tongue so that it can move freely.
Lingual frenulum – normal and abnormal
Ankyloglossia is usually something very obvious! You will see it and will not need to ask someone to check. It also has obvious symptoms. These include difficulty with breastfeeding in the baby, unclear speech due to difficulty with pronunciation of certain consonants in older children (not speech delay). There may also be difficulty with some oral activities like licking ice-cream and oral hygiene. If you see all these symptoms in a child with suspected tongue-tie, then see a doctor.
However if your child can lift out the tongue, cries and sucks well, s/he does not have tongue-tie. Please do not mistaken the normal frenulum for tongue-tie or go around cutting it. If you are not sure, you can ask your trusted Paediatrician to examine the baby. Let me also conclude by saying that tongue-tie even the confirmed one does not cause speech delay. That is pure myth!