Tongue-tie and its influence on children's health are gaining global attention. How to recognize and solve it.

Source:Wikipedia
When a newborn is born with an excessively tight frenulum, also known as the little strip of tissue that links the base of the tongue to the mouth, they might have a condition known as tongue-ties. Since of this, it may be difficult for newborns to nurse because their mouths are unable to rest in the appropriate position (on the roof of the mouth).

Even though it has been present for generations and is not always simple to diagnose, the sickness is most likely hereditary. However, it can be difficult to spot in certain people. According to a study that was conducted in the year 2020, it is estimated that around 8% of newborns in the United States are affected by it.

In certain countries, the number of confirmed instances has increased by a factor of ten, and doctors feel that, in recent years, there has been a general increase in awareness of the condition all over the world. The number of people diagnosed with tongue ties and having their tongues surgically released has skyrocketed in the United States.

Unfortunately, tongue-tie typically stays undetected and untreated for years in undeveloped countries in Africa due to the fact that doctors and nurses are too distracted with other urgent health concerns, such as infections, that afflict children. Even in regions where this diagnosis is more prevalent, it might be easy to miss.

According to the website Newsbulletin247.com, a woman called Kate Canavan from Raleigh, North Carolina who is a mother of two children said that her younger daughter Anna's speech was not very clear a number of years ago. Anna's pediatrician reassured her that there was no need for her to be concerned because Anna was only two years old and Canavan had never had any issues with breastfeeding. At the age of four, another pediatrician suspected something was wrong and suggested they consult a speech therapist.

Because of a lip-and-tongue-tie, Canavan's kid was unable to move her lips and tongue freely enough to produce speech that was understandable. Canavan notes, "The speech therapist advised us that she had a lip-and-tongue-tie, and if things weren't repaired, the speech therapy actually wouldn't be very beneficial since her oral architecture was impeding articulation."

Signs of Tongue-tie

When a tongue tie is present, it is possible that the infant may have trouble feeding and will also suffer pain.
"Children who suffer from tongue-tie have trouble pushing their tongues out beyond the boundaries of their mouths. As a result of this, the infant has difficulty latching onto the breast, sucking, and swallowing, all of which are essential to the process of breastfeeding but are rendered ineffective "This is explained by senior neonatologist Ju-Lee Oei from Australia's Royal Hospital for Women, located in Randwick.

When a baby is trying to breastfeed while his or her tongue is stuck, and the baby is trying to release his or her tongue by clamping down on the breast, the mother may suffer terrible agony. This can be because the baby is trying to free his or her tongue while trying to feed.

According to Amulya K. Saxena, president of the European Association of Pediatric Surgeons and a consultant pediatric surgeon at Chelsea Infants's Hospital, Chelsea and Westminster Foundation Trust, "many children with tongue-tie will not show symptoms."

It can be hard to see that the tongue is being tied down. A thin flap of tissue called the lingual frenulum connects the rear of the mouth to the center of the tongue. If this tissue is too tight, the tongue won't be able to protrude over the lips, and the condition is known as a tongue-tie. Saxena notes, however, that certain cases of tongue tie are more subtle and occur deeper in the mouth, making them difficult to identify and diagnose it without help of a medical expert.

Living with tongue-tie can make it difficult for children to utilize their tongues in a variety of ways, including playing wind instruments, licking their lips or ice cream, and cleaning their teeth. "For certain babies, it may create wounds beneath the tongue if the lingual frenulum is stuck between the lower incisor teeth," adds Saxena. "This can happen if the tongue gets caught between the teeth."

It's possible that a weaker tongue muscle and an unpleasant tongue posture might have systemic repercussions on top of the pain experienced locally in the mouth.

Ankita Shah, the head of the Tongue Tie and Sleep Institute in Mumbai and a pediatric dentist. According to Dr. Shah, one of the most significant issues that is associated with tongue-tie is that it disrupts the normal equilibrium of air pressure in the mouth. In turn, this may lead to nasal breathing while sleeping, which can be highly disruptive to the sleep cycle.

She notes that open-mouth breathing and snoring are frequent concerns for children who have tongue-ties, both of which may have a severe influence on the child's ability to obtain a decent night's rest. They wake up with regular headaches and neck and shoulder pain because, throughout the night, they clench their jaws and grind their teeth, both of which cause discomfort. The ongoing discomfort might have a detrimental effect on their posture as well as their overall health.

Just a band-aid?

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The condition may go away on its own in less severe cases, according to London surgeon Saxena. As the infant eats and moves her tongue, the connecting strip lengthens, allowing the tongue more freedom to move. He thinks that situations of this modest severity may be resolved by giving the mother advice on how to nurse properly, rubbing the frenulum, and doing tongue exercises. However, if it doesn't help, or if the tongue-tie makes nursing extremely challenging, he suggests doing the release surgery. To do this, a tiny incision is made into the frenulum to free the tongue.

However, there may be underlying issues that are causing the individual's difficulties with feeding, eating, breathing, sleeping, and communicating. Additionally, while tongue-tie may be under-diagnosed in places like Africa, some doctors in other nations worry about the opposite problem: over-diagnosis.
It was in 2017 that "we saw a large rise of instances, so we began to check into it," as Oei puts it. She delivers around 4,500 babies each year at the Royal Hospital for Women in Randwick, Australia. Up until that point, the monthly demand for tongue-tie operation had been around 10. The number of instances has increased from 10 per month to 10 per week, as Oei puts it.

The number of patients requiring treatment at these facilities was on the rise, and some doctors were even demanding exorbitant fees. "We saw that many people were interested in the operation since it offered a convenient way to resolve breastfeeding issues quickly. Frenulum release surgery, or removing the frenulum, is not a panacea "to state what she is saying.

In 2018, they released the results of their worldwide research, which found that tongue-tie diagnoses had increased by more than a factor of ten in certain nations, varied greatly from region to region, and required more concerted international efforts to standardize care.
Oei now claims that the hospital's policies have evolved since that time. Babies who have trouble nursing and are suspected of having tongue-tie now need to be evaluated by a breastfeeding expert. After two to four weeks of trying to resolve the breastfeeding challenges with the consultant's guidance, surgery is indicated.

According to the research report written by Oei and coworkers, "subjecting newborns to a surgical treatment, no matter how slight, causes discomfort, stress, and longer-term neurological impairment," therefore even the relatively easy surgery used to correct tongue-tie should not be performed carelessly.

Chiropractors and "tongue yoga"

London pediatric surgeon Saxena has seen an increase in family awareness of tongue-tie. She explains that social media has become a hub for "patient support groups and professional organisations delivering knowledge."

An increasing number of families, particularly those with teenagers, are reaching out to Shah for assistance in India. Nonetheless, she stresses the need of not rushing into surgery.

Shah estimates that around five of every ten individuals who visit her clinic will really require surgical intervention. The severity of tongue-tie and the manner it affects the body, particularly the airways, determine the best course of action. "We consider the wide range of symptoms these patients report and ask whether or not the tongue-tie itself is the root cause. Before resorting to surgical intervention, we explore non-invasive treatment options to resolve underlying issues."
Shah believes that while older kids could benefit from general anesthesia, most situations involving smaller kids can be handled with local anesthesia. For this reason, anesthesia is never administered to a baby, as the potential hazards would be too great.

The London-based midwife and lactation expert Carmelle Gentle emphasizes that surgical intervention is not the final step in therapy. After the snip, Gentle, who runs a tongue-tie center in South London that accepts donations, advises parents to help their child strengthen and utilize their tongue via a series of exercises.

We encourage infants to develop novel linguistic skills, she explains. "Practicing this is similar to yoga in several ways. Regular, gentle practice gets you to the point where you can touch your toes, even if you can't do so at the start of the session."
More and more people are becoming aware of the problem, and it is possible that an accurate diagnosis will have a significant impact on the quality of life for individuals who are given it.
Anna Canavan, the daughter of Kate Canavan, was a patient who benefitted from surgery. "Her frenulum was robust and muscular, and she was so young that the speech therapist and the [ear, nose, and throat expert] both supported doing the procedure medically, using a pair of scissors, and while she was asleep. Her frenulum was strong and muscular, and she was so young. When releasing the tongue, in order to protect the tissue that is immediately around it, "if the email from Canavan is to be believed.

After receiving the 15-minute treatment, Anna was instantly free of any pain and able to return to her regular diet as well as her customary consumption of fluids. The following morning, she showed up to preschool as planned. After having surgery, she made a remarkable recovery from her speech handicap within a month of having the procedure.

That brings us to the conclusion. I want to express my gratitude to you for taking the time to read this post, and I pray that God will richly reward you.

References

NHS. “Tongue-Tie - NHS.” nhs.uk, March 2020. https://www.nhs.uk/conditions/tongue-tie/#:~:text=Untreated%20tongue%2Dtie%20may%20not,and%20difficulty%20eating%20certain%20foods.

mayo clinic. “Tongue-Tie (Ankyloglossia) - Symptoms and Causes.” Mayo Clinic, May 15, 2018. https://www.mayoclinic.org/diseases-conditions/tongue-tie/symptoms-causes/syc-20378452.

Thiagarajan, Kamala. “How Dangerous Is Tongue-Tie?” How dangerous is tongue-tie? - BBC Future, April 2022. https://www.bbc.com/future/article/20220322-how-dangerous-is-tongue-tie.

@ClevelandClinic. “Tongue-Tie (Ankyloglossia): Symptoms, Causes & Treatment.” Cleveland Clinic. Accessed October 13, 2022. https://my.clevelandclinic.org/health/diseases/17931-tongue-tie-ankyloglossia.

Lindberg , Sara. “Tongue-Tie: What It Is and How It’s Treated.” Healthline, July 2020. https://www.healthline.com/health/baby/tongue-tie.

Laura Eisel, PA-C, and Jenna W. Briddell, MD. “Tongue Tie (for Parents) - Nemours KidsHealth.” Tongue Tie (for Parents) - Nemours KidsHealth, July 1, 2021. https://kidshealth.org/en/parents/tongue-tie.html.