Transcription:
Treating "Tongue Tie" in Children

Prakash Chandran (Host): Welcome to UK Health Cast with the University of Kentucky Healthcare. I'm your host Prakash Chandran and joining us today is Dr. Caitlin Fiorillo, a Pediatric Otolaryngologist for UK Healthcare. She's here to talk about a condition that affects a small percentage of children called tongue tie, what it is and how to treat it. So, first of all, Dr. Fiorillo, it's great to have you here today. I'd love to start by asking what it exactly means for our child to be diagnosed with a tongue tie.

Caitlin Fiorillo, MD (Guest): Tongue ties are just another name, in the medical field we call it ankyloglossia and it basically refers to the tongue being limited in its movement. And the limited movement it can be caused by a tight lingual frenulum, which is another name for the tongue tie. The lingual frenulum is a band of tissue that connects the underside of the tongue to the floor of the mouth. And unfortunately there's no good standard definition of what a tongue tie is. And there is a wide range of opinions on how to diagnose them and how to treat them. Your child may be diagnosed with this from a physician, from a lactation consultant, from a speech therapist, and being told that your child has a tongue tie doesn't necessarily mean that it needs further treatment. And I really only recommend treatment if it's causing issues specifically with feeding or speech.

Host: Just to be clear, Dr. Fiorillo, is this something that you develop at birth or is this something that you develop later as a child?

Dr. Fiorillo: It's almost exclusively developed at birth. Everyone is born with a lingual frenulum, and so it's completely normal to have that band and they come in all different shapes and sizes, just like babies do. And some are very thin and can actually tear on their own. Some are extremely thick chords. And where they attach is very different. So, some of them can attach the tip of the tongue. Some of them attach farther back on the tongue where you can't even see them and they can be congenital. Some parents have kids that have other kids that have had tongue ties. But it doesn't necessarily have to be passed down. Each frenulum is unique, just like each baby is.

Host: Yeah. I was just going to ask you to expand a little bit more on that. Do we know what specifically causes tongue ties?

Dr. Fiorillo: We really don't. It's just how your baby's developed. There I guess could be rare cases where someone gets a scar band under there from prior surgery or trauma, but really most of the tongue ties that we're talking about are things our babies are born with.

Host: So let's talk about some of the symptoms a child might experience who has a tongue tie.

Dr. Fiorillo: Yeah, in general, tongue ties cause that restricted tongue mobility, and that can be presented as difficulty lifting the tongue up, difficulty sticking the tongue out or moving it from side to side. And the symptoms can be very mixed and the severity of the tongue tie, how tight it is really doesn't correlate with the severity of symptoms. So, I have patients that have extremely tight frenulums that I'm seeing for completely other reasons, and they really have no issues at all. And then I'll see other children that have a very mild tongue tie, but are having significant problems with it. So, in infants, the most notable issue is with breastfeeding and babies require a good latch to express milk from their mother. And a poor latch can be seen with feeding with kids that have tongue ties. Breastfeeding in general can be a very frustrating and trying time for mom and baby. And especially, if they have a tongue tie, that's making things even harder.

Host: So, I just want to expand on what you were saying around breastfeeding. How exactly will mom know if their child might have a tongue tie? Like, does it manifest as pain? Are there other symptoms that she should be aware of?

Dr. Fiorillo: Sure. Yeah, that's a good question. Moms can have problems with pain when they breastfeed. They can experience a poor latch from their, their baby. They can have frequent detachment. Sometimes you'll hear this clicking sound that they'll make when they're feeding or they'll take in a lot of air, which can lead to gas and reflux. Those are the main symptoms to look out for.

Host: Okay. Great. So, if your child hasn't been diagnosed, those are some of the symptoms that might tell you, hey, maybe I want to get this checked out. Maybe my child might have it tongue tie.

Dr. Fiorillo: Yes.

Host: Okay. So, now let's move on to older children that have a tongue tie. What problems can potentially occur with them?

Dr. Fiorillo: Yeah, older children tend to have issues with speech and it's really uncommon that they will have them, but I do see it. It does not cause speech delay. And it's not a reason that a child is not talking. So, if that's the case, then we need to look at something else, but it can contribute to articulation errors or how they say certain sounds like the L, S sounds, which require a little bit more mobility of the tongue.

Host: Okay. So, we talked about some of the reasons a mother might bring their baby in if they suspect that they have tongue tie. But what about for older children? At what point should parents think about bringing their child into a doctor to get this diagnosed and then treat it.

Dr. Fiorillo: For older children, for the speech issues, I think it's really important to have them evaluated by a speech pathologist prior to considering treatment of the tongue tie. Many of those sounds that I had mentioned before that children can have issues with like that L, S sounds can be a normal part of a child's language development. For example, a child may say wag or yag instead of leg up until five years old, or they may say ting instead of thing. And that can also persist up to five years old. So, I rely heavily on speech pathologist to perform a really good evaluation of the child's speech before I consider treating a tongue tie.

Host: Okay. So, before we get into the treatment itself, I wanted to talk about if it was an issue going undiagnosed. You know, you mentioned that in many cases, things will just take care of themselves, but I'm trying to get a sense of how concerned parents should be if this goes undiagnosed in their child.

Dr. Fiorillo: In general, there isn't a lot of issue with it going undiagnosed. Infants are going to have trouble with breastfeeding and once they get out of the breastfeeding phase, it does not cause any issues with taking solid foods or the growth or development of their mouth. And I think the biggest issue you can see is in older children and even teenagers, they can have some issues moving their tongue and some social embarrassment with the restricted tongue mobility.

So, they can have difficulties like licking their lips or sweeping food from their teeth, which can affect their health of their teeth. They can have difficulties licking things like ice cream cones, which can be embarrassing when they're surrounded by their friends and peers. But in general, I think the biggest issue comes in the infant period, when they're trying to breastfeed.

Host: Okay. That makes sense. So, let's move on to the different treatments for tongue tie. Let's talk about when someone brings their child in to get treated? What might that look like?

Dr. Fiorillo: So, I think the first step is, if you think your child has a tongue tie, is to talk with your pediatrician about your concerns, whether you think it's causing feeding issues, speech issues, or even if you just look at your child's tongue and feel that it's not moving as well as it should. I think the pediatrician is the best go-to person for an initial evaluation to get you started on the best route for diagnosis and treatment. Treatment really depends on what issue the tongue tie is causing. So, if your child's not having any issues, but there's a tongue tie present, really no intervention or treatment is needed. If your infant is struggling to breastfeed, or mom is having a lot of pain with breastfeeding, then I think referral to either a lactation consultant or to someone like myself, an ear, nose and throat is the best next step. Lactation consultants can help mothers with other issues for breastfeeding, such as proper positioning on the breast, correcting the position of the infant lips when they're feeding. An ENT such as myself, can evaluate the child, determine that if a frenulectomy or dividing the lingual frenulum is the best next step.

And, what that looks like is coming in, I would do a full kind of exam and history of what's going on, what the issues are, and kind of discuss the process with parents about what's involved with a lingual frenulectomy.

Host: And with that lingual frenulectomy, let's talk about when that actually is the right option. And when parents should consider getting surgery for their children,

Dr. Fiorillo: In infants, less than six months old, I'll perform the lingual frenulectomy in the clinic. And this process only takes a few minutes. It does not require any sedation or anesthesia, and it can actually be really rewarding to have an infant and mother who are having trouble with breastfeeding, and after this procedure, it can just kind of change the whole family's life. The procedure itself takes about five minutes. I have the mothers breastfeed immediately after and often moms will notice a difference immediately. Other times moms do need to continue working with a lactation specialist, but overall, the procedure's very low risk, but should be done only when it's indicated.

Host: Yeah. And just expanding on that a little bit. I'm trying to get a good sense of when parents should really consider getting a procedure like this done for their child. You know, you mentioned that in many cases, it just goes away on its own, but when should parents really kind of start taking it seriously?

Dr. Fiorillo: In infants, it kind of depends on where they are in their stage of life. So, in infants they're having trouble breastfeeding, mom is having pain. I think it should be checked out and it should not be, put off or let go especially if your baby's having poor weight gain. You're really struggling to breastfeed. You're thinking about having to go to a bottle, but you would like to continue breastfeeding. I think getting evaluated for a tongue tie is extremely important. In children that in the two to five year old range that do have articulation errors that are struggling with their speech, I think those are kids that should be evaluated. There are lots of other reasons that they can have issues, but there certainly could be a tongue tie as well, contributing to things. Now in those older children, the frenulectomy does have to be done in the operating room for it to be done safely does require a general anesthesia, but it's still a very short procedure and the recovery is short and there are minimal complications. So, it's definitely an option for kids that really need it.

Host: Okay. So, if people suspect that their child might have a tongue tie, I'm sure there are lots of parents listening to this that already have a pediatrician or people that they see, but tell us a little bit more about why they should consider choosing Kentucky Children's Hospital for their child's care.

Dr. Fiorillo: Well, I'm biased, but I think we have an amazing team that can take care of any child, myself and my two partners, Dr. Asbell and Dr. Iverson have undergone additional training that is specific in the care of children with ENT issues, including tongue ties and like I said before, I think an appropriate evaluation of a child is kind of the crucial first step.

And tongue ties are a very common diagnosis. They, and like I said before, they're being treated pretty much more commonly than they used to be, but infant's feeding and child speech development is really complex. And so I think having a correct diagnosis is key. And I think that we can offer that and do a full evaluation of an infant and a child that is older with speech issues.

I have seen children that have issues, that's not so much from the tongue tie, but it's that they're having trouble breathing through their nose or they're having actual troubles with their swallow. Sometimes there can be other issues with the tongue or issues with the palette that may be misdiagnosed as a tongue tie or improperly managed.

So, that thorough evaluation I think is extremely important. And then for older children with speech delay, there are lots of causes that really should not be missed. And we have a wonderful team of speech pathologists, audiologists to kind of help us support and evaluate any child with speech delay. All three of us that are pediatric ENTs are parents. We have our own kids and we're here to treat our patients as we would our own. We're always available, especially for an infant that is having feeding difficulties. We will make sure to get them in and evaluated within a few days.

Host: That sounds extremely reassuring. So, thank you so much for that dr. Fiorillo, is there anything else that you feel is important to share with parents that might be listening or concerned that their children has a tongue tie?

Dr. Fiorillo: I'm the mother of two boys, and I know what it's like to struggle with breastfeeding an infant. And you would think that it's the most natural thing in the world, but it's really not. So, it can be painful for the first few weeks, even without a child with a tongue tie, it can be very frustrating feeling like you're not providing for your infant. But every situation is different. Every baby's unique. And I think at UK Pediatric ENT, we want to help you make the best possible decision for you and your child.

Host: Well, Dr. Fiorillo, I think that's the perfect place to end and a wonderful message for mothers or soon to be mothers. That's Dr. Caitlin Fiorillo, a Pediatric Otolaryngologist for UK Healthcare. To find out more information about our Pediatric ENT program, visit our website at ukhealthcare.uk y.edu and search children ENT in the search bar on the top, right of the page.

If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of UK Health Cast with the University of Kentucky Healthcare. My name is Prakash and we'll talk next time.