As I have mentioned previously, unaddressed tongue ties have the potential to lead to a number of health problems.
If this seems like overstating the case, consider that proper development/formation of the musculature is similar to adequate nutrition. If there is a deficiency of a particular nutrient, the effects of that deficiency can spill over into many different areas. And no “cure” can be successful while that necessary foundation is still lacking. The mouth is the beginning of the digestive tract and a major part of the airway; it also directly contacts other parts of the airway, several major nerves, etc. Incorrect development in the mouth, then, can potentially spill over into any of these body systems.
But most of the time, tongue ties are only recognized if they’re causing obvious breastfeeding problems — such as a poor latch. In many cases, babies are adaptable enough that they nurse just fine — at least for a while — making the tongue tie more likely to go unnoticed. There are some “symptoms” that can serve as “red flags” that you might want to check closely. For instance:
- a sudden drop in milk supply (commonly around 4 months, but this can happen at other times)
- “colic”/gassiness (without another clear explanation)
- recurrent ear infections
- sleep apnea
- enlarged tonsils/adenoids
- (with older children/adults) migraines/headaches
- (with older children/adults) ADD (because in this case it’s actually sleep-related)
Essentially, if you or your child are experiencing any of the health concerns that tongue ties can lead to, tongue tie should be ruled out before turning to other treatments as alternatives. (Depending on the issue, other treatments may still be needed, but they’ll be more effective with the tongue tie impeding them.)
What to Look For
Tongue ties often have physical indicators, though; they just can be subtle and easy to miss unless you know what to look for. Some of these may be direct evidence of a tongue tie, while others are more like “hints” — situations that usually coexist with tongue ties.
An Open Mouth
Except in certain short-term, acute scenarios, such as while battling a cold, mouth breathing is not normal. The normal “at rest” position of the mouth is closed, and normal breathing takes place primarily through the nose. (There’s good reason for this. The nose has protections against “foreign invaders” — like hairs — that the mouth does not have.)
Particularly if the child does not seem to have difficulty breathing, perpetually holding the mouth open is a red flag. This was a major clue to me that my daughter had a tie.
However, mouth breathing can be both cause and effect of difficulty breathing, so even if the child does have difficulty breathing through his nose, it is worth investigating whether a tongue tie may be part of the reason why this is the case.
A “Dropped” Tongue
Not only does the normal “at rest” position of the mouth involve the mouth’s being closed; the tongue should also be pressed against the roof of the mouth. This constant low-level pressure against the palate serves important functions. A variety of modern practices can interfere, such as sippy cups, but one of the primary causes for not holding the tongue against the roof of the mouth is a tongue tie.
If the tongue can’t comfortably reach its intended resting place, the body will adapt by choosing another position. Especially if you have an infant who is not using any artificial nipples (so there is no obvious alternative explanation), if the tongue is dropped, it’s highly likely there’s a tongue tie present.
But how can you tell if the tongue is dropped? You can see it. I don’t mean inside the mouth (although that might also be true if the child is sleeping open-mouthed). The tongue is a muscle, and it extends beyond the mouth. Just as you can see the difference in the muscles of the forearm when you make a fist, you can see the difference externally when the tongue is raised or lowered.
If you consider the point where the underside of the chin meets the neck as an inside “corner,” that area will look overly “soft” in an individual with his or her tongue dropped, and somewhat firmer or tighter if the tongue is properly raised. The appearance is a little similar to a double chin-type look.
You can get a little bit of a feel for this by feeling your own neck. Gently rest your fingers against that part of your neck, then raise and lower your tongue. See how that part of your neck pulls upward when your tongue goes up? Your child’s should do the same.
I tried to capture this in images, but it’s hard to photograph a baby’s neck, so you can’t see it well. This, though, was also a key clue to me that my daughter might have a tie.
A High, Narrow Palate
This indicator is harder to see visually, but you might be able to feel it. If the upper palate is very high and narrow, rather than broad and relatively flat, that can be a sign that the tongue is not being raised against it to put pressure on it. (This is more difficult, though, in my opinion, for a parent to pick up on, because we don’t see a lot of palates to have a frame of reference. You can learn to recognize the external appearance of a face with good posture, but the interior is trickier.) This baby might have a gag reflex that seems to be stimulated farther forward than expected, as well.
Misalignment of Teeth
Tongue and lip ties can impact the teeth, because the more prominent frenulums pull on the teeth in otherwise-unexpected ways. A lip tie, if severe enough, can force a gap between the front top teeth. This is because the frenulum actually comes down between the teeth, and doesn’t allow them to meet. (A baby should have some space between them, regardless, because the baby teeth are smaller than adult teeth. But you might notice an upper lip tie by seeing the teeth being pushed apart.)
A tongue tie will often pull the bottom two teeth inward from their center edges, resulting in a pair of teeth that angle inward in something of a V shape. This, too, was something we noticed in my daughter when her teeth started coming in.
Function is More Significant than Form
Why does all this matter? The severity of a tongue tie, in practical terms, is not really measured by how bad it looks, but by what it affects. My daughter’s ties didn’t look too bad. In fact, my doctor missed them altogether, even after being asked about them directly. To the untrained eye, they simply weren’t obvious.
And for much of her infancy, they didn’t seem to cause any obvious problems, either. (Although after having them corrected, I can see the difference in how well her lip flanges when she nurses, and I suspect she does a better job of stimulating milk supply.) But when we started introducing solid foods, she struggled a lot with choking and gagging and didn’t seem able to swallow anything that wasn’t liquid. After having her ties corrected, the swallowing issues were basically just gone. She went from completely unable to eat anything non-liquid to only gagging now and then like any other baby — overnight. All of those struggles could have been prevented had we recognized and addressed the ties sooner.
And although the signs of issues from the tie were not obvious until she tried to eat solids, all of these subtle indicators of the ties themselves were present all along. When examined by a trained provider, the ties that all these signs were hinting at were visible. With permission, I’m sharing the photos Dr. Marcus (pediatric dentist in Baltimore) took of my daughter’s tongue and lip ties.
You can see more clearly in this image how this is pulling at her lower teeth, too.