4/12/2010

1

Assessing for Tongue-tie

Catherine Watson Genna, BS, IBCLC

Problems associated with tongue-tie

Failure to thrive

Jaundice

4/12/2010

2

Shallow latchNipple damage and infection

Tongue-tie prevents normal palate expansion

V shaped narrow high palate

Palate spontaneously

broadened after frenotomy

And sucking blisters resolved

Speech Difficulties

Sarin, et al Tongue tie: Myths and Truths, Indian Pediatrics 29(12) 1992

4/12/2010

3

Normal Tongue Mobility

Hironori Takemoto, PhD

Normal Tongue Movements

extension

lateralization

elevation

Normal palate

Systematic Assessment

Look at baby at rest

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4

Observe relationships- lips and jawsExamine lips for sucking calluses

Bowed upper lip = narrow palate

Careful observation

Tight labial frenulum, midline furrow in tongue

Lesion from

rubbing on

lower gum

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5

Stimulate tongue extension/protrusion

See if baby can pull finger in

See if tongue can cup around finger, feel sucking

See if tongue can stay over gum ridge (this baby retracts)

Check lateralization using transverse tongue reflex Run

finger

along lower

gum, tongue

should follow

4/12/2010

6

Suspect tongue-tie

if tongue twists or

fails to lateralize

Check both sides

Finger Sweep – Jim Murphy, MDIdentifies invisible tongue-ties

Finger Sweep

• Sweep finger across from side to side with fingertip at base of tongue.

• Speedbump = may need frenotomy

• Fence = needs frenotomy

Murphy Maneuver

• Press on frenulum in front midline

• Observe for dipping down of tongue at forward extent of frenulum

Elevate Tongue

Hourglass type – Jim Murphy, MD

Wire type – Jim Murphy, MD

4/12/2010

7

Look at elevationImproved elevation after

frenotomy

Interactions between tongue elevation and gape

Retraction with gape

• Tug of war between jaw and tongue through hyoid bone

• Tongue tie restricts gape

• Opening wide retracts tongue

Extending tongue with mouth open

Baby breastfed initially, weight gain fell after solids were introduced

Examine Palate

4/12/2010

8

Palate width inversely proportional to tongue elevation Blanching

is abnormal

Elastic frenulum may allow bf

Mom’s breasts

matter: Elasticity,Nipples

everted

This baby breastfed

Evaluate Breastfeeding

Breastfeeding

• Depth/ease of latch, ability to sustain latch

• Maternal comfort

• Nipple damage/shape on release

• Milk transfer

• Suck:swallow ratio, sucking speed

• Coordination of swallowing and breathing

• Sucking compensations

4/12/2010

9

Rooting but not latching Inability to maintain latch

Poor milk transfer Difficulty handling milk flow

Chewing Excessive jaw excursion

4/12/2010

10

Excessive lip movement/shallow latch

Tongue recoil – popping sounds

Poor rhythmicity, lip overuse Sliding tongue

Presentations of Tongue-tie

Severe ankyloglossia – flaccid tongue

4/12/2010

11

Hidden tt: Submucosal

Thin frenula

are usually

more elastic

4/12/2010

12

Sides of tongue flip up Frenulum inserted through tongue

Tongue-tip rolls under on extension Flat tongue due to tongue tie

Twisting to lateralize

4/12/2010

13

SubmucosalBreastfed with difficulty, has

speech articulation problems

• High palate

• V shaped palate

• Nasal congestion

• Calloused lips

• Square tongue tip

Don’t Anchor:Tongue-tie might not be the only

issue!

Hypotonia, Prader Willi Syndrome

Baby M:

High Palate

4/12/2010

14

Baby M:

Central tongue

immobile, slightly

low-set ears

Baby M:

soft palate

cleft

Tongue-tie and Torticollis Neurological impairment and tt

Summary

• Carefully examine tongue mobility and breastfeeding to assess for tongue-tie.

• The more severe the tongue restriction, the more difficult it will be to visualize the frenulum.

• A more elastic frenulum may be more obvious.

• In infants with multiple problems, treating the tongue-tie may or may not improve breastfeeding (but usually won’t hurt).