4/12/2010

Assessing for Tongue-tie Problems associated with

tongue-tie
Catherine Watson Genna, BS, IBCLC

Failure to thrive

Jaundice

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Nipple damage
Shallow latch and infection

Tongue-tie prevents normal

V shaped narrow high palate
palate expansion

Palate
spontaneously Speech Difficulties
broadened after
frenotomy

Sarin, et al Tongue tie: Myths

and Truths, Indian Pediatrics
29(12) 1992

And sucking blisters resolved

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Hironori Takemoto, PhD

Normal Tongue Mobility

Normal Tongue lateralization

Normal palate
Movements

elevation extension

Look at baby at rest

Systematic Assessment

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Observe relationships- lips and jaws

Examine 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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Stimulate tongue
See if baby can pull finger in
extension/protrusion

See if tongue can cup around See if tongue can stay over gum
finger, feel sucking ridge (this baby retracts)

Check lateralization using

transverse tongue reflex Run
finger
along
lower
gum,
tongue
should
follow

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Check both sides

Suspect
tongue-tie
if tongue
twists or
fails to
lateralize

Finger Sweep – Jim Murphy, MD Finger Sweep

Identifies invisible tongue-ties
• Sweep finger
across from side
to side with
fingertip at base
of tongue.
• Speedbump =
may need
frenotomy
• Fence = needs
frenotomy

Murphy Maneuver Elevate Tongue

• Press on
frenulum in
front midline
• Observe for
dipping down
of tongue at
forward extent
of frenulum

Hourglass type – Jim Wire type – Jim Murphy,

Murphy, MD MD

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Improved elevation after

Look at elevation
frenotomy

Interactions between tongue Retraction with gape

elevation and gape
• Tug of war
between jaw
and tongue
through hyoid
bone
• Tongue tie
restricts gape
• Opening wide
retracts tongue

Extending tongue with mouth Examine Palate

open

Baby breastfed initially, weight gain fell after

solids were introduced

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Palate width inversely proportional

to tongue elevation Blanching
is abnormal

Elastic frenulum may allow bf This baby breastfed

Mom’s
breasts
matter:
Elasticity,
Nipples
everted

Breastfeeding

• Depth/ease of latch, ability to sustain latch

Evaluate Breastfeeding
• Maternal comfort
• Nipple damage/shape on release
• Milk transfer
• Suck:swallow ratio, sucking speed
• Coordination of swallowing and breathing
• Sucking compensations

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Rooting but not latching Inability to maintain latch

Poor milk transfer Difficulty handling milk flow

Chewing Excessive jaw excursion

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Excessive lip movement/shallow

Tongue recoil – popping sounds
latch

Poor rhythmicity, lip overuse Sliding tongue

Severe ankyloglossia – flaccid

tongue

Presentations of Tongue-tie

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Hidden tt:
Submucosal

Thin
frenula
are
usually
more
elastic

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Sides of tongue flip up Frenulum inserted through tongue

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

Twisting to lateralize

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Submucosal
Breastfed with
difficulty, has
speech
articulation
problems

• High
palate
• V shaped
palate Don’t Anchor:
• Nasal Tongue-tie might not be the only
congestion
• Calloused issue!
lips
• Square
tongue tip

Hypotonia, Prader Willi Syndrome

Baby M:

High
Palate

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Baby M:

Central Baby
tongue M:
immobile, soft
slightly palate
low-set cleft
ears

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).

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