A frenulum (tongue-tie) is a thin band of mucous membrane under the tongue that helps secure and support tongue movement. Tongue-tie (ankyloglossia) is a congenital anomaly where the lingual frenulum is short, thick, or abnormally attached, restricting tongue mobility. This condition can be detected immediately after birth or when a child begins solid foods or speech development.

Master, Doctor, First Degree Specialist Nguyen Huu Dung, from the Department of Pediatric Surgery at Tam Anh General Hospital TP HCM, stated that the severity of tongue-tie often correlates with the shortness of the frenulum. Doctors categorize this anomaly into four degrees:

• Mild (12-16 mm): Tongue movement remains almost normal.
• Moderate (8-11 mm): Movement begins to be restricted, potentially causing slight effects on feeding or speech.
• Severe (3-7 mm): Significant restriction of tongue movement, impacting feeding, eating, and speech.
• Very severe (under 3 mm): The tongue is almost completely attached to the floor of the mouth, typically requiring early assessment for intervention.

According to Doctor Dung, the frenulum's length is not the sole determining factor for surgical intervention. Below are the signs indicating a need for tongue-tie intervention in children.

Children with difficulty breastfeeding

Doctors often consider a tongue-tie release for infants in their first months if they struggle with breastfeeding. An assessment may be necessary if an infant has difficulty suckling, poor latch, prolonged feeding without adequate milk intake, frequent detachment from the nipple, slow weight gain, or if the mother experiences persistent nipple pain. If the infant feeds well, gains weight normally, and shows no functional disorders, monitoring may be sufficient without immediate intervention.

Children with restricted tongue movement

Between 3 and 6 months of age, signs indicating a need for evaluation include an inability to extend the tongue past the lips, inability to touch the roof of the mouth with the tongue, limited side-to-side tongue movement, or a heart-shaped indentation at the tip of the tongue when extended. These signs suggest clear restrictions in tongue movement and require assessment by a specialist to determine appropriate intervention.

Doctor Dung advises parents on the tongue-tie release procedure at Tam Anh General Clinic District 7. Illustration: Trung Vu

Children with difficulty chewing and swallowing solid foods

Tongue-tie can affect a child's ability to chew, swallow, and manipulate food within the oral cavity once they begin solid foods. Some children struggle to move food from their cheeks to the center of their mouth, eat slowly, or frequently drop food while eating.

If these symptoms persist and impact nutrition or daily activities, a specialist should evaluate the child to assess the extent to which tongue-tie is affecting them.

Children with speech difficulties during language development

During a child's speech development, tongue-tie can manifest as lisping or unclear pronunciation of sounds requiring flexible tongue tip movement, such as 'l', 'n', 't', 'd', and 'r'.

Tongue-tie does not cause speech delay but affects speech quality. If a doctor determines that restricted tongue movement is the cause, the child may be recommended for a tongue-tie release combined with speech therapy.

According to Doctor Dung, if a child has a mild tongue-tie, feeds well, and experiences no impact on eating or normal language development, intervention is not recommended. A tongue-tie release is a simple procedure, typically lasting only 5-10 minutes. For infants under 6 months old who have not yet developed teeth, doctors usually perform the procedure under local anesthesia. For children over 6 months old, doctors often administer mask anesthesia due to the presence of teeth, which can lead to biting and difficulty cooperating during the intervention.

During the procedure, the doctor uses an electrocautery device to release the tongue-tie while simultaneously controlling bleeding locally. This minimizes damage to healthy tissue, reduces blood loss, and aids recovery. After the procedure, most children can resume feeding or eating within about 15-30 minutes and are discharged the same day.

Parents should seek medical consultation if their child exhibits signs of poor feeding, eating difficulties, or abnormal speech to receive advice on the appropriate timing for a tongue-tie release.

Minh Tam