A 'tongue-tie' (also known as ankyloglossia) limits the tongue's mobility due to an unusually short/thick frenulum (a piece of skin) that connects the tongue tip to the floor of the mouth. As the mouth parts develop in the fetus during the 1st trimester, a failure of the frenulum to separate completely from the base of mouth results in tongue tie. The severity ranges from being mild to a complete loss of mobility of the tongue. Causes: The causes of tongue tie are still unknown. Symptoms:<ul><li>Baby can’t latch well</li><li>Baby tends to chew more than suck</li><li>Baby doesn’t gain weight</li><li>Baby is fussy when trying to feed</li><li>Baby makes a clicking sound while feeding</li><li>Tongue can’t move far from side to side</li><li>Tongue can’t reach the upper gums or roof of the mouth</li><li>Tongue can’t stick out past the gums</li><li>Tongue has a V shape or heart shape at its tip when it’s sticking out</li><li>Older children may have difficulties pronouncing certain words with 't; 'th; 'd', 'dh', 's', 'Z', 'r', or 'II in it.</li><li>There is a higher possibility of dental problems (tooth decay, gingivitis, space between the bottom front teeth) in older children.</li><li>Gagging or choking on foods as your child starts to eat solids.</li><li>A hard time with basic things, like licking an ice cream cone.</li></ul> Diagnosis:A physical exam is all it takes to see what’s going on. The doctor will:<ul><li>Ask how feeding is going.</li><li>Check your child’s tongue, mouth, and teeth.</li><li>Use a tongue depressor, which is like a big popsicle stick, to look under your child’s tongue and check the range of motion.</li><li>The doctor may ask older kids to move their tongue around and make certain sounds, like of an r or l</li></ul> Treatment:The lingual frenulum generally loosens over time and it can be cured on its own most of the times. But if the problem persists, a lactation consultant can help with breastfeeding and a speech-language therapist can help with speech therapy. If there is any severe complication, then your doctor may suggest some surgical procedures like frenectomy or frenuloplasty. Frenectomy: This is a simple surgical procedure wherein the doctor uses sterile scissors to cut the frenulum free. It is a quick procedure. The baby hardly feels any pain during or after the surgery as there are few blood vessels in the lingual frenulum. The procedure can be done with or without sedation. Frenuloplasty: If the lingual frenulum is too thick, the doctor might need to do some additional repair and this is an extensive procedure known as Frenuloplasty. General anaesthesia is given by the doctor. The wound is usually closed with sutures. Complications are similar to frenectomy - Bleeding, infection, damage to tongue or salivary glands. In this procedure, the doctor will:<ul><li>Give your child drugs so they sleep through the whole thing</li><li>Use special tools to cut the frenulum</li><li>Put in a few stitches that dissolve on their own as the wound heals</li><li>After the surgery, the doctor might suggest a few tongue exercises to increase the movement of the tongue.</li></ul> Prevention: Tongue tie cannot be prevented.

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