The term 'ankyloglossia' or 'tongue tie' indicates a restriction in a tongue's capacity to move and it is present from birth.
It may be caused by genetic or environmental factors, though there are still less studies exploring this second possibility.
With a tongue tie, the frenulum (i.e. the membrane attaching the bottom of the tongue to the floor of the mouth) may be too short and/or too tight/stiff or may be positioned in a way that affects the mobility of the tongue.
This is particularly relevant when it comes to breastfeeding because painless and effective milk extraction requires the baby to move her tongue like a wave, while maintaining a wide open mouth and an unbroken seal at the breast (deep latch).
There are different types and presentations of tongue ties: some may come with a frenulum which attached to the tip of the tongue (anterior tongue tie) while some may have a frenulum which is attached a little or further back than that (posterior tongue tie). From the bottom of the mouth side, some frenula might be attached to the centre of the lower gum, while some others a little or further back.
All types of ties might or might not affect the tongue's ability to move. That is why it is important to have a functional diagnosis performed by a professional who has been specifically trained in this field.
A regular pediatrician, dentist, ENT who has not developed a personal interest in suckling dysfunctions might not be equipped to diagnose a tongue tie in a newborn nor to suggest the appropriate course of action.
In order to transfer an adequate amount of milk - and to do this without giving pain to her mother - there are many functions that a baby's tongue needs to perform at the same time.
A baby needs to be able cup the breast with her tongue and maintain a full seal at the breast with her mouth wide open (deep latch) and at the same time she needs to be able to move her tongue like a wave: the back of the tongue elevates and then it drops and comes forward to cover the lower gum.
The tongue periodically covering the lower gum prevents the baby from 'gumming' and bitying on her mother's breast.
The wave like movement of the tongue is what creates the vacuum required for milk to flow from the breast to the baby's mouth.
Tongue tied babies may not be able to do any of the above described actions or they may be able to do just one of them and not the other, or again they may be performing one or both of them suboptimally.
For example we may have a baby who can thrust her tongue forward as well as elevate it at the back, but she may have to keep her jaws less widely open in order to do so. Some of these babies might not have major feeding difficulties: they may simply be able to get going just by feeding a little more frequently or with longer nursing sessions. Some others may nevertheless not be able to extract enough milk or involuntarily give pain to their mother while compressing her breast more than normal when feeding. Some of such babies might swallow air during the feeds and as a result develop colic pain and reflux. Hearing clicking and kisses-like sounds while a baby nurses indicates a brief break in the seal, which can result in air swallowing. These noises are different from the noises indicating deep swallows and 'active milk transfer' that you can, for your reference, hear in this brief video: https://youtu.be/LpHoYK9dOJc
The following are some of the symptoms that may be associated with tongue ties. Remember though that they are aspecif symptoms and they are not always caused by a tongue tie:
Painful feeding
Reflux
Colic pain
Low milk intake/ low supply
Oversupply
Mouth breathing
High arched palate
Snoring
Sleep apneas
Inability to sustain suckling on a deep latch
It is recommended to work on a deep latching technique and to seek counsel on breastfeeding management before jumping to the conclusion that the cause of the above listed issues is a tongue tie.
Other possible reasons need to be evaluated as well, yet it is important to include tongue and lip ties in the set of causes to be considered.
If you have given a good try to improving your baby's latching technique and you still experience problems, it is a good idea to have your baby checked for tongue ties by a professionals who is trained to diagnose suckling disfunctions.
The term lip tie refers to a tight or stiff lip frenulum (i.e. the tiny membrane attaching the lips to the upper or lower gum) and/or a frenulum which extends to the backside of the gum.
A lip tie may affect a baby's capacity to flange her lips outwards while breastfeeeding and maintain a seal at the breast.