According to the literature, some variant of the classic tongue tie can be seen in up to five percent of newborns, and about half of them will present with feeding difficulties in the first few days of life.  Half of them feed just fine, and those are the ones we don't see.  The percentage of babies with visible tongue ties is a lot higher in the group of children of mother seeking help for breastfeeding problems, of course.  If it's not causing mother any pain and baby is thriving at the breast, it's not a problem in my book.  Liz Brooks' version of anticipatory guidance sounds right on target to me.  

As Cathy Genna emphasizes frequently, some of the worst tongue ties also go undiagnosed because they are submucosal, posterior, and so complete that the baby can't even extend its tongue far enough to reveal a possible heart shape.  Where I live there is no alternative to waiting for the baby to grow larger so its mouth fits better on the breast, which involves using other means to maintain supply and keep baby fed in the meantime.  I envy those who live near someone who will clip these ones; I don't.

Since tongue tie presents with such a huge range of visual findings, and manifests itself according to both the features of the tongue and the nature of the breast, I would not expect to find any other common characteristics among children with problematic tongue tie, like learning disorders or even need for orthodontia.  It's one of the most common anatomic 'anomalies', so common that it's debatable whether we should always consider it an anomaly.  I may be proven wrong some day, but for now I doubt whether tongue ties are markers for some other conditions that also affect many children, such as dyslexia.  It goes without saying that if a tongue tie prevents a child from being breastfed, then any other challenges the child has may be magnified because the child has to do without the normal stimulus to motor and cognitive development that breastfeeding ensures.

Rachel Myr
Kristiansand, Norway

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