How to detect if your baby has a frenulum problem?

What is frenulum?

A short sublingual frenulum or ankyloglossia is a disorder that occurs from birth. And, as its name suggests, it means that the sublingual frenulum has formed with a shorter size than usual, thus causing limitations in the baby's tongue movements. But how can I detect if my baby has a frenulum problem?

It is a disorder that occurs in many newborns, in fact according to the Spanish Association of Pediatrics (AEP), it affects 1.7% - 4.8% of babies, so, given its relevance, it is a topic worth knowing.

To detect if your baby has a frenulum problem, i.e., ankyloglossia (restrictive frenulum), we must observe if he/she has difficulty sticking the tongue out of the teeth or if the tongue curves. 

As you can see, detecting if your baby has a serious problem in the frenulum is a quick procedure, but it is not always detected at birth for several reasons. One is because not all health care providers are specialized and it is important to find the right person and another reason may be because it does not show its face at the beginning and little by little this restriction starts to give problems during the first weeks/months.

What to do when you detect that your baby has a frenulum problem

First of all, it is important to note that there are different types of sublingual frenulum, depending on the degree of sublingual frenulum. Dr. Elizabeth Coryllos and Catherine Watson Genna have created a global classification scale, which helps us to understand it better.

• Frenulum type 1 anterior: The insertion of the frenulum occurs at the tip of the tongue. The tongue is heart-shaped, as the frenulum is pulled from the tip of the tongue towards the inside of the mouth.

• Anterior frenulum type 2: The insertion of the frenulum occurs a few millimeters further back than type 1. The tip of the tongue descends downward.

• Type 3 posterior frenulum: This type of frenulum could be defined as a combination of types 2 and 4, it is one of the most difficult to detect since the tongue appears normal. When the tongue is stretched, it will be bent at the periphery and depressed in the center, and will not be able to touch the palate with the mouth fully open. 

• Type 4 posterior frenulum: The frenulum is not visible to the naked eye, as it is hidden under a layer of mucosal tissue. This type of frenulum restricts practically the entire mobility of the tongue. This is usually the most difficult to diagnose, it usually shows its face after a few weeks and months, but it has a positive side and that is that, in many cases it does not require intervention (frenotomy or frenectomy) since it usually gives good results with physiotherapy treatment.

Once we detect that our baby has a frenulum problem, we should contact a healthcare professional specialized in frenulum assessments as soon as possible.

What is a frenotomy or frenectomy?

Although it is true that there are cases in which it does not cause problems, in others it is necessary to make a brief intervention, which consists of making a small incision in the frenulum. This procedure is called "frenotomy" (or frenectomy) and, although it may scare you at first, it is a very quick process that does not even require anesthesia in most cases, especially if it is performed within the first six months of life, hence the importance of quickly contacting a health professional specializing in the subject, if your baby has a problem in the frenulum.

Consequences when your baby has a frenulum problem

As we said at the beginning, some newborns have an unusually short frenulum, which conditions the movement of the tongue and, therefore, affects several important aspects of the baby's life. This problem also has a negative influence and has consequences for the mother (pain when breastfeeding, incomplete emptying of the breast leading to complications such as obstructions, mastitis, inadequate production, among others). This restriction can not only cause problems with breastfeeding, but also with artificial breastfeeding, increasing gas and digestive discomfort, milk leaking out of the sides due to the lack of a good vacuum, among others.

In infants, having a short sublingual frenulum or ankyloglossia will affect how they eat and swallow; among others: they do not manage to maintain a good latch on to the breast and let go frequently, inability to ingest enough milk which means a slow weight gain, the feeding becomes very long and the baby gets tired, so he asks for a lot and is at the breast for a long time, causing problems in many babies when breastfeeding (maternal or artificial) and even having consequences in adulthood if not corrected in time. Other different signs may be that the baby sleeps with the mouth open or has a small blister on the upper lip, when excessive pressure is applied during sucking. 

For its part, the AEP details a series of difficulties/inconveniences that mothers who breastfeed a baby with a frenulum problem may have, including: cracks in the mother's nipple, mastitis, low milk production or hypogalactia, early withdrawal from the breast.

In addition, in the long term, this problem, if not solved in time, can lead to other problems in adult life, such as: incorrect development of the maxillofacial structure (teeth and palate), problems in the articulation of various phonemes, causing dysglossia that will affect the proper pronunciation of sounds, among others, rotacism.  

The frenulum assessment service at Maternify

At Maternify, we have a large team of healthcare professionals who love motherhood. And, among many services offered, we have a midwife who assesses your baby's frenulum, with an online session or a visit to your home. This assessment is carried out in conjunction with the physiotherapy team to provide a complete care with our multidisciplinary team and thus be able to solve the complications.

Maternify is undoubtedly a safe and reliable option, covering all the needs of the baby and the family.