This is the million dollar question! Providers in the "tongue tie space" make this recommendation based on function. Is a tight frenulum impacting feeding and weight gain? Milk supply? Is in interfering with nasal breathing and oral rest posture? If so, is that going to impact cranial-facial development? Do we suspect it will impact future feeding, speech, dental and airway health? Could there be other things going on that have similar symptoms to a tongue tie? Are there co-existing factors impacting feeding? These are all things that need to be considered in a thorough assessment. And while we can't predict the future, we do want to be very thorough in assessing these domains, making appropriate referrals for team input.
The First Step:
If you suspect a tongue tie, the best place to start is with a lactation provider or feeding/myofunctional therapist (depending on child's age and provider specialty). If it is determined that a tongue tie is impacting function, your provider will recommend feeding/myofunctional therapy and bodywork first. This is considered best practice, and should be implemented before a surgical release. Sometimes, by starting with the most conservative measures, we improve function and rule out need for frenectomy. At the very least, feeding therapy and bodywork address co-morbidities (because there are always compensations/co-morbidities with tongue ties), and prepare the little one to be a more ideal candidate for a frenectomy- by reducing the risk of reattachment or having an incomplete release.
But what if we don't want to do a release?
We support you. Sometimes babies have other medical things going on and and a release may not be appropriate. Similarly, a family may choose to be conservative and pursue therapy alone. Maybe that's you, and you'd prefer to monitor the situation. That's okay! As providers, we want to educate families, so that you can make the best decision for your family. Sometimes the anatomy is questionable, but symptoms don't warrant a release, and we can educate on what to watch for while we wait-and-see. Other times, symptoms may be present but we choose a "work-and-see" approach, to see how much improvement can be achieved without surgery. If progress leaves us with less than ideal results, we can revisit the discussion of "what now".
Is it ever too late to address a tongue tie?
It is never too late to have a tongue tie released- adults have it done! But age does matter. Generally, the younger we address a tongue tie, the shorter the course of treatment. For example, an infant responds really quickly to feeding therapy, while feeding therapy with a tongue-tied toddler can be painstakingly slow. Toddlers may or may not be candidates for a frenectomy, simply because post-op wound care is a challenge at this age (Picture a toddler opening wide and allowing you to lift and stretch their tongue 6x a day for several weeks--without getting bit ). In these instances, a release provider may suggest feeding therapy to maximize function, and wait until the child is older before considering a release. There is emerging evidence to suggest that kiddos with untreated tongue ties (or incomplete releases, reattached releases) are at an increased risk of developing picky eating behaviors and speech sound errors. These are things to be on the lookout for.
It's important to know that a frenectomy is not a quick fix. It can be frustrating for families to start down that path without a roadmap, only to find that nothing changes after surgery. We aim to support families from start to finish. No matter how you want to address a tongue tie, we are here to help you feed your family.
Ligh, RQ et al (2021). Collaborative approach to treating ankyloglossia. The Journal of Multidisciplinary Care: Decisions in Dentistry; 7(7)35-38.
Baxter & Hughs (2018). Speech and feeding improvements in children after posterior tongue tie release: a case series. International Journal of Clinical Pediatrics, Volume 7;3, pages 29-35