Irish Times Coverage Highlights Critical Tongue Tie Considerations

October 14, 2025

We're encouraged to see comprehensive coverage of ankyloglossia (tongue tie) in today's Irish Times, which advances public understanding of this complex condition. The article addresses several crucial aspects of assessment and management that deserve wider recognition. As specialists in this field, we'd like to provide additional clinical perspective on some key points raised.

Understanding Functional Tongue Tie

The article references the RCPI/HSE joint report stating that the majority of infants with ankyloglossia breastfeed successfully without intervention. Our extensive clinical experience leads us to a more nuanced perspective on this assertion.

When true functional tongue tie exists, successful breastfeeding without intervention is uncommon. In cases where feeding appears successful despite anatomical restriction, one of two scenarios typically applies:

1. The restriction is not functionally significant - the anatomical variation does not meaningfully impair tongue mobility or feeding mechanics i.e. it is a tongue frenulum but not a tongue tie
2. Compensatory mechanisms are masking dysfunction - the infant and/or mother have developed workarounds that allow feeding to occur, but often at a cost

These compensations, while enabling some degree of feeding success, frequently create secondary issues. Mothers may experience ongoing nipple trauma, pain, or recurrent mastitis. Infants may exhibit excessive feeding times, inadequate weight gain, reflux symptoms, or develop feeding aversions. The dysfunctional patterns established early often manifest in speech, oral motor, or orthodontic challenges later in childhood.

The Role of Lactation Support

Optimising positioning, latch technique, and addressing maternal factors provides crucial baseline support. However, when functional tongue tie exists, lactation support alone rarely resolves the underlying mechanical restriction. Instead, it serves as the foundation upon which successful intervention builds.

Beyond "Snip and Send Home"

We're particularly pleased the article emphasises what we consider the most concerning misconception in tongue tie treatment: that it constitutes a simple, straightforward procedure.

The physical release represents only a fraction of what's required for successful outcomes.

As quoted in the article, infants with tongue tie spend months in utero and after birth developing compensatory movement patterns. The lingual restriction doesn't exist in isolation - it creates a cascade of muscular adaptations throughout the oral cavity, neck, and torso. Even after anatomical release, this dysfunction remains deeply embedded in the neuromuscular system.

Our Comprehensive Approach

Successful tongue tie management requires:

Pre-operative Assessment

• Functional evaluation using validated scoring systems
• Assessment of both infant and maternal factors
• Identification of established compensatory patterns
• Evaluation for concurrent restrictions (lip tie, buccal ties)

Skilled Intervention

• Precise tissue release addressing the full extent of restriction
• Techniques that optimise healing and minimise reattachment risk

Post-operative Management

• Structured motor retraining protocols
• Skilled bodywork to address compensatory patterns
• Feeding therapy tailored to individual dysfunction
• Ongoing lactation support
• Regular follow-up to monitor healing and functional improvement

This "snip and send home" approach referenced in the article explains why some families experience minimal improvement despite having had the procedure. Without comprehensive pre- and post-operative management, surgical sites frequently heal with suboptimal tissue quality, and functional gains remain limited.

Advancing the Standard of Care

The variation in reported prevalence (0.1% to 10.7%) highlighted in the article stems from inconsistent diagnostic criteria. This underscores a critical need: standardised functional assessment protocols that evaluate tongue mobility and feeding mechanics rather than anatomical appearance alone.

We welcome increased public awareness of tongue tie, as it enables earlier identification of feeding difficulties and prompts families to seek appropriate assessment. However, awareness must be paired with understanding that successful intervention requires multidisciplinary expertise extending well beyond the procedure itself.

Looking Forward

Comprehensive media coverage like today's Irish Times article contributes meaningfully to informed decision-making for families. As the field continues to evolve, we remain committed to evidence-based practice, ongoing professional development, and achieving optimal functional outcomes for the infants and families we serve.

For families navigating tongue tie concerns, we encourage seeking assessment from providers who offer truly comprehensive evaluation and management, including structured post-operative support.

For more information about our functional approach to tongue tie assessment and treatment, or to schedule a consultation, please contact our clinic.