In Nigeria, many mothers believe that the number one cause of speech delay in children is the so-called “tongue-tie”. They strongly believe this “tongue-tie” must be cut or else the child will not be able to speak on time or the speech will not be clear.
It is not unusual for mothers to bring their babies to the hospital asking that they are checked if their babies brought on account of speech delay has tongue-tie or not. Indeed many would have gone ahead to ask the traditional birth attendant to help cut the “tongue-tie” maybe once or twice before coming to the hospital after realizing there is no improvement. Oftentimes, the cut becomes infected or heals with excessive scar leading to more complications.
Tongue-tie (ankyloglossia) is a condition present at birth that occurs when the strip of skin connecting the tongue and the floor of the mouth is shorter or tighter than usual. This can restrict how the tongue moves. Somebody who has a tongue-tie may experience difficulty sticking out their tongue. It can be mild or severe, depending on how much extra tissue is underneath the tongue.
Tongue-tie has many proven complications and in the newborn, the major effect is the interference with proper latching on and suckling which can have negative effects on exclusive breast-feeding.
A cross sectional study to elucidate the myths and practices surrounding ‘tongue tie’ among mothers in an immunisation clinic of the Abia State University Teaching Hospital (ABSUTH), Aba, puts the prevalence of tongue-tie surgery at 27.3% in South-East Nigeria.
The reasons for the procedure were mainly concerns about delay in speech, problems with the quality of speech or coercion by health workers who put the fear of possible speech problems in the mothers. Feeding difficulties were not found to be a reason for the procedure in any baby. Also, the level of education or the place of delivery did not affect the prevalence of the practice.
Complications of frenotomy, a procedure to treat tongue-tie, like bleeding were found in 13.3% of those that had the procedure. The bleeding was severe enough to warrant hospital admission and transfusion. It was in the 2021 edition of Acta Scientific Paediatrics.
Frenotomy is a procedure performed by a range of health practitioners including midwives, doctors and dentists. It involves cutting the extra tissue underneath the tongue in a child at less than 4 months. The first study internationally to report complications relating to tongue-tie following minor surgery for tongue-ties in babies published in the Australasian scientific journal, Journal of Paediatrics and Child Health said its complications include breathing problems, pain, bleeding, weight loss and poor feeding.
All surgery, even when minor, is not risk-free. Much more, Dr. Omobola Olanloye, a pediatric dentistry consultant at the University College Hospital, Ibadan, said tongue-tie is an over-diagnosed condition in Nigeria.
According to Dr. Olanloye: “Every midwife thinks that a baby has a tongue tie, so if a child moves the tongue in a certain way then the child must have a tongue tie. So we see mothers coming with infants claiming that their infants have a tongue tie, it is not as common as the general population is making it look. It is a relatively rare condition.
“Take January 2022, as an example, I have seen about 5 babies whose mothers brought them because they felt the child had the tongue tie. Out of the five, only one had a tongue tie. It was even a mild tongue tie that will cause no problem.
Dr. Olanloye declared that parents should ensure that all supposed tongue-tie babies be examined by a specialist given that it is not every tongue tie that needs surgical intervention, although mothers are always worried.
She stated: “There are different types of tongue-tie. The severity of the tongue tie and the handicapping condition associated with tongue-tie will determine whether the tongue-tie will need an intervention or not.”
Dr. Olanloye stated that practices like the forceful use of gloved hands to cut a queried tongue-tie or a surgical blade to nip it when most times it is not even necessarily need to be discouraged in the community because of the complications that could arise such as bleeding and infection.
She advised that mothers concerned about speech problems in children should rather seek a specialist who is trained to assess and diagnose hearing and speech conditions rather than result to Google to find a solution.
Dr. Olanloye declared, “Google has caused a lot of problems because a little problem, they run to their phones and they Google it and they believe whatever they read on Google is the solution to the problem. In some instances, what they call tongue-tie is actually something else. It is totally different.”
Dr. Adekunle Daniel, a consultant ENT surgeon, stated that a tongue-tie cannot prevent a child from speaking or learning to speak.
According to Dr. Daniel, “The worst tongue-tie can do to a child is to give the child abnormal and distorted speech, but to prevent the child from speaking is not true. It is something else, either the child had a brain injury when he was born or the child cannot hear because if a child does not hear, he cannot speak.
“So the best thing if you think that the child has a tongue-tie or a child that has never developed any appreciable speech is to have that child evaluated as soon as possible to know what is wrong with the child. The child might probably have another problem. That the child will not develop any speech at all and it is due to tongue-tie is not true.”
Research has shown that a significant number of infants with tongue-tie do not require treatment; it resolves on its own. Howbeit, every situation should be revived by a specialist for the health of that child.