Which specialists examine pediatric tongue tie?

Specialists Who Examine Pediatric Tongue Tie

Pediatric tongue tie (ankyloglossia) should be primarily evaluated by a pediatric otolaryngologist, although a pediatric plastic surgeon, pediatric surgeon, pediatric dentist, or pediatric oromaxillofacial surgeon with appropriate training may also be suitable. 1

Primary Specialists for Tongue Tie Evaluation

Pediatric Otolaryngologists

• Most qualified specialist for evaluating tongue tie in infants and children
• Have completed 4-5 years of otolaryngology/head and neck surgery residency plus 1-2 years of pediatric otolaryngology fellowship 1
• Specifically trained to evaluate and treat congenital malformations of oral cavity structures
• Can determine if surgical intervention (frenotomy or frenuloplasty) is necessary

Alternative Qualified Specialists

• Pediatric plastic surgeons: Trained in managing congenital malformations of the mouth 1
• Pediatric surgeons: May evaluate and treat tongue tie, especially in infants 5 years or younger 1
• Pediatric dentists: May have training in evaluating oral restrictions
• Pediatric oromaxillofacial surgeons: May evaluate and treat oral abnormalities including tongue tie

Multidisciplinary Team Approach

For comprehensive care, particularly when tongue tie affects feeding or speech, a team approach may include:

1. Lactation consultants: Often the first to identify tongue tie in breastfeeding infants 2, 3

   • Play crucial role in identifying feeding difficulties related to tongue tie
   • In some settings, specially trained lactation consultants (IBCLCs) may be credentialed to perform frenotomy 3

2. Speech-language pathologists: Important when speech/articulation problems are present 2, 4

   • 60% of speech pathologists believe tongue tie can be associated with speech difficulties 2
   • Speech issues are a common indication (64%) for tongue tie division 4

3. Audiologists: May be involved if hearing assessment is needed as part of comprehensive evaluation 1

Referral Considerations

When to Refer

• Breastfeeding difficulties: poor latch, maternal nipple pain, continual feeding cycle 5
• Speech or articulation problems 2, 4
• Restricted tongue movement affecting function 4

Referral Process

When referring a child to a specialist for tongue tie evaluation, the primary care provider should:

• Document the specific reason for referral
• Provide relevant history including feeding difficulties or speech concerns
• Explain to parents the reason for referral and possible management options 1

Treatment Approaches

The approach to treatment varies by specialist background:

• Otolaryngologists are more likely to recommend surgical intervention (53-74% recommend surgery for various indications) 2
• Pediatricians are less likely to recommend surgical intervention (only 19-29% recommend surgery) 2
• Surgical techniques include:
  • Frenotomy (simple division) - can be performed with no/local anesthesia or under general anesthesia
  • Frenuloplasty (more complex repair) - often performed under general anesthesia 4

Important Considerations

• There is significant controversy among healthcare professionals regarding the appropriate treatment of tongue tie 6, 2
• Procedures performed under general anesthesia appear to have lower reoperation rates (0.6%) compared to those done with no/local anesthesia (nearly one-third require reoperation) 4
• Early identification and treatment may prevent feeding difficulties and support successful breastfeeding 5
• The procedure is generally quick, simple, and has minimal complications when performed by properly trained specialists 5

For optimal outcomes in managing pediatric tongue tie, referral to a pediatric otolaryngologist or other appropriately trained pediatric specialist is recommended, particularly when the condition is affecting feeding, speech development, or causing other functional limitations.