Glossoptosis

Glossoptosis means a backward-positioned tongue. It happens when your baby’s tongue is farther back in their mouth than what's typical. This positioning can block your child’s airway, making it hard for them to breathe, eat and swallow.

Glossoptosis (pronounced "glah-sop-TOH-sis") can be a symptom of a birth defect called Pierre Robin syndrome. An infant with this condition has a lower jaw that’s smaller than usual. The small jaw causes their tongue to sit too far back in their mouth. It can also occur with Down syndrome and cerebral palsy.

Often, the issue corrects itself as your child grows and their jaw gets bigger. In the meantime, your child’s healthcare provider can help you manage the condition. If your baby is struggling to breathe or not getting enough nutrition, they may need surgery.

What are the most common causes of glossoptosis?

It’s most often a symptom of conditions that impact how your baby’s mouth forms. It may relate to genetic disorders or issues during pregnancy. Sometimes, it’s a sign of conditions that involve having weak tongue muscles. Weak muscles can cause your baby’s tongue to rest too far back in their mouth.

Children with these conditions can have glossoptosis:

• Pierre Robin syndrome: Babies born with this condition have three common features: a small jaw, glossoptosis and a U-shaped cleft palate. This is called the triad of Pierre Robin syndrome.
• Down syndrome: Babies born with this genetic disorder have muscle weakness, flattened facial features and glossoptosis.
• Cerebral palsy: Your child may be born with this condition or develop it because of a brain injury. It leads to low muscle tone, including in their tongue. As a result, their tongue may sit too far back in their mouth.

How do healthcare providers treat glossoptosis?

Your child may not need treatment, especially if the cause is a small jaw. As your child grows, so does their jaw. Once their tongue has more room in their mouth, glossoptosis goes away. Infants with Pierre Robin syndrome often have a normal-sized jaw by 18 months.

Some infants need help breathing and with feeding while their jaw is small. Treatments include:

• Breathing tubes: A breathing tube in your baby's nose or throat can help them get air. Rarely, a child needs a tracheostomy, where the tube connects to their windpipe through a cut (incision) in their neck.
• Feeding tubes: A nasogastric tube sends formula through your baby’s nose to their stomach. They get the nutrition they need without struggling to swallow.
• Orthodontic airway plate (OAP): This is a removable device that goes in your baby’s mouth. Much like a retainer holds a child’s teeth in place, an OAP positions their tongue forward.
• Mandibular distraction osteogenesis: In rare cases, surgeons do this surgery to lengthen your child’s lower jaw.
• Tongue-lip adhesion: With this rare procedure, a surgeon attaches your child’s tongue to their lip. This keeps their tongue from falling backward. They’ll reverse the procedure once your child’s jaw grows bigger.

What can you do at home if your baby has glossoptosis?

Your healthcare provider will let you know how to care for your baby if they need a breathing or feeding tube. They may advise you to place your baby on their side or stomach to sleep.

Healthcare providers typically recommend placing newborns on their backs to sleep. This position lowers the risk of sudden infant death syndrome (SIDS). But with glossoptosis, this position causes your baby's tongue to fall farther back toward their throat. It can cut off their airway and lead to obstructive sleep apnea. Rarely, it may be life-threatening.

Your child’s provider will let you know how to make stomach or side sleeping safer for your baby.

What are the complications of glossoptosis?

The improper positioning of their tongue back toward their throat can affect your infant’s ability to take in enough oxygen through their windpipe. They may have:

• Difficulty breathing
• Shortness of breath
• Signs of obstructive sleep apnea, like temporary pauses in breathing during sleep

Tongue displacement can also cause feeding problems, like:

• Difficulty swallowing
• Not being able to breastfeed or bottle-feed well enough to get the nutrients they need to grow (growth faltering)

Some children with glossoptosis also have speech and language issues. A child who has swallowing or speech difficulties from this condition may benefit from speech therapy.

When should this symptom be treated by a doctor or healthcare provider?

Often, healthcare providers notice this symptom during a routine newborn health check. This happens as soon as your baby’s born. If glossoptosis is mild, providers may notice it a little later, during an early check-up.

They’ll recommend treatments based on your child’s condition.

Always let your child’s provider know if your baby has trouble:

• Breathing
• Feeding
• Swallowing