Macroglossia, a polite word for rude baby disease

Of course I’;m joking – babies aren’t rude, they are just babies and if their tongue sticks out all of the time practically then there may be an underlying problem that might have treatment options. Human babies and young children don’t just leave their tongues hanging out for no reason. For canines and species with few sweat glands, sticking out the tongue is an important way to lose extra body heat. Dogs pant and hang their tongue out when they are too hot. Elephants lose excess heat by flapping their ears.

A baby with macroglossia and BWS [link]

[Macroglossia] – try searching the phrase “protruding tongue” and you’ll find that it is a significant symptom for some [genetic] and [deficiency problems]. (Wikipedia links)

Macroglossia is an enlarged tongue – a little swollen looking – edematous in fact – (puffy). When a baby sticks its tongue out most of the time and it doesn’t seem to have good muscle control then it is a sign of a weak muscle problem and there can be a few reasons for that. Feeding tips are great for the average baby but for that occasional baby whose tongue doesn’t seem to want to stay in its mouth, ever, then there might be an underlying nutrient deficiency or rare genetic syndrome – and treatments may exist that could help.

This link to an article on about what it might mean when your baby sticks its tongue out does not mention macroglossia but the last paragraph does mention excessive drooling and feeding troubles as something to discuss with the baby’s doctor. [, article, by Kelly Stevens] The infant in the picture is portraying a tongue with poor muscle tone, seen in the rounded pickle shape. The minimal eyebrows are also associated with hypothyroidism. The physical appearance clues suggest to me a need for iodine and selenium support or treatment with thyroid hormone. I would refer the infant to a physician for further testing. Life doesn’t come at us one diagnosis at a time whether a dietitian or physician happen to notice a certain pattern.

Having to get a physician involved for every dietary counseling tip seems quite disabling – in addition to the already disabling but standard dietitian’s rule “don’t diagnose anything – ever – period”.  I was trained to be very very careful about any diagnostic language in charting because of the fact that dietitians are not physicians and therefore don’t diagnose. But we are trained as specialists to recognize the symptoms and external appearance of nutrient deficiency and toxicity as well as interpreting the standard lab tests. We are also trained to check and adjust diet orders or formula feeding “recommendations” for the physician to consider and approve or modify. Training may include crossing fingers to hope that the physician agrees with the “recommendations.”

Dietitians and physicians need to know and look for symptoms of deficiency and toxicity and so do moms and dads and individual owners of a living body.

Coping with feeding issues and health discomforts are what dietitians are trained to do and consider – the feeding tips in the article are on target and helpful. Check it out and then move on to this [, article by Julie Christensen] just to compare tongues and children’s eyes. The first baby also looks hypothyroid to me because of the dull, flat, depressed look of apathy. The look of apathy was poetically described in the original work that was done for iodine nutrient guideline guidelines. Entire villages would be quiet without evidence of children playing or adults working, even pets weren’t seen running about. A year after providing the iodized salt (The original fortification level had been designed to provide 150 micrograms in ten grams of salt which at the time was effective. Our current nutrient guidelines for salt would limit us to around 3 grams which would only provide 50 micrograms of iodine at the standard level of fortification. The fortification level for iodine hasn’t been reexamined since those 1940’s villages which didn’t have doughnut shops and fast food on every other corner and so the villagers didn’t have as much bromide or fluoride competing with the iodine as we do in our modern diet.)

The tongue is a muscle that can be strong and is meant to move food around in the mouth and into position to swallow. The baby in the first blog has a little round shaped tongue and it does not look like the agile muscle that is possible. A tongue potentially can be quite strong. [, young baby feeding tips article, by Kelly Stevens]  The older child in this [ article, by Julie Christensen] on “Why do rude kids stick their tongues out?” shows a boy with sparkling eyes and no slight puffy paleness underlying the skin, his eyebrows look average and hair is shiny with health and his skin has a slightly pink undertone. The picture shows a normal tongue sticking out rudely or in fun. The shape is a little pointed and flattened, the muscle is being purposefully extended for the gesture. The picture doesn’t show a soft little pickle shape just lollygagging around.

The rude child article has some unrude advice about telling the difference between a rude gesture and one that was triggered by shyness,  or just for fun, or from other attention getting motivations. Recognizing the underlying motivation can then help with choosing a more effective discipline method. Ignoring naughtiness at home can sometimes be the most effective strategy to reducing attention getting behavior. Punishments may be necessary if the attention getting naughtiness progresses to rudeness to adults outside of the home. One of the references mentioned in the story was written by Barbara Colorosa, one of my favorite authors who wrote the parenting book, “Positive Discipline”. She suggests discipline be considered as moments for teaching more appropriate ways to behave rather than as penalties. Punishing a child for spilling milk doesn’t teach them how to pour more carefully or why cleaning up the sticky mess while it is fresh is easier than waiting until it dried up and hard to clean.

I care about macroglossia because I felt sorry for the mother who kept asking her doctors why her baby wouldn’t keep its tongue in its mouth. She was getting no answers and she kept trying to poke her baby’s tongue back in its mouth. It can’t have been very fun for the anxious mother or for the baby. I only saw her once. However the information that I had collected for her next appointment was useful a few year’s later when I worked with a mother and children who shared the genetic condition BWS. The first baby and mom were more likely to have had iodine issues. BWS has several unique symptoms not just macroglossia. Starting a newborn with thyroid hormone replacement promptly can help normalize some types of congenital hypothyroidism. Trying to reduce fluoride rather than just providing more iodine may be part of the problem [5].

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. Kelly Stevens, “What Does A Baby Sticking Out Its Tongue Mean? (Aug. 11, 2011) []
  2. Julie Christensen, “The Rude Child’s Behavior of Sticking Out the Tongue” (Sept. 2, 2011) []
  3. Barbara Colorosa, “Kids Are Worth It!”, 2002 []
  4. by Zelda Doyle, et al, “Are Australian Children Iodine Deficient? Results of the National Iodine Nutrition Study” (MJA, Vol. 184, No. 4, 20 Feb. 2006) []  (or are they goitrogen excessive?) Excerpt: “Western Australian children had the largest glands /an early sign of goiter/, despite having the highest median UIE level of the five states. The explanation for this phenomenon is not clear. It may relate to factors other than iodine, such as dietary or environmental goitrogens.” /fluoride for example/
  5. Thyroid history, History of the Fluoride/Iodine Antagonism” [] *Fluoride inhibits hyperthyroidism. Fluoride in the air from pollution or in ground water naturally promotes enlargement of the thyroid gland and symptoms of hypothyroidism.
  6. From the same website, “Salt Facts / Fluoridated Salt FAQ”  – [] – It was thought to be a good idea to add fluoride to salt in addition to the iodine and at even greater levels – world wide, beginning around 1986-1994 – oops. It’s still being added.
  7. The paper mentioned in the above link on fluoridation of salt,  Milner T, Estupiñán-Day D, “Overview of Salt Fluoridation in the Region of the Americas: Part II. The Status of Salt Production, Quality & Marketing and the State of Technology Development for Salt Fluoridation,” Salt 2000, 8th World Salt Symposium, Volume 2, pg 1033-1038 (2000)  pdf []
  8. USDHHS, NIDDK, National Endocrine and Metabolic Diseases Information Service page on hypothyroidism:  []
  9. Thomas W. Heinrich and Garth Graham, Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited,  Prim Care Companion J Clin Psychiatry. 2003; 5(6): 260–266.  []
  10. (I’ve been looking for the reference to the 1940’s study but I haven’t found it yet.)