Breastfeeding And Tongue Tie

Overview

Tongue-tie (known as ankyloglossia) is a rare condition in newborns in which the tiny band of tissue (lingual frenulum) that connects the back of the tongue to the mouth's floor is thick, tight or short. This causes restrictions in the infant’s tongue movement.

Tongue-tie in infants affects breastfeeding. It makes it hard for the infant to latch onto the mother’s breast and suck milk. This leads to poor breast milk intake, which may eventually cause poor infant growth.

Treatment options are lactation consultation and frenotomy (removal of the lingual frenulum). A lactation consultant will help the mother with breastfeeding and positioning techniques to ease breastfeeding difficulties.

Understanding tongue tie

What is tongue tie?

Tongue-tie (known as ankyloglossia) is a condition in which the tiny band of tissue (lingual frenulum) that connects the back of the tongue to the mouth's floor is thick, tight or short. This makes the tongue inflexible and restricts its movement in the mouth.^1,2

Tongue-tie is a condition that people are born with. It affects breastfeeding in infants and speech in older children.^1,2,3 It affects 3%-5% of newborns (depending on the criteria used to evaluate the condition).⁴

Types of tongue tie

Tongue-tie can be anterior or posterior based on where the band of tissue (frenulum) connects the back of the tongue and the mouth’s floor.

If you divide the back of your tongue into three sections, where the first section is the tip of the tongue, the anterior tongue-tie occurs in the first two-thirds section of the tongue, and the posterior tongue-tie happens at the last section, which is further towards the back of the mouth.

Causes and risk factors

Usually, when a baby’s tongue forms in the womb, there is a release of the tiny string of tissue that connects the tongue to the floor of the mouth (lingual frenulum). Failure to release is what causes tongue-tie. The lingual frenulum stays connected to the tongue and the mouth floor, and this connection is usually thick, short or tight.⁵

Tongue-tie is higher in males than in females.^5,6

Breastfeeding and tongue tie

Breastfeeding is necessary for newborns. Breast milk provides the baby with antibodies for protection and the nutrients it needs for growth. WHO recommends that infants be exclusively breastfed for the first six months, after which they gradually get introduced to adequate baby food.

During breastfeeding, the baby’s tongue latches to the mother’s breast, and the baby sucks breast milk using both the tongue and upper gum of the mouth. Flexibility and easy tongue movement are necessary for effective breastfeeding, as the baby moves its tongue to hold the teat of the mother’s breast and suck milk.^5,8

About 25%-80% of infants with tongue-tie have problems with breastfeeding.⁷ Some babies with tongue-tie find it difficult to latch onto the mother’s breast, while others with no trouble latching may find it hard to suck milk. Both scenarios happen because their tongues have restricted movement. The breastfeeding mother could also experience pain and bleeding nipples from the friction the tongue movements create. This could make the mother stop breastfeeding early.⁸

The inability of the baby to get breast milk from the mother and the early end of breastfeeding eventually leads to poor infant growth.

Diagnosis and assessment

Signs and symptoms of tongue tie in infants

An infant with tongue-tie may experience any or all of the following:^1,9

• Difficulty latching to the breast during breastfeeding
• Frequent feeding because the baby is always hungry
• Uncoordinated sucking during breastfeeding
• Difficulty sticking out the tongue past the lower front teeth
• Difficulty moving the tongue from side to side or up and down
• Excessive drooling
• Gagging or choking when eating
• Difficulty swallowing

These problems may result in slow or poor weight gain for the baby. The breastfeeding mother may also experience nipple pain and breast trauma. 

Evaluation by lactation consultants and healthcare providers

A doctor (paediatrician) or lactation consultant may identify tongue-tie through the baby and mother’s symptoms, physical examination, and the use of a tongue-tie assessment tool to determine what type of tongue-tie the baby has.

Doctors use various assessment tools for tongue-tie classification, but none is universally acceptable worldwide.¹⁰ Your doctor may use assessment tools such as Hazelbaker’s Assessment Tool for Lingual Frenulum Function (ATLFF), Coryllos classification, and the Bristol Tongue-tie Assessment Tool (BTAT).^2,10

Potential complications of untreated tongue tie

Tongue-tie in infants may lead to speech articulation problems and jaw and dental issues when older.⁷ It may be difficult for older children and adults to produce certain sounds. Tongue-tie can also cause difficulty with eating and swallowing.⁹

Treatment options

Treatment isn’t necessary where tongue-tie has no effect, but where tongue-tie affects breastfeeding, it can be treated through conservative approaches or a surgical procedure known as frenotomy.^7,8

Conservative approaches

Conservative approaches to treating babies with tongue-tie include lactation consultation with a lactation consultant. The lactation consultant will provide breastfeeding and positioning techniques that help both the baby and the mother.⁵

Frenotomy (tongue-tie release)

Frenotomy (frenulotomy or frenectomy) is the surgical removal of the band of tissue (lingual frenulum) that connects the back of the tongue with the mouth’s floor. It is also known as tongue-tie release. Frenotomy aims to improve tongue mobility. 

Frenotomy benefits both the baby and mother and is more effective than lactation consultation.⁸ It improves infant breastfeeding and reduces pain and trauma for the mother.

Although frenotomy is a simple and safe procedure, there may be complications after the surgery, such as infection and minor bleeding, pain and discomfort, and a risk of injury to the salivary ducts near the lingual frenulum.⁵

FAQs

Can you successfully breastfeed with tongue-tie?

You may successfully breastfeed your baby with the help of a lactation consultant. The lactation consultant can help you with breastfeeding and positioning techniques that could help relieve your pain and ease breastfeeding for your baby.⁵

What does breastfeeding with a tongue-tie feel like?

For the baby, breastfeeding with a tongue-tie may cause difficulty latching onto the mother’s breast and an inability to feed well. This can cause frustration for the baby. Breastfeeding a tongue-tied baby may also come with nipple pain and trauma for the breastfeeding mother.

What problems can a tongue-tied baby have breastfeeding?

Due to the restriction of tongue movement, a tongue-tied baby finds it difficult to latch onto the mother’s breast or suck breast milk. This causes the baby to have insufficient breast milk intake, which could result in poor infant growth.

How do you treat a tongue-tie while breastfeeding?

A breastfeeding mother may visit a lactation consultant who could provide breastfeeding and positioning techniques that help the baby and the mother. A frenotomy (removal of the lingual frenulum) also treats babies with tongue-tie.

Can tongue-tie cause a baby to choke on milk?

Tongue-tie may cause gagging or choking when eating in infants.⁹

Is tongue-tie surgery necessary?

Tongue-tie surgery, also known as frenotomy, isn’t necessary if it doesn’t affect your child. However, if it interferes with your child’s feeding and speech, it is advised. Another alternative is with the help of lactation consultants who can show you the best way to breastfeed a tongue-tied baby, but this isn’t as effective as a frenotomy.⁸

Can I prevent tongue-tie?

Tongue-tie is a condition some babies are born with, so it is unlikely to be prevented. Fortunately, tongue-tie is a condition with effective treatment options.

Summary

Tongue-tie (known as ankyloglossia) is a rare condition in newborns in which the tiny band of tissue (lingual frenulum) that connects the back of the tongue to the mouth's floor is thick, tight or short.

Tongue-tie affects breastfeeding due to the restriction of tongue movement. The baby finds it hard to latch to the mother’s breast or suck milk properly. This difficulty may cause frustration for the baby, and nipple pain and trauma for the mother. When tongue-tie affects breastfeeding, it results in poor infant growth because the baby doesn’t take in sufficient breast milk.

The most effective way to treat tongue-tie is through surgical removal of the lingual frenulum known as frenotomy. Visiting a lactation consultant can help with breastfeeding and positioning techniques for the baby to breastfeed better and ease the mother’s pain.

Although tongue-ties in infants can be a concern, especially when it affects breastfeeding, it can be treated. See your doctor or visit a lactation consultant if your baby has difficulty latching onto the breast or sucking breast milk, and if you experience nipple pain and trauma in the breast.