In babies, tongue tie is a condition that can make it much harder to move the tongue. And this can make it difficult for babies to breastfeed. Here’s what parents need to know about tongue tie.
What is tongue tie?
Tongue tie is the common name of the medical condition ankyloglossia. It involves the frenulum---the small band of tissue that connects the bottom of the tongue to the floor of the mouth.
When a baby has tongue tie, their frenulum is too short, too tight, or too thick. This restricts the movement of their tongue.
Babies with tongue tie are born with this condition, as it develops in the womb due to a genetic mutation. It is three times more common in boys than girls. And because it’s caused by genes, it often runs in families.
It’s estimated that around 5% of babies have tongue tie. The exact prevalence is unknown, though (the 5% estimate only accounts for the most obvious, most visible tongue tie).
Diagnosing tongue tie
A pediatrician, primary care doctor, or ear/nose/throat doctor can diagnose tongue tie. Tongue tie is usually diagnosed by examining baby’s mouth, using a tongue depressor to try to elevate the tip of the tongue, and asking you about any feeding problems baby is experiencing.
However, your lactation consultant may notice possible tongue tie first if mother and baby are having trouble breastfeeding. In that case, they’ll refer your family to a doctor to get a diagnosis.
Signs of tongue tie
Sometimes, a baby with tongue tie will have a frenulum that’s attached very close to the tip of the tongue.
This can keep baby from moving their tongue freely, lifting it up, or even sticking it out past their gums.
And sometimes, tongue tie can make baby’s tongue look heart shaped when baby cries or tries to stick it out. This varies from baby to baby, though, because tongue tie can vary in severity.
Many of the other signs --- and effects--- of tongue tie involve breastfeeding. We’ll go over them in the next section.
Tongue tie and breastfeeding
Tongue tie can make it difficult to breastfeed. It can cause baby to have trouble latching onto the breast or staying attached, because they can’t open their mouth wide enough or extend their tongue far enough to latch.
They’ll use their lips and gums to latch on instead, creating an ineffective latch that can make breastfeeding difficult.
That’s why tongue tie is often first found when a mother and baby have breastfeeding problems.
The University of Florida Department of Health shares more on tongue tie and breastfeeding:
If your baby has tongue tie, it may affect breastfeeding in these ways:
- Baby may have trouble latching onto the breast.
- Baby may struggle to stay latched on.
- Baby may be unable to latch deeply.
- You may hear clicking sounds during a feed, a sign that baby is losing suction.
- Baby may chew or gum on the nipple instead of suck.
- The mother’s nipples may be sore, cracked or damaged.
- The mother’s nipples may be compressed into a wedge shape.
- Breastfeeding may be painful for the mother.
- Baby may have trouble gaining or maintaining weight.
- Baby may constantly fuss and show signs of hunger, because they aren’t able to suck out enough milk during a feed.
- Baby may suck in too much air during a feed.
- The mother may experience engorgement, breast inflammation (mastitis), or a blocked duct, because baby can’t remove milk effectively enough.
- The mother may have a low milk supply because baby can’t remove milk effectively enough.
- The breastfeeding process may cause sadness, discouragement or feelings of guilt when baby isn’t getting enough milk.
- Breastfeeding may become a frustrating, tiring process for both mother and baby.
(Tongue tie doesn’t always cause breastfeeding problems. Some babies with tongue tie have no issues with breastfeeding. And sometimes, these breastfeeding problems aren’t caused by tongue tie, but by problems with positioning and latch. Seeing a lactation consultant first can help you determine if tongue tie or something else is causing the difficulties.)
How to help a baby with tongue tie breastfeed?
A lactation consultant can help you make sure you’re using the best breastfeeding techniques.
But if baby still continues to struggle to latch, the consultant may recommend a nipple shield for babies with tongue tie. This will both help with their latch and help relieve your nipple soreness and pain. (Learn more on using a nipple shield here.)
Pumping your breastmilk and feeding it to your baby using a breastmilk bottle may also help relieve your nipple pain. Babies with tongue tie tend to have less trouble bottle feeding than breastfeeding. If possible, though, it’s recommended to switch back and forth between bottle and breast, so baby doesn’t prefer the bottle or refuse the breast.
If baby continues to have trouble breastfeeding, and your nipples remain sore, painful or damaged after you’ve worked with a lactation consultant, you should talk to your doctor. Your doctor may recommend removing the tongue tie.
How can tongue tie be treated?
If baby has mild tongue tie, your pediatrician may recommend a wait-and-see approach, especially if it doesn’t interfere with feeding.
But, if baby has more severe tongue tie and has trouble breastfeeding, your pediatrician may recommend a tongue tie removal. A tongue tie removal can also help prevent possible speech impediments, dental problems and eating difficulties in the future that are associated with tongue tie.
There are two ways that doctors can remove tongue tie. These procedures are known as frenotomy and frenuloplasty.
Frenotomy
A frenotomy involves a quick and simple cut of the frenulum with sterile scissors (or sometimes a laser). It usually doesn’t cause much pain.
The earlier a frenotomy is performed, the less painful it is for a baby. In newborns and babies who are only a few months old, doctors will sometimes snip the frenulum with little to no anesthesia, because baby has very few nerve endings in that area.
You’ll be able to breastfeed again right away. Breastfeeding right away will help keep the wound clean and encourage baby to move their tongue.
You’ll probably notice an improvement in baby’s latch soon after. In fact, a 2016 study on breastfeeding and tongue tie has shown that frenotomy improved babies’ breastfeeding within a week, with continued improvements for several weeks after.
But rarely, a frenotomy can cause pain, bleeding and infection. And sometimes, the frenulum may grow back, causing tongue tie all over again.
And regardless of how the frenotomy goes, parents or caregivers will need to stretch the tissue that was cut daily for around a month. This way, the tissue won’t grow back too tightly as it heals.
Frenuloplasty
If baby is older and their frenulum is too thick for a frenotomy, a doctor may perform a frenuloplasty. This is a surgery that removes the frenulum. It requires general anesthesia (so baby is unconscious during the surgery). The wound is closed with stitches that will dissolve on their own in a few weeks. Complications of this surgery are very rare, but may include bleeding, scarring, or infection.
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