Tongue-tie and breastfeeding

What is tongue-tie?

Tongue-tie occurs when the thin piece of skin under the baby's tongue (the lingual frenulum) restricts the movement of the tongue. In some cases the tongue is not free or mobile enough for the baby to attach properly to the breast. Tongue-tie occurs in about 5% of people. It is three times more common in males than females and can run in families.

Some babies with tongue-tie are able to attach to the breast and suck well. However, many have breastfeeding problems, such as nipple damage, poor milk transfer and low weight gains in the baby, and recurrent blocked ducts or mastitis due to ineffective milk removal.

Why is a tongue-tie a problem for breastfeeding?

A baby needs to be able to cup the breast with his tongue to be able to remove milk from the breast well. If the tongue is anchored to the floor of the mouth, the baby cannot do this as well. The baby may not be able to open his mouth wide enough to take in a full mouthful of breast tissue. This can result in ‘nipple-feeding’ because the nipple is not drawn far enough back in the baby’s mouth and constantly rubs against the baby’s hard palate as he feeds. As a result, the mother is likely to suffer nipple trauma.

There are many signs that a baby’s tongue-tie may be causing problems with breastfeeding, but you don’t have to have all of them:

  • nipple pain and damage
  • the nipple looks flattened after breastfeeding
  • you can see a compression/stripe mark on the nipple at the end of a breastfeed
  • the baby keeps losing suction while feeding and sucks in air
  • the baby makes a clicking sound when feeding
  • the baby fails to gain weight well
  • he may readily gag

It is important to note that all of the above signs can be related to other breastfeeding problems and are not necessarily related to tongue-tie. If you experience any of the signs above, you may wish to call the breastfeeding helpline to speak with a breastfeeding counsellor.

Diangosis of tongue-tie 

Australian Breastfeeding Association counsellors are not medically trained and cannot assess whether or not a baby has a tongue-tie.

If you suspect your baby has a tongue-tie that is causing breastfeeding problems, you may wish to contact a lactation consultant or other experienced health professional. They will be able to assess your breastfeeding and check your baby's mouth to see whether the tight frenulum may need to be released.

Treatment for tongue-tie 

If it is deemed that a tongue-tie is interfering with breastfeeding, then release (snipping) of the tight frenulum can improve the baby's ability to breastfeed.

Snipping a tight frenulum in young babies is a simple procedure that takes only a second or two. No anaesthetic is needed. The baby usually breastfeeds straight after the procedure. The mother will often notice a difference in how the baby breastfeeds, but it can take up to 2–3 weeks for a complete improvement to be made. Breastfeeding straight away also helps to stop any slight bleeding, distracts the baby from any discomfort and acts as an analgesic.

Mother's story

Breastfeeding was uncomfortable and not quite what I expected. I had seen my sister and friends feed before but not really taken much notice. My baby was taking over an hour to feed and I was sore. After leaving hospital it went from bad to worse, with my nipples eventually cracking and bleeding.

Then a child and family health service midwife told me that my baby was tongue-tied and booked her in the next day to have it fixed. As scary as it was to see my 3-week-old have this procedure, I was grateful that there was a solution.

The very next feed after her ‘snip’ was like heaven. It confirmed that I was doing it right. We have now gone on to have a fantastic feeding relationship. Breastfeeding is the most rewarding experience ever and, 9 months later, I don’t want to stop.

References

  1. Brodribb W (ed), 2012, Breastfeeding Management in Australia. 4th edn. Australian Breastfeeding Association, Melbourne.
  2. The Royal Women’s Hospital 2015, Tongue-tie: information for families. The Royal Women’s Hospital, VictoriaAustralia.  
  3. Geddes DT, Langton DB, Gollow I, Jacobs LA, HartmannPE, Simmer K 2008, Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 122:e188–e194.
  4. Buryk M, Bloom D, Shope T 2011, Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics 128(2):280–288.

Websites

NHS National Institute for Health and Clinical Excellence – Division of ankyloglossia (tongue-tie) for breastfeeding

American Academy of Pediatrics - Congenital Tongue-tie and its impact on breastfeeding

Academy of Breastfeeding Medicine protocols – Ankyloglossia (currently under revision) 

© Australian Breastfeeding Association Reviewed February 2016