Is your baby having problems latching on during breastfeeding? Is it painful when you breastfeed? If you're a rookie breastfeeding a newborn, the answers to both of these questions will probably be "yes, and yes."
But if you also notice that your baby isn't able to fully stick out her tongue and is having difficulty latching, it could be a condition known as tongue-tie (aka ankyloglossia).[1]
There's a lot of confusion about tongue-ties these days (and plenty of old wives' tales). Pediatricians don't always check for it, and it's not always easy to notice. Here's some information to help you sort through the facts.
What is tongue-tie?
Tongue-tie is largely genetic. It occurs when the lingual frenulum — a small stretch of tissue that connects the bottom of the tongue to the floor of the mouth — is too short and tight. This causes babies not to have enough tongue mobility and often makes breastfeeding harder.
Fortunately, many babies with mild cases can compensate without issue and continue to nurse normally even if they have a tongue-tie.
Tongue-tie related symptoms may include:
- Nipple pain and trauma
- Difficulty with latching on to the breast
- Frequent or insufficient feedings
- Uncoordinated sucking
- Audible clicking sounds during feeding
- Chomping or chewing instead of sucking
- Liquid coming out of the sides of the mouth during feedings
- Difficulty gaining weight
These tongue-tie-related problems may result in a mom deciding to forego breastfeeding. If you're experiencing any of these systems, talk with a lactation consultant and your pediatrician.
What does a tongue-tie look like?
Tongue-tie can be mild or severe, and it depends on how much extra tissue connects the bottom of the tongue to the floor of the mouth. The closer the frenulum is to the front of the tongue, the more severe the tongue-tie.
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There are both anterior and posterior tongue-ties, and some babies who have tongue-ties also have lip-ties.
How does tongue-tie affect breastfeeding?
Babies use their tongues a whole lot when breastfeeding; it's kind of a key part of the whole process. If your baby can't fully move her tongue around and open her mouth wide enough, it may impact her ability to latch on the breast and form a good seal. (Of course, there are plenty of mildly tongue-tied babies who don't have any trouble with this.)
What else can happen? Well, if the tongue is tight and can't move around, it makes it harder for a baby to suck. Combined, these effects can prevent a baby from getting the milk she needs from the breast.
Aside from having a very hungry baby on your hands, tongue-tie may potentially lead to other health problems:
- Failure to thrive (not gaining weight as quickly as they should)
- Dehydration in baby
Mom may also notice some effects like:
- Clogged milk ducts
- Cracked nipples
- Low milk supply
- Mastitis, an inflammation of the breast that sometimes involves infection
Note: Most breastfeeding problems are not caused by tongue-tie and can be overcome with support. Don't be afraid to reach out to a lactation consultant or your baby's pediatrician for help.
What is the treatment for tongue-tie?
You've heard the phrase "if it isn't broken, don't fix it." Well, this can be applied to tongue-tie treatment: If your baby is feeding normally and you aren't experiencing any additional health problems as a result of tongue-tie, treatment is not always needed.
The American Academy of Pediatrics (AAP) says, "Surgery (frenotomy or frenuloplasty) should be considered if the tongue-tie appears to restrict tongue movement, such as inability to latch on with breastfeeding."[2] Clipping the frenulum can allow a baby's tongue to move freely enough to latch on to the breast with a good seal.
"Tongue-tie clipping" has been the subject of debate in recent years; some say if left alone, a baby learns to compensate for a tongue-tie. Others recommend revising it.
The AAP and the American Society of Pediatric Otolaryngology say the surgery is a simple, safe and effective procedure that can usually be done right in your pediatrician's office. General anesthesia is not required, and many babies latch immediately after, while others take a little longer.
Talk it through with the pediatrician or ENT to learn what is best for you and your baby. Ask about before and after care if a revision is recommended. Remember, a fed baby is a happier baby.
How can you continue breastfeeding if your baby has tongue-tie?
If your baby is having trouble latching, talk to a lactation consultant and/or your baby's pediatrician to see if tongue-tie is the problem. In the meantime, here are some things to try:
- Special nipple shields. There are ones made specifically for moms of babies with nursing challenges. Just make sure you work closely with a lactation consultant when using a nipple shield.
- Different positioning. Holding your baby in a less-traditional way may improve feeding. Talk with your lactation consultant (or a pediatric physical therapist familiar with tongue-tie) for ideas.
- Mouth exercises. Some lactation consultants and pediatric physical therapists recommend exercises to help strengthen your baby's suckling ability.
Don't be too discouraged if your baby's mouth problems make breastfeeding difficult or impossible. Whether you pump breast milk and bottle-feed your baby or choose to feed her formula instead, rest assured that your baby will get the nutrition she needs.
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