Tongue Tie (Ankyloglossia)

Nursing Issues Related to Tongue Tie

Despite a breastfeeding mom’s best attempt to correct latch and position and to breastfeed her baby frequently and effectively, some mothers find themselves with breastfeeding problems (including sore nipples, recurrent plugged ducts, mastitis, low milk supply). Sometimes baby displays the issue by not gaining weight well, making clicking sounds or gagging/choking at the breast.
 
Tongue tie (also known as ankyloglossia) can cause many of these nursing problems.  Unfortunately, some practitioners do not acknowledge the fact that tongue tie can cause many nursing difficulties, but there is a lot of research which shows tongue tie negatively impact the breastfeeding relationship.

What is Tongue Tie?

Tongue tie - having tongue mobility restriction, due to a short frenulum describes the situation where a baby’s tongue does not have enough range of motion to latch onto the breast, maintain the latch, suck and swallow effectively. Tongue tie is caused by a lingual frenulum (the membrane under the tongue) that is either too short or too thick. Some babies with tongue tie also have an abnormally tight membrane attaching their upper lip to their upper gums, which is known as a lip tie. Babies with lip tie often have difficulty flanging their lips properly to feed and do not make a good seal at the breast when latching. This can cause them to take in excess air during breastfeeding which often makes these babies gassy and fussy.

Between five and ten percent of babies are tongue tied and sometimes the trait runs in families; therefore, if you have one baby with the issue, you may have more. Sometimes tongue tie is obvious, yet they don’t have sore nipples and their baby continues to gain weight. These mothers have a lot of milk, so they manage. For most mother of babies with tongue tie, milk production will often decrease and then their baby may not gain weight well after three or four months. Also, many children who are tongue tied may not be identified early and this may lead to speech problems later in life.

What can be done if my baby has limited tongue mobility?

The solution for tongue tied is to release it. The procedure is referred to as a frenotomy, which is a relatively painless, in-office procedure, where the tight frenulum is released.  This release allows for improved range of motion of the tongue.  If tongue-tie is causing severe breastfeeding difficulties, the frenulum should be released as soon as possible to minimize the impact on the breastfeeding mother and baby. The earlier the problem is identified, and the frenotomy is done, the less time it will take for the baby to nurse effectively and comfortably after the procedure. If the tongue-tie is not identified and the frenulum is not clipped until the baby is several weeks or months old, it may take longer for the baby to learn to suck normally. 

The procedure, in our office, takes less than a few minutes and baby is placed immediately back into his mother’s arms, with the goal of latching the baby onto the breast instantaneously.  In most cases, the mother notices an immediate improvement in both her comfort level and the baby’s ability to nurse more efficiently.  A mother’s discomfort is considerably less and baby feeds better at the breast, and when baby empties the breast better, the mother makes more milk. 

Kenneth Toff DO FAAP, FACOP, IBCLC