Tongue Ties and Breastfeeding

A tongue tie refers to when the frenulum, the attachment from the tongue to the floor of the mouth, is thickened, shortened or tight. As a pediatrician and a lactation consultant, I see many babies with tongue ties and parents that are concerned about them. In fact, it is estimated that between 4 and 10 percent of infants will have a tongue tie. A health care provider can diagnose a tongue tie by doing an exam of your infant’s mouth to see if there is limitation in tongue movement up to the roof of the mouth or past the lips. Some ties appear as a “heart-shaped” tongue.

Tongue ties can cause problems with breastfeeding.

When the tongue has limited movement, it inhibits the compression of the nipple by the tongue against the roof of the mouth which is necessary for breastfeeding. Some infants with tongue ties also have problems bottle feeding.

Symptoms of tongue tie include:

• painful latch
• nipple damage
• difficulty latching or maintaining a latch
• poor weight gain or poor milk transfer; or
• decreased milk supply after several months of breastfeeding.

Even “mild” tongue ties can cause significant pain for a mother or breastfeeding problems. Fortunately, many infants with tongue ties breastfeed well and do not require any treatment.

If you suspect your baby has a tongue tie and you are experiencing problems breastfeeding, It is best to discuss your concerns with your pediatrician or a certified lactation consultant. Sometimes, all that is needed is some repositioning and assistance with the latch at a lactation visit. However, if breastfeeding difficulties persist, your healthcare provider might recommend having the tie released.

One treatment of a tongue tie is called a frenotomy.

It is a brief, in-office procedure where the tie is clipped or treated with a laser. Trained medical professionals who can perform frenotomies include ear, nose and throat doctors (ENT or otolaryngologist) and some pediatricians and pediatric dentists. A frenotomy is an effective treatment and usually helps resolve the symptoms of a tongue tie.

As with all procedures, frenotomies do have risks and therefore should not be done unless necessary. Parents should seek out a provider that is trained and highly experienced in frenotomies when deciding to have the procedure performed. Even after a tongue tie is treated, it is important to follow up with a lactation consultant to ensure that breastfeeding has improved and that re-attachment has not occurred.

Although a frenotomy can be performed at any age, early treatment is important to help relieve pain and prevent nipple damage and decreased milk supply that can interfere with breastfeeding.

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About the Author

Tara Doman - Guest Blogger

Tara Doman, MD, FAAP, IBCLC is a board-certified pediatrician and International Board Certified Lactation Consultant and a mother of two young children. She enjoys helping families reach their breastfeeding goals at the Lactation Center at Pediatric Health Associates in Naperville, IL.