Friday, March 8, 2013

Tongue-Tie in Breastfed Babies

Tongue-tie, or Ankyloglossia, is a condition that occurs in a small percentage of babies (about 4%) that makes it hard for them to breastfeed. It also exists among children and adolescents, but for the purposes of this blog, we will focus on newborns.

The frenulum, or the cord of tissue that connects from underneath your tongue to the bottom of your mouth, is sometimes too short or too tight in newborns (we also have a frenulum between our top lip and our top gums).

As a result of the tight frenulum, baby might not latch correctly, cause pain and nipple trauma for the mother and frustration for everyone. If the baby has trouble sucking, they will have poor weight gain and will be fussy all the time.

photo by Janelle Aby, MD
Anne Smith, IBCLC writes,
In addition to problems with nipple soreness and weight gain, some other signs that the baby may be having problems nursing effectively include breaking suction often during feedings, and making a clicking sound while nursing. Since these symptoms can also be caused by other problems, it’s a good idea to be evaluated by a knowledgeable health care provider (an IBCLC, if possible) to rule out causes other than tongue-tie. Tongue-tie should definitely be considered a possibility if breastfeeding doesn’t improve even after other measures such as adjustments in positioning have been tried.
Additionally, other signs of tongue-tie might include:
  • Heart-shaped tongue tip. The tip of the tongue may be heart shaped or have a “v” shape indentation in the center when the baby sticks out the tongue or cries. (It is possible to have a restrictive frenulum without this classic symptom or to have a tongue that functions adequately, yet has the heart shaped tip.) 
  • Square or round tongue tip. The tongue looks square, or round, on the tip instead of pointed when extended. Difficulty extending the tongue. If your baby is tongue tied 
  • Your baby has difficulty extending the tongue past the gum line. Tapping the tip of the tongue should cause the tongue to come forward, where it should cross the gums. 
  • Tongue does not cup well. When your little one sucks on your finger the tongue should wrap around it like a hot dog bun wraps around a hot dog. 
  • Difficulty moving tongue from side to side. If you rub your baby’s lower gum, the tongue should follow your finger, side to side. 
  • Frenulum is attached very close to the tip of the tongue. Some babies have frenulums attached near the front, but the frenulum is very elastic and allows effective breastfeeding without treatment.

Because ankylogossia can cause problems for breastfeeding and cause failure to thrive in the infant, it is a good idea to have it taken care of. Tongue-tie can also cause speech problems for a child in the future.

A really quick out-patient surgery can be performed, where the frenulum is snipped (frenotomy)  and baby can go right back to breastfeeding. There is generally only 1 or 2 drops of blood, and no anesthesia is required.

This procedure has been associated with latch improvement and reduction in maternal pain during breastfeeding. 

Tongue-tie is becoming more and more commonly diagnosed, as lactation consultants and physicians are trained to recognize it, but it is still hard to find someone who can diagnose and treat it. I've known many mothers who have had to search for second and third opinions before someone would finally perform a frenotomy.

Go here for more resources on tongue-tie.

Was your baby tongue-tied? 


  1. Our second baby is significantly tongue-tied, but we chose (with our midwife's and the baby's primary care provider's agreement) to wait and see. We have a general policy of not cutting our babies unless there's a clear need. In our case, breastfeeding has been 100% problem-free. The frenulum has loosened enough (at 9 months) that our family nurse practitioner is no longer concerned about it affecting his speech. So, sometimes it causes problems, and it's definitely something to watch ... but sometimes it doesn't.

  2. I saw a frenulectomy performed in my first week of nursery! I was so scared it would be painful just to watch. Baby didn't even flinch - there was no blood, and really, there shouldn't be if done properly - usually the part of the frenulum that is overgrown is just a thin membrane that you can often see through, not actually part of the tongue. My attendings tell me that in the old days if they saw a baby with a frenulum they'd just quickly stick their finger under the baby's tongue to break it. easy peasy!


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