Breastfeeding Challenges -- Tongue-Tied Babies

by Teresa J. Mitchell

Tongue-Tied BabiesDuring your baby's newborn exam, your pediatrician might have said, "Oh, she's tongue-tied."

It seems like a weird thing to say about your beautiful, perfect baby! What your doctor means is that your baby has a common abnormality that affects that the tissue at the base of the tongue.

Best estimates put the incidence of tongue-tied babies between 1.7 and 4.8 percent. It's more common in boys than in girls and tends to run in families.

A membrane called the lingual frenulum attaches the underside of the baby's tongue to the floor of the mouth. Stand in front of a mirror. If you lift your tongue up you can see this band of tissue.

Sometimes a baby will be born with frenulum that restricts the tongue's motion. A tongue-tied baby might have problems moving the tongue up and down or from side to side. It may not extend past the lower lip. A tight or short frenulum can make it difficult for your baby to nurse.

One mom said, "I don't know what's wrong. I'm holding my baby right. He's taking enough breast in his mouth. He doesn't seem to get any milk and nursing hurts!"

Even though your pediatrician might not have mentioned the condition, do you suspect your baby has ankyloglossia, which is the official term for a tongue-tied baby?

Can You Stick Out Your Tongue?

Tiny newborns will try to imitate you. Try and get your baby's attention and stick out your tongue. Pause and repeat. Within a few minutes, you'll more than likely see your precious babe try to do what you just did.

Does the tongue extend past the bottom lip? Does it have a heart-shaped appearance on the tip? You can also try offering a finger, pad side up, to suck on. Does the tongue extend over the gum line to cup the bottom of your finger? If so, you may want to have your doctor take a look.

It can sometimes be a challenge to find a doctor who recognizes the condition and is willing to perform a frenotomy. As more "in-the-know" moms breastfeed, the number of pediatricians who are aware of the issues and how they affect breastfeeding babies will increase as well. In time, more will know how to properly diagnose tongue-tied babies.

The Tongue's Role in Breastfeeding

The tongue has a vital position in breastfeeding. It helps pull the breast into proper position in the mouth, makes a channel to keep the breast in place and catches the milk your baby swallows.

The tongue tip elevates and traps milk in the front of the breast. It will continue to compresses from the front to about halfway back, pressing milk from the areola toward the nipple. Finally, the back of the tongue drops toward the floor of the mouth and decreases the pressure in the mouth. Milk flows from the nipple by this combination of compression and suction, all put in motion by the tongue's movements.

How Do I Know My Baby Has Ankyloglossia?

The symptoms below can be caused by other breastfeeding challenges. However, they are good signs to look out for if you're suspecting that your child is affected. If you're at all unsure, an empowering option is to make an appointment and speak with a qualified lactation consultant. Your baby might be tongue-tied if:

  • Can't stick out tongue farther than the lips
  • Tongue is heart-shaped at the tip
  • You're experiencing extremely sore nipples
  • Baby has significant weight loss after birth
  • Has a shallow latch
  • Is fussy during feedings -- more than usual
  • Breaking suction during feedings -- more than usual
  • Makes clicking sounds while feeding
  • Your milk supply is low
  • Can't make proper seal, so milk dribbles down baby’s mouth
  • Baby bites or chews on your breast instead of sucking

Tongue-Tied Treatment Options

Experts do not agree whether or not mild ankyloglossia interferes with breastfeeding. In the decades when formula feeding was common, caregivers usually allowed the condition to resolve on its own.

Some breastfeeding advocates say these babies might be better off getting treatment before problems start. Three separate studies found that nursing moms report nipple pain relief and easier nursing after clipping of the frenulum.

In the past, midwives routinely clipped tongue-ties. Treatment today includes snipping, surgical revision of the frenulum or laser surgery, depending on the severity of the condition.

Two Options for Treatment

Some tongue-tied babies nurse effectively. It depends on the way the frenulum is attached and the mother's breast. If you have small or medium nipples, your baby can manage to nurse effectively in spite of being tongue-tied.

On the other hand, if your nipples are large or flat, even a slight degree of being tongue-tied could cause challenges for your nursing baby.

When tongue-tie starts to cause breastfeeding issues, your baby can have a frenetomy, a clipping of the membrane. There is little bleeding and your baby can start breastfeeding immediately after the procedure. That's the first option.

The second option is that you can wait it out. Sometimes the frenulum will stretch out on its own as a result your baby sucking. Some moms choosing this option have had to supplement with formula.

Has your baby been diagnosed with ankyloglossia or had a frenetomy? How did your breastfeeding get affected?