Tongue-Ties and Breastfeeding

Read on to learn more about tongue-ties, how tongue-ties may affect breastfeeding, and how they can be treated, and discover a few of our breastfeeding education resources.

The lingual frenulum is the piece of tissue that connects the tongue to the lower part of the mouth. Tongue-tie (ankyloglossia) occurs when this connective band is shorter, tighter, or thicker than usual, tethering the tongue to floor of the mouth and restricting the tongue’s movement.

Up to 11 percent of newborns have some form of tongue-tie. Tongue-ties appear to be more common in boys than girls and may run in families. Tongue-ties may be accompanied by lip-ties, which occur when the labial frenulum (the tissue connecting the upper lip to the gumline) is short or tight, restricting the movement of the upper lip.

To create a good latch, a baby’s upper and lower lips need to roll outward. The baby’s tongue should extend over his or her lower gum and beneath the mother’s breast. The tongue should draw in as much of the areola and breast tissue as possible well into the back of the baby’s mouth. With the baby’s lips creating a seal against the breast, the baby gently use his or her gums, jaw, and cheek muscles to squeeze as much of the areola as possible. The baby’s tongue then cups the nipple and sweeps back and forth in a wavelike manner as it presses the nipple against the roof of the mouth. The motion causes milk to flow from the mother’s breast, following in a rhythmic sequence of suck, swallow, breathe; suck, swallow, breathe.

Babies who have tongue-ties and or lip-ties may have trouble lifting or extending their tongues or rolling their upper lips to create a good latch, making it difficult to create the necessary seal against the breast for successful breastfeeding. As a result, they may be trying to squeeze milk from the breast instead of sucking it out, leading to nipple pain in the mother, inadequate feeding of the baby, and a possible decrease in the mother’s milk supply.

Babies with a tongue-tie may:

• Have trouble latching on or staying attached for a full feeding

• Have poor weight gain

• Seem hungry all the time

• Make a clicking noise during feeding, caused by the loss of suction

Mothers of babies with tongue-ties may:

• Experience cracked or sore nipples

• Suffer from mastitis

• Have a low milk supply

• Feel tired and discouraged

If you or your baby experience any of these breastfeeding issues, consult a lactation consultant or other healthcare professional as soon as possible. Breastfeeding concerns, such as poor weight gain in a baby, should be addressed immediately.

Just because a baby has a tongue-tie or a lip-tie doesn’t mean that the condition requires any intervention or treatment. In fact, many people have lingual and labial frenulums that do not cause problems. If a baby with a tongue-tie or lip-tie is able to breastfeeding without difficulty, intervention for breastfeeding is not necessary.

Diagnosis and any treatment decisions for a tongue-tie should always be made in consultation with a healthcare professional. A feeding assessment by a healthcare professional, such as a lactation consultant, can help rule out other potential problems and possible solutions for breastfeeding issues (such as proper positioning) and help determine whether a tongue-tie or lip-tie is causing breastfeeding difficulties. A healthcare professional also may suggest stretching exercises to help babies move their tongues before recommending surgical interventions.

When most babies were born at home, midwives often kept one long, sharp fingernail to cut the frenulum after birth if deemed necessary. Today, a healthcare professional can treat a tongue-tie by performing a frenotomy (division of the frenulum) with surgical scissors or a laser while the baby swaddled and held. The procedure is relatively quick and easy, lasting only a few minutes. Babies under 6 months of age may need only topical numbing (general anesthesia is not required), and there is little risk of complications.

Many mothers report that their babies breastfeed better and their nipple pain issues improve after their baby has a frenotomy. Some studies also suggest that a frenotomy can help with reflux.

However, the effectiveness of whether frenotomy (as well as the clipping of lip-ties) improves breastfeeding is open to debate. Research has suggested that currently there isn’t enough evidence to conclude that having a frenotomy improves babies’ ability to breastfeed, and there is also a lack of evidence on whether having tongue-ties and lip-ties clipped at the same time can improve breastfeeding outcomes.

Remember: Successful breastfeeding is a learned experience for both mother and baby that takes time and practice. Anytime you have questions or concerns about breastfeeding your baby, contact your lactation consultant or baby’s healthcare professional for proper diagnosis and interventions.

To learn more about tongue-ties and lip-ties and their potential effects on breastfeeding, consult your baby’s healthcare professional or a lactation consultant.

To learn more about our breastfeeding education models and materials that are ideal to teach about latching on, breastfeeding positions, dealing with common breastfeeding issues, and more, please visit our Breastfeeding Products Education Section.

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