What is tongue-tie?

Tongue-tie occurs when the thin membrane under the baby's tongue (called the lingual frenulum) restricts the movement of the tongue. In some cases the tongue is not free or mobile enough for the baby to attach properly to the breast. Tongue-tie occurs in 4-11% of newborns and is more common in males.

Some babies with tongue-tie are able to attach to the breast and suck well. However, many have breastfeeding problems, such as nipple damage, poor milk transfer and low weight gains in the baby, and possibly blocked ducts or mastitis due to ineffective milk removal.

Why is a tongue-tie a problem for breastfeeding?

A baby needs to be able to have good tongue function to be able to remove milk from the breast well. If the tongue is anchored to the floor of the mouth due to a tongue -tie, the baby cannot do this as well. The baby may not be able to take in a full mouthful of breast tissue. This can result in ‘nipple-feeding’ because the nipple is not drawn far enough back in the baby’s mouth and constantly rubs against the baby’s hard palate as he feeds. As a result, the mother is likely to suffer nipple trauma.

There are many signs that a baby is having problems with breastfeeding and they may be related to tongue-tie:

nipple pain and damage

the nipple looks flattened after breastfeeding

you can see a compression/stripe mark on the nipple at the end of a breastfeed

the baby fails to gain weight well

You won’t necessarily have all these signs when you are having a problem and they can all be related to other breastfeeding problems and not necessarily related to tongue-tie. If you experience any of the signs above, you may wish to call the National Breastfeeding Helpline to speak with a breastfeeding counsellor or consider contacting a lactation consultant.

Diagnosis of tongue-tie

Australian Breastfeeding Association counsellors are not medically trained and cannot assess whether or not a baby has a tongue-tie.

If you are concerned that your baby has a tongue-tie that is causing breastfeeding problems, you may wish to see a lactation consultant who can carry out a full assessment including assessing breastfeeding and checking your baby's mouth. A lactation consultant can discuss the assessment findings with you and your options. If it is thought that a tongue-tie may be contributing to the breastfeeding problems, you can be referred onto an appropriate health professional (eg medical professional, paediatric dentist) who can make the diagnosis and release the tongue-tie, if necessary.

Treatment for tongue-tie

If it is decided that a tongue-tie is interfering with breastfeeding, then a surgical procedure to release the tight lingual frenulum can improve the baby's ability to breastfeed.

There is currently no formal accreditation for health professionals performing tongue-tie releases.

Other ‘ties’

Studies done so far have not been designed in a way to determine if an ‘upper lip-tie’ may or may not impact breastfeeding. Currently, there is no published evidence about releasing ‘buccal’ ties for breastfeeding problems.

References

Brodribb W (ed), 2012, Breastfeeding Management in Australia. 4th edn. Australian Breastfeeding Association, Melbourne. Buryk M, Bloom D, Shope T 2011, Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics 128(2):280–288. Francis D O, Krishnaswami S, McPheeters M, 2015, Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics 135(6):e1458–e1466. Geddes DT, Langton DB, Gollow I, Jacobs LA, HartmannPE, Simmer K 2008, Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 122:e188–e194. O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, Davis PG, (2017), Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews 3(CD011065):DOI: 10.1002/14651858.CD011065.pub2. The Royal Women’s Hospital 2018, Tongue-tie: information for families . The Royal Women’s Hospital, Victoria Australia.

Websites

NHS National Institute for Health and Clinical Excellence – Division of ankyloglossia (tongue-tie) for breastfeeding

Academy of Breastfeeding Medicine protocols – Ankyloglossia (currently under revision)

© Australian Breastfeeding Association Reviewed January 2018