What is a Tongue-Tie
(ankyloglossia) is caused by a tight or short membrane (lingual frenulum) under the
baby's tongue. The tip of the tongue may appear blunt, forked or heart shaped.
The membrane may be attached at the tip of the tongue or further back. Recent
research suggests that one in ten babies may appear to be tongue tied, with
half of them likely to have feeding problems.
Tongue-Tie and Infant Feeding
For pain free and effective breastfeeding, free movement of the tongue is vital. The baby needs to move his tongue beyond the lower gum and take in a portion of the mother's breast behind the nipple. This will place the nipple near the back of the mouth.
In contrast if a baby has a tongue-tie, the tongue cannot move freely. The baby may not be able to attach easily to the breast or bottle and swallowing may also be difficult. The mother's nipples may get damaged and blocked ducts and mastitis may result.
How can a Tongue-Tie Affect Mother and Baby
- Sore, damaged nipples, painful feeding
- Mastitis from poor drainage
- Reduced milk supply
- Exhaustion from frequent feeding
from failing to establish breastfeeding
- Difficulty in staying attached to the breast or bottle
- Frequent or very long feeds
- Excessive early weight loss, failing to gain weight
- Clicking noises while feeding, dribbling
- Colic due to poor attachment
- Sucking blister
Tongue-Ties - Chewing and Speech
For some parents the reason for treating a tongue-tie may be related to potential problems with oral hygiene, licking between the lower teeth and lip, licking the upper lip, cleaning food from the roof of the mouth and sometimes problems with chewing or swallowing lumps.
The reasons for some speech difficulties are very complex, however if you have a tongue-tie to the tip of your tongue you may lisp or have trouble with sounds l, t, th, and s. If you needed treatment for the tongue-tie when your child was older, this would be under a general anaesthetic.
Treating a Tongue-tie
Not all babies with tongue-tie need treatment in the early days. Early diagnosis and support may prevent or solve problems, or the tie may loosen or break on its own. If problems continue the baby should be referred for assessment and treatment as soon as possible with a lactation expert.
Frenulotomy or dividing the tongue tie is a simple procedure. No anaesthetic is needed and it takes a couple of seconds to release the tightness under the tongue. I can snip the membrane with sterile, round ended scissors and no stitching is needed and there is little if any pain or bleeding. The baby can feed straight away and I can assist you with latching if required. I can do this in the comfort of your home.
UK Baby Friendly Initiative www.babyfriendly.org.uk
NICE Guidelines www.nice.org.uk/ipg149
Carmen Fernando, speech-language pathologist www.tongue-tie.net
www.lcgb.org Tongue-Tie and Infant Feeding
Hogan M, Westcott C, Griffiths M, 2005. Randomised controlled trial of division of tongue-tie in infants with feeding problems. Journal of Paediatrics and Child Health, 41 Issue 5-6:246-250
Conclusions: This randomised controlled trial has clearly shown that tongue-tie can affect both breast and bottle feeding and that division is safe and successful. Treatment improved feeding for mother and baby significantly better than intensive skilled support of a lactation consultant.
Geddes D et al 2008. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics vol 122 no 1: e188-e194
Conclusions: Infants with ankyloglossia and persistent breastfeeding difficulties showed less compression of the nipple by the tongue post frenulotomy, improved breastfeeding, increased milk transfer and less maternal pain.