Most people have heard of being “tongue tied” but few know that it is real medical condition. Being tongue tie or “ankyloglossia” is when the connecting membrane under the tongue called the frenulum is too tight or too short.
Being tongue tied tends to run in families and effects between 4-7% of all births. There are different degrees of tongue tie from the membrane being attached at the tip giving the tongue a heart shaped appearance. To the frenulum being attached further back in the middle of the tongue, the tongue looks normal from the top but when lifted has a thin membrane attached underneath. There is even a rare form of tongue tie called a posterior tie, the tongue is tightly attached to floor of the mouth in the back, it appears normal but it is extremely difficult for the baby to move their tongue laterally or up towards the roof of the mouth.
Why is this problem? The tongue is one of the most important structures of the mouth and extremely important for good, effective breastfeeding. To breastfeed properly, your baby must be able to draw a large amount of breast tissue into his mouth using the tongue. The tongue moves in a wave like motion to transfer milk from the breast; it also forms a cup to catch breast milk so the baby can swallow. So you can see how incredibly important a flexible tongue is to a newborn infant.
Breastfeeding difficulties vary with each nursing mother and baby. Such as the degree of tongue tie, flexibility of the floor of the infant’s mouth and anatomical factors of the mother’s breast such as short or flat nipples, and the elasticity of your breast tissue. Not all babies have trouble nursing when they are tongue tied, some babies can compensate very well. The condition also improves for some babies as they get closer to six weeks of age when the oral structures of the mouth naturally change. However, for a few mothers and babies things do not improve but become can significantly worse.
Signs that your baby may be tongue tied:
You hear clicking sounds when your baby nurses
It is impossible to get a deep latch
Your baby often loses suction or pops on and off frequently while nursing
You feel a burning pain while your baby is nursing like your baby is chewingon the breast instead of sucking
Your nipples are cracked and bleeding
It has always been painful to nurse your baby even directly after birth
Your baby’s tongue does not lift off the floor of the mouth, even when they are crying
You have never seen your baby lick his/her lips even when milk is dripping out of their mouth
The tip of the tongue may look heart shaped or square instead of pointy
Using different positions does not help, it is painful every time you breastfeed
Your nipple appears flattened like a tube of lipstick and drained of color after it comes out of your baby’s mouth
Feedings seem to take forever , your baby is fussy after a feeding or tires easily
Your baby is gaining weight very slowly or not at all
Your milk supply is dwindling
Mastitis or plugged ducts from inadequate breast drainage during a feedings.
Vasospasms, an intensely burning pain in your breast as the the blood rushes back into the nipple and areola.
If you have some or all of these problems breastfeeding then you should seek help from a medical professional, preferable an IBCLC, a board certified lactation consultant. A lactation consultant can accurately diagnose tongue tie and rule out other medical problems. Your lactation consultant can also develop a care plan for you and your baby which may include different therapies and care options from other medical professionals such as a frenotomy or tongue release. A frenotomy is a simple in office procedure performed usually by an ENT or dentist with many benefits to your child such as improved breastfeeding, better oral health and hygiene because a constricted tongue cannot clear food from the mouth easily. This procedure can also prevent potential speech problems as your child gets older from restricted tongue movement and make simple childhood pleasures such as licking ice cream fun.
If for any reason, you are experiencing pain and nipple trauma, contact a lactation consultant immediately. Nipple pain and damage during breastfeeding is never normal or “a rite of passage” for breast feeding mothers. If you feel something is wrong, get help immediately. Breastfeeding should be a pleasant experience for you and your baby, a brief period of time with many warm memories that will stay with you a lifetime.
photo by Janelle Aby, MD, Stanford University