I recently learned how much I didn’t know about tongue-tie when it comes to breastfeeding.
One of my daughters was struggling to breastfeed her new baby. Baby Bianca would latch on but struggle to feed. She would feed for a short time, get hungry, and feed again. She was getting milk, but my daughter was not getting sleep and her breasts were getting very sore. Her lactation consultant suggested a tongue-tie evaluation.
The medical term for tongue-tie is ankyloglossia. We are all born with a band of tissue that tethers the tongue to the floor of the mouth. This tissue is called the lingual frenulum. Normally, the frenulum does not restrict tongue movement. But if the frenulum is too thick, too tight, or attached too far forward, it can cause tongue-tie.
In my former life as a small town ear, nose, and throat doctor, many years ago, I snipped a lot of frenulums. It was usually in young children sent over by a speech pathologist. But the rule of thumb – or rule of tongue – was always that if the child could get the tip of the tongue past the teeth, tongue-tie was not a problem.
So when my daughter asked me if the baby had tongue-tie, I advised that it was not a problem. Fortunately – as usual – my wife overruled me and the baby went to see a younger and wiser ENT surgeon.
What We Now Know About Tongue-Tie and Breast Feeding
In the old days, midwives were well aware of tongue-tie. They used to keep one finger nail long to snip tongue-tie before babies started breastfeeding. When bottle feeding became more popular than breast feeding, this wisdom was lost.
We now know that tongue-tie is very common, and it does not have to be severe to interfere with breast feeding. Tongue-tie may run in families and tends to be more common in boys. We also know that breast feeding is much better than bottle feeding for babies. Tongue-tie may be one reason why the 70 percent of women who start breastfeeding exclusively drops to under 20 percent within 6 months.
Babies with tongue-tie have trouble latching. To get a good latch on your nipple, your baby needs to slide his or her tongue over the lower gum. Babies with tongue-tie compensate for restricted tongue movement by using their jaws more and chewing to get more milk. The baby gets tired easily, needs to feed more often, and the mother gets very sore nipples.
We took baby Bianca to one of the ENT surgeons where my wife works. The surgeon told us that she has done about a thousand tongue-tie releases for breast feeding problems. The medical term for this surgery is frenotomy. She also told us that the frenulum attaching the upper and lower lips to the gums can also cause breastfeeding problems.
She examined the baby and recommended snipping the lingual frenulum. While my daughter held the baby tightly, she put some numbing medication on a Q tip under the baby’s tongue. She then lifted the tongue and did a quick snip with sterile scissors. She held a gauze pad under the baby’s tongue for a few minutes and then told my daughter to start breastfeeding. Baby Bianca latched on like a pit bull. My daughter is now breast feeding less often and getting more sleep. Her breasts are less sore and the baby is chubby and happy.
Frenotomy is a quick and simple procedure that can really help if you are struggling with breast feeding. There is very little pain or bleeding, since there are very few nerves or blood vessels in the frenulum.
If your baby has trouble latching and seems to be working too hard on your nipple, ask your health care provider about tongue-tie. It might be worthwhile to have a consult with an ENT doctor who is up-to-date on tongue-tie and breast feeding. A simple snip could be the difference between the breast and the bottle.
Did your baby or any baby you know have tongue-tie? Share the story in the Comments section below!