Breastfeeding a Baby With a Tongue-Tie

What Is It, How Does It Affect Breastfeeding, and What Can You Do?

Mother with newborn baby sleeping on shoulder
Some babies with a tongue-tie can breastfeed without any issues. Image Source / Getty Images

A tongue-tie is a relatively common condition that approximately 5% of newborns are born with. When a baby has a tongue-tie, the frenulum or the piece of tissue that connects the tongue to the bottom of the mouth is short, tight, or thick. It may be attached close to the tip of the tongue preventing the tongue from moving freely and from sticking out past the baby's gums. The tongue may even look heart-shaped when the baby cries or tries to push it out.

The medical term for tongue-tie is ankyloglossia.

Breastfeeding a Baby With a Tongue-Tie

A baby with a tongue tie may be able to breastfeed without any problems, or he may not be able to breastfeed well at all. It really depends on the baby and the severity of the tongue-tie.

Children use their tongue when they latch on to the breast. They extend their tongue out to take the nipple and some of the surrounding areola into their mouth. They also use their tongue to form a good seal around the latch. But, a baby with a tongue tie may not be able to open his mouth wide enough to latch on to the breast and seal the latch well. The tightness of the tongue may also keep the baby from making the movements necessary to squeeze the milk ducts under the nipple as he's breastfeeding. The combination of a poor latch and difficulty sucking can prevent the baby from effectively removing the breast milk from the breast.

How a Tongue-Tie Can Affect Babies

  • Other Issues: As the baby grows a short frenulum can cause problems with eating, swallowing, and speech.

How a Tongue-Tie Can Affect Mothers

  • Sore Nipples: If your newborn is only latching onto your nipple or he's chewing or gumming your nipple as he's trying to nurse, it can lead to sore, cracked, damaged nipples.
  • Painful Breast Problems: When the baby isn't able to breastfeed well, he can't drain the breasts of the breast milk. The build up of breast milk in the breasts can lead to breast engorgement, plugged milk ducts, and mastitis.
  • A Low Breast Milk Supply: A poor latch and the ineffective removal of breast milk can quickly decrease the breast milk supply.
  • Emotional Stress: Breastfeeding difficulties can lead to frustration and a lack of breastfeeding confidence. If the baby isn't getting enough milk, it can also be scary or cause sadness and feelings of guilt.
  • Early Weaning: Painful breastfeeding, a low breast milk supply, and dealing with a frustrated, hungry baby who is gaining weight too slowly can all lead to early weaning.

    What to Do if Your Baby Has a Tongue-Tie

    • If you think your little one has a tongue tie, notify his doctor right away. The faster you can get a diagnosis, the faster you can get the help you need to make breastfeeding work better for you and your child.

    • Make sure your breastfeeding technique is correct and learn about your options.

    • Discuss the pros and cons of a frenotomy with your baby's healthcare team.

    • If you decide against a frenotomy, you can continue to breastfeed but have your little one monitored to be sure she's gaining weight and getting enough breast milk. You may have to pump and give your baby your expressed breast milk in a bottle as a supplement if necessary.

    • If your child is having trouble latching on, talk to your doctor or a lactation consultant about using a nipple shield. A nipple shield can be a helpful breastfeeding tool for babies who have difficulty latching on to the breast. However, if you do decide to use a nipple shield, learn how to use it correctly, wear the right size, and work closely with your doctor. If you don't wear it as directed, a nipple shield can cause even more breastfeeding issues.

    • If your nipples are too sore to breastfeed and you need to rest them to heal, pump to maintain your breast milk supply and provide your child with your expressed breast milk in a bottle.

    • If your supply of breast milk is declining, take steps to boost production and increase your supply.

    • Continue to see the doctor at regular intervals to monitor your baby's health and weight gain.

    What Is a Frenotomy?

    A frenotomy (also called a frenulotomy) is a minor surgery or procedure for babies with a tongue-tie. It's a simple snip of the frenulum under your child's tongue. The doctor can use local anesthesia, but most newborns can handle it without any anesthesia. It does not bleed much, and stitches are usually not needed.

    In general, a frenotomy is quick, simple, and safe. However, there are risks for all procedures. And, although it's rare, a frenotomy can cause pain, bleeding, and infection. That's why it's so important to have it performed by a trained healthcare provider. If your child's physician does not do this procedure, he can give you the name of a doctor, dentist, ENT, or pediatric surgeon who does. A lactation consultant or a local breastfeeding group can also provide you with information on who to go to for this minor surgery.

    Should You Have Your Baby's Frenulum Cut?

    If your newborn has a tongue-tie but doesn't have any trouble breastfeeding, then a frenotomy is not necessary. And, if your baby's tongue-tie is mild, you can wait and see how he does. However, if your child is having trouble latching on and you're finding it very uncomfortable to breastfeed, you may want to consider having this procedure.

    The cutting of a tight frenulum allows your baby's tongue to move more freely and protrude out his mouth enough so he can make a good latch with a good seal. You'll be able to put your baby to the breast immediately after the procedure, and hopefully, your child will be able to latch on and breastfeed well right away. Once your newborn is latching on better, he'll be able to get more breast milk, and breastfeeding should become easier and more comfortable for both of you.

    While a frenotomy may be the answer for some children, it doesn't solve all breastfeeding problems. So, there's always a chance that your baby will still have breastfeeding difficulties even after the procedure. However, for many newborns and moms, it can make breastfeeding more successful and help it to continue for a greater length of time.  

    Sources:

    Academy of Breastfeeding Medicine Clinical Protocol Committee. ABM clinical protocol #11: Guidelines for the Evaluation and Management of Neonatal Ankyloglossia and its Complications in the Breastfeeding Dyad. 2004. Published online. No longer accessible due to expiration.

    Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002 Nov 1;110(5):e63-e63.

    Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

    Riordan, J., and Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2014.

    Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia Methodologic review. Canadian Family Physician. 2007 Jun 1;53(6):1027-33.

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