You’re having problems breastfeeding, and you have sought help from your informal online support network. Many of the other moms have suggested your baby might be tongue tied. What does this mean and, how do you know it this might be the source of your breastfeeding problems?
Tongue tie (which you may also hear called ankyloglossia) happens when the membrane that connects the tongue to the floor of the mouth (the lingual frenulum) is unusually short, thick or tight. It occurs in 4% to 16% of babies depending on the study, and is more common in boys. Tongue tie can decrease tongue mobility – something essential for milk transfer and maternal comfort when breastfeeding. Some researchers think tongue tie can impact your child’s speech, jaw and dental development, and nutrition. Sometimes babies with tongue tie develop reflux, and may eventually have problems with eating solid foods.
Signs and symptoms of tongue tie include:
- Nipple pain or breast pain that is not resolved by positioning changes or a deeper latch – mom’s nipples may have broken skin, and probably look compressed after nursing. They may look creased, bruised or have a white stripe across the tip right after a feeding. They might look like a brand-new tube of lipstick when baby comes off the breast.
- Vasospasm – which occurs due to the constriction of the blood vessels when baby is incorrectly attached at the breast
- Low milk supply – due to the fact that baby isn’t able to transfer enough milk
- Recurrent plugged ducts or mastitis – again from poor milk removal
- Recurrent thrush infections
- Poor latch and weak suck, difficulty establishing suction and staying attached to the breast (the breast may slide in and out of baby’s mouth while feeding)
- Unusually strong suck (which may be accompanied by a quivering jaw after or between feeds) – baby is compensating for lack of tongue function by increasing the suction to try and get more milk
- Clicking while feeding – due to the loss of suction
- Poor weight gain, weight loss, or ineffective milk transfer
- Infrequent swallowing after mom’s initial let-down
- Gas, irritability, colic symptoms, reflux – swallowing air during feeding
- Breast refusal, arching away from the breast
- Short feedings, fatigue with feeding, falling asleep before finishing a full feeding
- Clamping down on the nipple, chewing or biting motions at the breast
- No interest in comfort nursing
In order to determine if tongue tie is the cause of baby’s feeding issues, you should work closely with a lactation consultant and your baby’s doctor. Referral to a specialist, such as an ENT doctor or a pediatric dentist, may be recommended. Your baby’s healthcare provider will likely do an oral exam by letting the baby suck on a gloved finger, and by sweeping a finger under the tongue. You can assess your baby’s tongue initially by looking at the following:
- Does your baby’s tongue look heart-shaped (is there a cleft in the tip)?
- Can your baby extend his tongue over his bottom gums? It’s necessary for baby to keep his tongue extended when nursing.
- Can you actually see the tight frenulum?
- Does your baby’s tongue rise toward the roof of the mouth when crying? (It normally should, but will stay low in the mouth if movement is restricted by a tight frenulum.)
- Does the tongue look dipped in the center?
- Is the roof of your baby’s mouth especially high or narrow?
Not all babies with tongue tie will have all of these warning signs; but, if he has some, he may have tongue tie.
The first step in treatment should be getting professional help with latching and positioning from a board-certified lactation consultant. Typically, even with tongue tie, comfort and milk transfer can be improved with simple interventions to improve feeding.
Treatments for tongue tie fall into three main categories:
- Surgical intervention: Using surgical scissors or a laser, the physician “snips” the tissue to release the tongue. If your baby has a frenotomy, be sure you discuss aftercare with the doctor. Suck exercises may also be used to help baby learn to use his tongue properly afterwards.
- Alternative treatments: Body work, such as chiropractic and cranio sacral therapy (CST) can be useful for babies with tight tongues.
- Wait and see: If the tongue tie is mild, baby’s growth is acceptable and mom isn’t have pain, then your healthcare provider may suggest just patience and time.
You are the best advocate for your baby. If you feel that tongue tie is the source of your baby’s poor feeding and your nipple pain or low milk supply, be persistent. Find a doctor who will listen to your concerns, and who is familiar not only with tongue tie but with breastfeeding, as well. Get the treatment you need so that you can preserve a long, enjoyable nursing experience.