Tongue-tie and breastfeeding – can mums and babies experience difficulties?

tongue tieWhat is tongue-tie?

The correct term to describe this condition is ankyloglossia (but we can stick to tongue-tie, can’t we?), and it’s a congenital anomaly that can reduce mobility of the tongue tip. It happens because the membrane connecting the underside of the tongue to the floor of the mouth (called lingual frenulum) is just a bit tighter and shorter than in most people. Although this is just proof that we are indeed all different, tongue-ties can vary in degree of severity – this is also due to where, under the tongue, the frenulum is attached (either towards the tip of the tongue or towards the back of the tongue). Essentially, tongue-tie has the potential to have different effects on different people, and difficulties in breastfeeding (and then later on in life, if the tongue-tie is severe and not corrected), eating and speech are the most common effects.

How can tongue-tie affect breastfeeding?

In order to achieve a good latch, a baby needs to latch onto both the nipple and the breast tissue around it, and their tongue needs to cover the lower gum to protect the nipple from damage. Babies with tongue-tie may have difficulties in opening their mouths wide enough to latch onto their mother’s breast properly, and in doing so they can ‘slide off’ the breast and chomp on the nipple with their gums. This is of course can be very painful for the mum, and it contributes to breaking the nipples, which can become sore, with ulcers and bleeding. And it’s not so great for the baby either – because the baby can’t stimulate the breast tissue well enough, they are not feeding efficiently, and this results in poor weight gain and frequent fussing and feeding.

How frequently do mums and tongue-tie babies experience difficulties?

According to a study conducted in 2000 by Messner et al on a small number of 36 infants with tongue-tie, approximately 25% of mothers reported encountering difficulties with breastfeeding, compared to only 3% of mothers in the control group. Among the difficulties they reported they listed:

  • Longer lasting nipple pain (for longer than 6 weeks);
  • Difficulty in baby latching on or staying latched on onto the mother’s breast.

How can tongue-tie be identified and what can you do about it?

If you suspect that your baby may have tongue-tie, you should contact your midwife, infant feeding / lactation specialist, health visitor or GP. It can sometimes be difficult to diagnose tongue-tie in a baby – it is possible for a health professional to either miss or misdiagnose a tongue-tie, as not all cases may as clear and unmistakeable as we’d like them to be. For example, something called a ‘posterior tie’ can be a bit harder to detect than an ‘anterior’ one (where the frenulum is attached almost to the tip of the tongue, giving it a typical heart shape when the tongue is pushed out).

Unfortunately, a misdiagnose can have important consequences for a family – if the parents trust that their baby doesn’t have tongue-tie and continue to attempt various solutions to improve breastfeeding, which they find unsuccessful, they might interrupt breastfeeding before they (and their baby) are ready, and this can cause stress and anxiety. Luckily, various organisations in the UK are calling for more professionals to be better trained to recognise and deal with tongue-tie in an attempt to create a more robust service and support network and guarantee a more consistent experience for parents.

So in certain cases it may be useful to have a couple of (or more) opinions to have a tongue-tie diagnosed for sure, and like with most baby-related things, it’s helpful for parents to be aware of some of the signs and effects of tongue-tie, so that if they believe that their baby could be affected, trusting their intuitions and being persistent in having it assessed by professionals could make all the difference in the mum-and-baby breastfeeding experience.

What can you do about your baby’s tongue-tie?

If breastfeeding is affected, sometimes the solution is may be getting help to improve the latch.

Otherwise, in specific cases and under medical advice, it is possible to perform a small surgical operation known as ‘tongue-tie division’ to cut the short piece of skin connecting the underside of the tongue with the floor of their mouth. While babies are a few days, weeks or months old, the procedure is considered so simple and potentially painless that it is carried out without pain relief or under local anaesthetic to just numb the tongue – this is because there are very few nerve endings in that area of the mouth at a very young age. It’s only when a child is older and has teeth that the procedure is carried out under general anaesthetic.

For some babies, having their frenulum cut creates better movement of the tip of the tongue, which allows them to breastfeed better, and the results can be seen almost immediately. For others, improvements with breastfeeding may not be straightforward, and further advice might need to be sought; in such cases the options are to either repeat the procedure or support the mum to achieve a more efficient latch for their baby.

In a similar study to the one mentioned earlier, mothers who stated that they were experiencing breastfeeding difficulties were asked to assess their experiences pre- and post- surgical tie division, and only 40% of mothers reported immediate improvements. Despite the fact that 60% of the mums continued to breastfeed for a few months after the surgical procedure, 30% of mothers didn’t notice any improvements at all. So the conclusion is that tongue-tie may adversely affect breastfeeding in some babies, and that surgical division of the tongue may (or may not) improve the situation. It sounds like surgical intervention isn’t always a guarantee.

Did you know?

  • All tongue-ties do not look alike!
  • Tongue-ties often runs in families
  • Tongue-tie affects approximately 3% to 11% of newborn babies
  • Tongue-tie is more common in boys than in girls
  • The frenulum is tissue that is left over from the time the foetus was developing in the mother’s womb, and which would normally reduce to insignificance before the birth

Not all experiences are the same

Like all tongue-ties look different, we must also remember that each mum-baby breastfeeding relationship is unique. A baby with tongue-tie may be feeding perfectly well while another baby with a similar condition isn’t – this also depends on how efficient the combination between an individual mum’s breasts and their individual tongue-tied baby works (for example, a severe tongue-tie may not work very well with inverted nipples, but in other cases it might be). This shows that experiences vary enormously, and we shouldn’t focus on someone’s not-great experience and think that the exact same scenario is going to be true for us. And just to show you an example, watch out for a story from mum-of-two Pippa and MummyNatal teacher for Gateshead, who kindly shared her experience with us.

Do you have a story or some tips to share? Did your baby have tongue-tie? Did it affect breastfeeding? Did your baby have a tongue-division? Tell us your experience and help us show parents that each story is unique!