In this month’s blog, we are covering the challenges of breastfeeding when the infant has a tongue-tie. First, we will define what is a tongue-tie. Then we will cover some of the common, but not so widely known signs that point to a possible tongue-tie. We will cover possible treatment strategies, and referral sources. Lastly, we will point to some of the consequences of tongue-tie as a child ages.
Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the fiber that anchors the tongue to the floor of the mouth is overly short and thick, preventing the tongue from moving freely. Usually, this fiber detaches at birth. In roughly 10% of babies, mostly boys, it doesn’t. The cause is unknown; however, genetics may play a part.
You can suspect tongue-tie if the tongue appears heart- shaped, notched, or dimpled. The child may have difficulty sticking the tongue out below the lower gums or teeth. It is important for breastfeeding that babies are able to keep their tongue over the lower gum while sucking. If tongue movement is limited the baby may chew rather than suck.
Chronic nipple pain while breastfeeding is not ‘something to get used to.’ Damage to the nipple while breastfeeding can result in plugged ducts and mastitis. This can cause nipple pain as well as inadequate nutrition.
Get help from your baby’s primary provider or lactation consultant if you experience the following:
Cracked or bleeding nipples even after a lactation consultant has helped you with positioning.
A nipple that is flattened, has a line, or is lip-stick shaped after nursing.
The baby makes chompy, or chewy noises, or has dimpled cheeks while sucking. The struggle to nurse may also be accompanied by excessive movement of the baby’s head, and a neck that looks strained.
The following are signs that the baby may not be getting enough milk out of the breast:
Over frequent nursing that happens every day.
A baby who never sleeps more than 30 minutes at a time. A baby who is never full wakes frequently to feed or is often sleepy.
Milk leaking out of the sides of the mouth while nursing.
Poor weight gain and failure to thrive.
Tongue-tie is not at the root of all breastfeeding challenges, but it should be considered as a cause. Not all tongue-ties present with difficulty in nursing. A tongue-tie can anchor the tongue at the tip or at the back of the tongue. In addition to difficulties with breastfeeding other consequences of limited range of motion of the tied tongue can present as difficulty swallowing, effecting digestion. A tongue-tie can impact speech. There can be oral hygiene issues as the tied tongue lacks the agility necessary to clear food from the oral cavity. There can be respiratory issues due to a narrowing of the oral cavity and maxillary sinuses. Children’s developing oral and cranial bones are extremely malleable and adapt readily to the forces that act upon them such as tongue mobility and airflow.
Manual approaches such as osteopathic manipulative treatment, chiropractic, pediatric physical therapy, myofunctional therapy, and craniosacral therapy with or without surgical release of the lingual frenulum are first-line options for improving tongue mobility and overcoming some of the obstacles to breastfeeding.
As mentioned, children’s cranial and facial bones are very malleable. Craniosacral therapy, for example, with the gentlest touch can help the baby recover from the physical forces of the birth process which can result in compression of a number of cranial nerves between the head and neck that control motor functions of the tongue and throat.
Treatment of a tongue-tie can involve the release of the lingual frenulum with surgical scissors, scalpel, or laser. This is called a frenotomy. The lingual frenulum has a very small nerve and blood supply, so while this swift procedure in infants is momentarily painful, it is done without the use of anesthesia. Tongue-tie release in children beyond infancy may be done with or without the use of anesthesia, depending on the degree of the tongue-tie. Some babies experience immediate improvement in breastfeeding. Side effects are rare, but there is risk of inflammation, infection, temporary interruption of breastfeeding, as well as recurrence of the tie if the procedure is not followed by the necessary therapy.
A frenotomy must be followed by exercising and stretching of the baby’s tongue so that the condition does not recur. Parents will be taught to carry on these exercises with their child once instructed by any one of the following team of qualified health professionals: pediatric physical therapist; occupational therapist; speech therapist; lactation consultant; myofunctional therapist; pediatric dentist; oral surgeon; ENT; osteopathic physician.
Some sources suggest that the release of the tongue-tie is unnecessary if it does not interfere with breastfeeding. As mentioned earlier, not all tongue-ties interfere with breastfeeding and some tongue-ties will resolve with time. However, it may be wise to monitor an apparently asymptomatic tongue-tie if you consider some of the potentially long term digestive, oral health, speech, and respiratory complications of limited tongue mobility in childhood.
As always, this blog is meant to raise awareness to medical issues that can affect us and is not meant to give medical advice. If you are or someone you love is experiencing any of the issues in this blog please reach out to your doctor.