Tongue Tie – 9 Facts You Need To Know

Tongue Tie - 9 Facts You Need To Know

In recent times, there has been increased interest about the topic of tongue tie and breastfeeding.

With so much talk and conflicting information about it, it’s no wonder many mothers feel overwhelmed and confused about how tongue tie may relate to any breastfeeding issues she may be experiencing.

With more information, you can work out what it may mean for your breastfeeding relationship with your baby.

Here are 9 facts to help you understand tongue tie much better:

Tongue Tie Fact #1: It’s Normal To Have A Frenulum!

Everyone has a string of tissue underneath their tongue. This is called the frenulum (or frenum).

Simply the presence of a frenulum is not a cause for any concern. It’s only when the frenulum is short, tight, restricting tongue movement and causing a functional problem (such as for breastfeeding) that it becomes a tongue tie.

Tongue Tie Fact #2: You Can’t Diagnose Tongue Tie Just With A Photo

You cannot tell if a baby has a tongue tie just by looking at a photo of their tongue.

Again, it’s not the presence of the frenulum that’s an issue, it’s whether the frenulum is causing a functional problem or not.

So, when someone posts a photo of their baby’s tongue on the internet and asks, “Is my baby tongue-tied?”, the response should be, “This cannot be determined until a health professional does a thorough assessment.”

Tongue Tie Fact #3: A Tongue Tie Can Affect Breastfeeding

A baby needs to have good tongue movement to be able to:

  • Achieve a deep attachment to the breast
  • Remove milk well from the breast

If a baby’s tongue movement is restricted due to a tongue-tie, then a baby cannot do these things as well.

Tongue Tie Fact #4: Signs Your Baby’s Tongue Needs To Be Assessed

There are several possible signs that a breastfeeding mother should consider having her baby’s tongue assessed, including:

  • Painful breastfeeding
  • Damaged nipples
  • Baby loses suction while feeding
  • Clicking noise while feeding
  • Low weight gain in baby over time
  • Recurrent blocked ducts or mastitis

Please note that all of the above signs could be due to a range of other breastfeeding-related issues. It is the role of a health professional, such as a lactation consultant, to assess why the above signs may be occurring. For more information about the signs and symptoms of tongue tie, read our article here.

Tongue Tie Fact #5: It Isn’t Always Clear-Cut If A Baby Has A Tongue Tie

Given there is no universal and accepted tongue tie classification, it is possible that one health professional may diagnose a tongue-tie and another may not in the very same baby. Neither health professional is ‘wrong’.

Indeed, some health professionals seem to diagnose every frenulum as a tongue tie and assign every breastfeeding issue to a tongue tie. Other health professionals believe tongue tie is a current craze.

Having no clear consensus amongst health professionals regarding the diagnosis of tongue-tie makes things even more confusing for parents to be able to make a decision about what to do!

Tongue Tie Fact #6: Diagnosing A Tongue Tie Needs A Detailed Assessment

Assessing if a baby has a tongue tie needs a detailed assessment including:

  • A physical examination of the baby’s tongue whereby the health professional puts their finger inside the baby’s mouth and assesses the baby’s tongue movement and suck
  • Observing the baby breastfeed (or bottle feed)
  • Talking in-depth to the mother about all the signs and symptoms and taking a detailed history

While there are a range of tools and techniques that a health professional can use to assess for a tongue-tie, nothing comes close to the importance of a thorough individualised assessment.

Tongue Tie Fact #7: Sometimes, A ‘Wait And See’ Approach May Be Best

Once a thorough individual assessment is done and all the pieces of the assessment are pulled together, the big-picture analysis may point towards the best approach being to:

  • Do nothing about the frenulum (e.g. because the breastfeeding problems are rectified in other ways such as by optimising positioning and attachment)
  • Deciding to get the frenulum snipped (e.g. because when breastfeeding basics like positioning and attachment are optimised, the breastfeeding problems, such as sore nipples, continue)
  • Deciding to wait and see (e.g. because there are other issues such as an oversupply and fast let-down reflex that are deemed to be contributing to the breastfeeding problems and need to be addressed before deciding if anything about the frenulum needs to be done)

Tongue Tie Fact #8: Snipping Of A Frenulum Is Called A Frenotomy

If a tongue-tie is diagnosed and is assessed to be contributing to or causing a functional problem, the procedure to snip the frenulum is called a frenotomy. This can be performed with sterile scissors or with laser by a paediatrician, ENT specialist, paediatric dentist, GP, or specially trained lactation consultant or midwife.

Tongue Tie Fact #9: There Is Mixed Research About The Effectiveness Of Frenotomy

A recent systematic review concluded: “A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain. But with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.”

As more evidence emerges, it’s likely there will be more consistent recommendations amongst health professionals about when a frenotomy is best performed. This will help more breastfeeding mothers be able to reach their own breastfeeding goals.

If you are having breastfeeding difficulties and suspect your baby may have a tongue tie, see a lactation consultant who can help you work out what to do.

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Renee Kam is a mother of two daughters, an International Board Certified Lactation Consultant (IBCLC), a physiotherapist, author of 'The Newborn Baby Manual' and an Australian Breastfeeding Association Counsellor. In her spare time, Renee enjoys spending time with family and friends, horse riding, running and reading.

One comment

  1. Thanks for writing this Renee. As a fellow IBCLC, I love your balanced approach regarding tongue ties. Tongue ties certainly can cause issues but we cannot forget to look at the many other possible causes for a breastfeeding problem.

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