In recent times, there has been increased interest in the topic of tongue tie and breastfeeding.
With access to more information, you can work out what it might mean for your breastfeeding relationship with your baby.
Here is some information that will help give you a much better understanding of tongue tie:
#1. It’s normal to have a frenulum
Everyone has a lingual frenulum underneath the tongue. This fold of tissue is what holds the tongue to the floor of the mouth.
Quite simply, the presence of a frenulum is not a cause for any concern. It’s only when the frenulum is short or tight, restricts the tongue’s movement or causes a functional problem that it becomes a tongue tie.
#2. You can’t diagnose tongue tie with a photo
You cannot tell whether a child’s tongue is tied just by looking at a photo.
Again, it’s not the presence of the frenulum that causes the problem; it’s the function of the lingual frenulum that requires assessment.
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 performs a physical exam and makes a thorough evaluation’.
#3. Tongue tie symptoms
There are several possible signs that a breastfeeding mother should consider having her baby’s tongue assessed.
Some of the signs are:
- Painful breastfeeding
- Damaged nipples
- Baby loses suction while feeding
- Clicking sound while feeding
- Poor weight gain in a baby, over time
- Recurrent blocked ducts or mastitis
- Low breast milk supply.
It’s important to note that all of the above signs could be due to a range of other difficulties related to breastfeeding.
It is the role of a health professional, such as a lactation consultant or your child’s pediatrician, to assess why the above signs might be appearing.
For more information about the signs and symptoms of tongue tie, read our article 6 Signs Your Baby May Have Tongue Tie.
#4. 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.
If a baby cannot achieve a deep attachment or transfer milk effectively from the breast, it can result in any of the above symptoms.
#5. It isn’t always clear that a baby has a tongue tie
Given there is no universal and accepted tongue tie classification, it’s possible that, in the same baby, one health professional might diagnose a tongue tie and another might not. Neither health professional is ‘wrong’.
Indeed, some health professionals seem to diagnose every frenulum as a tongue tie and assign every breastfeeding problem to a tongue tie. Other health professionals believe tongue tie is a current craze.
Having no clear consensus amongst health professionals with regard to the diagnosis of tongue tie makes things even more confusing for parents, and more difficult for them to make a decision about what to do.
How is tongue tie diagnosed?
This information might lead you to wonder how a tongue tie is actually diagnosed.
There are common signs of tongue tie, such as a heart shaped tongue or an unusually short tongue, or the inability to stick out the tongue past the bottom gum line.
As mentioned earlier, it is more important to assess the tongue function than the appearance alone.
Assessing whether or not a baby has a tongue tie requires a thorough evaluation, including:
- A physical examination of the baby’s tongue. A health professional, such as an international board certified lactation consultant or a speech-language pathologist, will put a finger inside the baby’s mouth and assess tongue function
- Observations of the baby’s breastfeeding (or bottle feeding) to assess what feeding problems a restricted tongue might be causing
- Talking in-depth to the mother about all the signs and symptoms and taking a detailed history with regard to breastfeeding.
Although there is a range of tools and techniques that a health professional can use to assess for a tongue tie, nothing is more important than a thorough individualized assessment.
#6. Sometimes a ‘wait and see’ approach is best
Once a thorough individual assessment has been done and all the pieces of the assessment are put together, the big-picture analysis can be made.
It might show that the best approach is to:
- Do nothing about the frenulum. This is because the breastfeeding problems can be rectified in other ways, such as by optimising positioning and attachment
- Decide to get the tongue tie treated. This might be because breastfeeding problems or poor weight gain continue, even when the breastfeeding basics, such as positioning and attachment have been optimised
- Decide to wait and see. This might be because breastfeeding problems could subside, as the child grows and develops.
#7. Tongue tie treatment
If a tongue tie is diagnosed and assessed as contributing to, or causing, a functional problem, then surgical intervention is sometimes recommended.
Tongue tie treatment involves a simple surgical procedure called a frenotomy, which is performed in a doctor’s office.
The surgical tools used in the procedure are sterile scissors or a laser tool. Most babies breastfeed immediately after the procedure.
Although a tongue tie division is considered a very low risk procedure, there are risk factors involved in any surgical procedure.
When the lingual frenulum separates due to surgical intervention, possible complications are damage to the tongue or salivary glands or damage to the surrounding nerve endings or blood vessels. Complications, however, are rare.
Another consideration for many parents is that complications might arise from untreated tongue tie. Some parents worry that not treating tongue tie in their baby could lead to speech difficulties or dental problems.
For a tongue tie to be considered for surgical treatment, it has to be affecting tongue functionality at that particular time. Preventative surgical treatment for tongue tie is not currently recommended.
If you are concerned about your older children’s speech or their ability to make certain sounds, seek professional advice from a speech-language pathologist.
#8. There are mixed research results on the effectiveness of surgical treatment for tongue tie
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 among health professionals about the best course of action for tongue tie treatment.
This will help more breastfeeding mothers be able to reach their own breastfeeding goals.
If you are having breastfeeding difficulties and suspect your baby might have a tongue tie, see a lactation consultant who will help you to work out what to do.