Learning About Ankyloglossia (Tongue-Tie)

We thank our educator-in-residence, Laurie Flower, for sharing information on a common (and under-diagnosed) issue! Ankyloglossia, what, you might say? You may think it sounds foreign. It is Greek for crooked tongue. It is the true medical name of a baby being tongue-tied. Many new mothers are not informed about the very common condition of babies being tongue-tied and how it can lead to unsuccessful breastfeeding.

A tongue-tie consists of an abnormally short, tight, or deep lingual frenulum, which restricts the mobility of the tongue. It is a membrane of tissue that attaches the tongue to the floor of the mouth that constricts movement for feeding. Tongue-ties vary greatly in length and thickness. It is not always at the tip of the tongue, which is what many people commonly look for, which can mislead the diagnosis. Why is that a problem? Freedom of movement is essential for the withdrawal of milk from the breast.

Symptoms for Mom:

  • Sore cracked nipples
  • Thrush
  • Mastitis
  • Insufficient milk supply

Symptoms for Baby:

  • Short feeds
  • Non-stop feeds
  • Unsettled baby
  • Weight issues
  • Tongue can look like it has a heart shaped tip when trying to extend
  • Tongue can look square or flat
  • Baby can not poke tongue out beyond bottom gums or lip
  • The tongue humps up in the middle instead of plunging forward
  • Tongue can not move freely to the left or right of mouth
  • Baby often makes a clicking or smacking sound while trying to eat

It affects more boys than girls. Babies who have a family history of tongue-tie are more genetically inclined to have tongue-tie as well. Most of the time it is found through moms trying to breastfeed, because it doesn’t appear to hinder babies who bottle feed.

Not only can being tongue-tied affect breastfeeding, it can affect children and adults who desire to play wind instruments. Long term, it can affect dental hygiene, kissing and speech.

For years every baby was checked at birth for tongue-tie to prevent breastfeeding problems. Then, in the 1940’s and 50’s when the number of breastfeeding babies declined, the monitoring of newborn tongue-tie virtually stopped. As breastfeeding rates have risen, it has once again become a potential issue and a nasty nuisance for struggling newborns. As new parents are educating themselves and choosing breastfeeding as the “normal” way of feeding, tongue-tie can be an issue for some mothers and babies.

A breastfeeding baby with a correctly-working tongue should be able to lick his lips and touch the tip of his tongue to the roof of his mouth. The tongue is the major component of breastfeeding. It is what pulls the breast into the mouth and holds the breast in position. When the tongue tip elevates, it traps the milk in the front of the breast and then presses the breast moving the milk from the areola to the nipple. The tongue then helps “catch” the milk and “throws” it smoothly down the throat for the baby to swallow. When that cannot happen, the baby instead struggles to use his lips and jaws to clamp down, and painfully compensates with an incorrect latch. This causes pain to the mother and can contribute to low milk production.

Who Usually Finds a Tongue-Tie?

  • Lactation counselors/specialists
  • Lactation consultants
  • Occasionally pediatricians

Breastfeeding clinicians base their assessment of tongue-tie upon the following:

  • Closely monitoring the mother and baby dyad during a feeding
  • Comfort/pain level of the mother
  • Breast damage
  • Babies feeding poorly, if at all.
  • Referral for either low milk supply or low baby weight

What to do Once Tongue-Tie has Been Found?

A frenotomy can be an appropriate option for most babies. A referral would be made to one of the following specialists to perform this quick and easy procedure: an ENT (ear, nose and throat doctor), general dentist, some pediatricians, some midwives or pediatric surgeons.

What Does the Procedure Entail?

When many new parents are told their baby might need a surgical procedure, they might become very alarmed and filled with concern. However, this office procedure takes less then one minute. Sometimes a local anesthetic or a topical analgesia is used. When the frenulum is released the tongue is then freed to make natural wide movements. This is done by making a small direct cut to the part of the frenulum that is preventing the tongue to move properly. Usually within a minute the baby can go right to the mothers breast to be calmed and also to see if a proper latch can occur. This is a very low risk procedure. On occasion, there can be short term bleeding or infection, but these complications are very uncommon.

The joy, success and the health benefits of breastfeeding outweigh the fear of this extremely common procedure. If you find that you are having any of the above mentioned symptoms, it is imperative to see a breastfeeding specialist/consultant as soon as possible to help you get breastfeeding back on the right track; before too much damage is done to the breast or the milk supply is depleted.