Breastfeeding and Tongue Tie
By Jennifer Clark, IBCLC. Revised February 2022.
What is a tongue tie?
A tongue tie or restricted lingual frenulum is when the lingual frenulum, the piece of tissue that tethers the tongue to the floor of the mouth, is restricted. The lingual frenulum (the small bit of skin) is present in 99.5% of healthy infants and is normal. However, if movement of the tongue is restricted and affecting breastfeeding then support is required.
How can baby be assessed for a tongue tie
Your baby will need an oral exam to assess tongue function. This must be by a trained professional who will use a gloved finger to assess the way your baby moves their tongue side to side, whether they can lift the tongue sufficiently and stick the tongue out past the gum and lip. Sometimes a cleft in the tongue can be seen giving it a heart like appearance and is more obvious in some babies. However, in other babies it is more difficult to notice.
This assessment needs to be performed by a Midwife, Health Visitor, or IBCLC. Some Doctors (Paediatrician’s and GP's) may be able to perform an assessment but not everyone is trained. It is important to remember that the only people who can say a baby HAS a tongue tie are Tongue Tie Practitioners. Everyone else can refer based on a restriction.
Newborn with a posterior restrictive lingual frenulum
8 year old with a restrictive lingual frenulum
This image shows a baby being assessed for the lift (or elevation) of the tongue.
This image shows a baby being assessed for the extension of the tongue.
How can a tongue tie affect breastfeeding?
Research shows that babies who have a restriction in tongue movement can find it more difficult to feed and some may not be able to latch at all. They may struggle to get a deep latch onto the breast resulting in the mother having sore nipples which may become cracked or bleed. Due to the shallow latch babies may not remove milk efficiently which can impact on weight gain, nappy output, jaundice (in the early days) and in turn affect a mother’s milk supply (milk supply is built on demand and supply). Baby may slip off the breast during feeding, feed often due to not being able to remove milk efficiently, click while feeding as he is unable to maintain suction or splutter and choke due to difficulties coping with milk flow. You are more likely to experience blocked ducts, blebs, and mastitis due to inefficient milk removal. If baby is taking bottles they may click, struggle with flow and take in a lot of air during feeding.
How can I improve feeding with a tongue tie?
First thing is to ensure that your positioning and attachment is as good as possible to help baby latch well. Breast shaping may be helpful
Exaggerate the latch
Ensuring baby is in a good position (looking up to the nipple as opposed to the nipple being in line with the mouth), shaping the breast and pointing the nipple up can help get a deeper latch. Some babies may need you to hold this position at the start of the feed or throughout.
See this video for more information How to latch a baby using the exaggerated latch technique. - YouTube
Breast compressions are simple but can make a huge difference to the amount of milk your baby gets. Compressing the breast when the baby sucks and releasing when he stops. By doing this you increase the pressure on the milk ducts to release more milk to the baby.
See this video for more information Breast Compressions - YouTube.
What happens if my baby has a tongue tie?
If there is thought to be a restriction your baby should be referred (with your consent) to the local clinic for further assessment and diagnosis. If the tongue tie practitioner believes there is a restriction, they will offer a frenulotomy. This means cutting the frenulum to release the tongue. In young babies this is done quickly and rarely with any complications. Research shows that 96% of infants that did not improve feeding after good lactation support did after frenulotomy.
What do I do while I wait for my appointment?
Continue to improve your baby’s latch as discussed above. If your baby is not feeding well and not gaining weight adequately (around 30g/day) it maybe advised to give them some expressed breastmilk after a feed. It is also very important to establish your milk supply if baby is not removing milk from your breasts effectively. See Expressing breastmilk | My Site (lowestoftandwaveneybreastfeeding.co.uk)
If extra milk is needed this can be given by cup, finger feeding, supplementer tube or bottle. If bottles are being given paced bottle feeding is advised to help baby transition well between breastfeeding and bottle feeding as well as to avoid overfeeding. Paced bottle feeding - https://youtu.be/OGPm5SpLxXY
Breastfeeding with a tongue tie can be very painful and cause damage to nipples. Nipple shields may be a useful option for helping to continue breastfeeding. Before resorting to nipple shields ask for help and support.
Nipple Shields Good or Bad? - Breastfeeding Support
Please contact us if you have any questions or concerns about the above information.