What Can I Do if My Baby Is Tongue-Tied and I Can’t Breastfeed?

Most people have heard the term “tongue-tied” but are unaware that babies can suffer from an actual condition called ankyloglossia, also known as being tongue-tied. New moms who are having difficulties with breastfeeding, and are also suffering from nipple pain, should have their infant assessed for a tongue-tie by a physician or lactation consultant. Although not all tongue ties cause breastfeeding difficulties, many do.

Most new moms look forward to the unique bonding experience and health benefits that breastfeeding provides. Many, however, experience some apprehension in their ability to master this new skill.

When they encounter breastfeeding problems soon after birth, new moms may blame themselves for their lack of expertise. However, the baby’s difficulty in achieving a good latch may be due to an issue they have never heard of before — a tongue-tie.

What is a tongue-tie?

If you look inside a baby’s mouth, you will notice a piece of tissue, called a labial (lip) frenulum, joining the upper lip and lower lip to the baby’s upper and lower gums. Another piece of tissue under the tongue, called the lingual (tongue) frenulum, joins the tongue to the lower jaw.

The frenulum is made of muscle fibers covered by a mucous membrane and has low blood supply. It anchors the upper and lower lips to their respective gums and the tongue to the floor of the mouth to give support for the lips and tongue.

When a lip (labial) frenulum is too tight, it limits the movement of the lips, and is called a lip-tie. When a tongue (lingual) frenulum is too short or tight, it limits the movement of the tongue. This is called a tongue-tie or ankyloglossia. This article concentrates on ankyloglossia.

Why is this important to know? During breastfeeding, the baby needs free movement of both its lips and tongue, to create a seal around the mother's nipple, in order to suckle milk from her breast. When a baby is tongue-tied, they are often unable to achieve a good latch, which impacts breastfeeding.

Symptoms of a tongue-tie

If new moms know the symptoms of a tongue-tie, and suspect this is an underlying issue to their breastfeeding problems, they will know to seek medical help. The symptoms of a tongue-tie are:

• Difficult latch. A baby’s ability to latch onto the nipple to breast feed is dependent upon their lips and tongue. A tongue-tie may prevent the baby from obtaining a good latch.
• Nipple pain. The new mom can experience nipple pain when the baby is unable to obtain a good latch and continually pulls off her breast, or from prolonged feeding by a fussy baby who is unable to get an adequate milk intake due to an incomplete latch.
• Poor weight gain. The baby is unable to get adequate breast milk with an incorrect latch, or an imperfect latch, which can cause poor weight gain.
• Heart-shaped tongue. A very short frenulum pulls on the tip of the tongue, which is especially noticeable when the baby is crying and the tongue is slightly protruded from their mouth.

Surgical repair of a tongue-tie

First of all, if your baby is tongue-tied and not having difficulty breastfeeding, then you don’t need to do anything. Tongue ties that aren't causing feeding issues may resolve on their own as the baby grows and the frenulum stretches. It is also important to recognize that there are other reasons for breastfeeding difficulties than tongue-ties.

However, if you are having difficulty breastfeeding, you should ask your physician, pediatrician, or lactation consultant to assess your baby for a tongue-tie. If they determine that your baby’s frenulum is tight and affecting your breastfeeding, they may advise that your baby have a frenotomy — have the frenulum under the tongue cut.

The procedure is simple. The physician will swaddle the baby, hold the tongue with a piece of gauze, and then make a small cut with a scalpel, scissors, or laser. Since the lingual frenulum has a limited blood supply, there will be minimal bleeding, and your baby can breastfeed immediately afterward.

Why tongue-ties are overlooked

New moms may wonder why their physician or nurse didn’t advise them that their new baby was tongue-tied. What they didn’t know is that their tongue-tied baby landed them in the middle of a medical controversy.

Historically, midwives who delivered most babies kept one long fingernail to sweep under an infant's tongue at birth, if they suspected a tongue-tie. More recently, there has been a lack of agreement in the medical community over the management and surgical intervention of tongue-ties. Since not all tongue ties cause breastfeeding issues, some physicians and nurses have stopped routinely assessing newborns.

Once a diagnosis of a tongue-tie has been made, there is a general consensus to clip the lingual frenulum, if it appears to be causing problems with breastfeeding. However, the delay in recognizing and diagnosing a tongue tie leaves many new moms feeling frustrated and unheard by the medical system.

Few babies are diagnosed with a tongue tie before leaving the hospital after delivery, and only about 50% are diagnosed within the first two weeks. This leaves new moms unable to establish their breast supply within the first few days of birth, an essential element for successful breastfeeding. They also report having increased mental health issues caused by lack of sleep due to their hungry, crying babies, from excruciating breast and nipple pain, and from feeling guilty for how their babies suffered.

If you are having difficulties breastfeeding and suspect a tongue-tie, you now have the knowledge you need to advocate for yourself and your baby.

Tips for moms of tongue-tied babies

Here are some tips you can follow if you are having difficulty breastfeeding and suspect your baby has a tongue-tie:

• Ask for an assessment. Ask your physician, nurse, or lactation consultant for an assessment if you suspect a tongue-tie.
• Insist on a timely intervention. Remind your physician that establishing your milk supply should be a priority.
• Use a breast shield. Try using a breast shield to improve your baby’s latch and decrease nipple pain.
• Ask for help. Ask a family member or friend to watch your baby for several hours, so that you can get some rest.
• Educate your healthcare provider. You may have to educate your healthcare provider about tongue-ties and that intervention is needed when the baby is having trouble breastfeeding.
• Don’t blame yourself. Feel proud of yourself for knowing the symptoms and advocating for yourself, and your baby.
• Share your experience with other moms. Many of you are on social media mommy groups. Tell the other moms about tongue-tied babies. You may be surprised how many of them are also struggling with this issue.

Breastfeeding your baby is an experience that can be challenging when you have a tongue-tied baby. With appropriate support and interventions, you can overcome this obstacle. I encourage you not to give up.