Tongue-Tie

As one of the International Board-Certified Lactation Consultants at Annapolis Pediatrics, I often address tongue-tie concerns with parents. Parents may be worried that their baby has a tongue tie, either from something they read on the internet, heard from a friend, or even was told by a member of the healthcare team when their baby was born. Sometimes parents worry that a tongue-tie may affect their baby’s ability to breastfeed.   Spoiler alert – a tongue tie is not always a barrier to successful breastfeeding!   

~ Meaghan Rosso, RN, IBCLC

There has been growing interest in tongue-ties over the years as seen by a dramatic increase in the diagnosis and treatment of tongue-ties globally (Academy of Breastfeeding Medicine). According to a recent New York Times article, titled “Inside the Booming Business of Cutting Babies’ Tongues,” published in December 2023, google searches for “tongue tie” reached a record high in June 2023, and Ear Nose and Throat specialists in 25 states said they have seen a sharp increase in requests for tongue-tie consultations.  There is also heightened concern from pediatricians that unnecessary procedures may be taking place especially since there is a lack of high-quality evidence-based studies to help determine the optimal management (Academy of Breastfeeding Medicine).  As well, surgical procedures for tongue-ties have risks and do not always solve the underlying breastfeeding issues.

What is a Tongue-Tie?

Tongue-tie, also known as ankyloglossia, is a condition present at birth in which the sublingual frenulum, a fold of tissue that connects the tongue to the floor of the mouth, is short or thick or tethered to the tip of the tongue, causing the tongue to not have full range of motion.

Should I be worried that my baby has a tongue-tie?

The presence of a tongue-tie is not always a barrier to successful breastfeeding and there are many cases where babies even with significant tongue-ties latch well and transfer well while breastfeeding.  Sometimes a tongue-tie is not the reason a baby is not latching well.  Working with your pediatrician and having skilled lactation support may help answer questions or concerns you may be having.  Some questions to ask:

1 – Tongue – Does the tongue have a notch or heart shaped appearance? Does the tongue appear to not extend beyond the lips? 

2 - Is there difficulty with breastfeeding?  Is your baby not latching well to the breast, not staying latched or appearing frustrated trying to latch to the breast?

3 – Pain – Is the mother experiencing significant pain in the presence of a tongue-tie?

4 – Weight – Is the infant having trouble gaining weight?

Management of Tongue-ties

A great place to start for evidence-based information is talking to your baby’s pediatrician about your questions and concerns.  Your pediatrician can assess for tongue-ties and help provide information, weigh the risks and benefits of each approach to tongue-tie management, and provide any necessary referrals.  Oftentimes, conservative management and skilled lactation support may help improve breastfeeding outcomes by assisting with latch and position and observing a breastfeeding session.  Over time, a baby’s ability to latch effectively may improve with overall growth.  On-going support and follow up is often helpful.

In some cases, an infant may be referred to an Ear Nose and Throat specialist for evaluation.  A frenotomy, the surgical release of a restrictive tongue-tie, may be recommended if a mother’s pain and/or poor milk transfer during breastfeeding cannot be corrected in a timely way through conservative measures.  As with any intervention, there are risks and benefits that need to be considered.  There are several methods of frenotomy but the goal is to perform the surgery in the least invasive way possible to give the tongue increased range of motion and improve breastfeeding outcomes.  It is very important to work under the guidance of your pediatrician to ensure your baby is referred to the proper skilled clinician for the frenotomy because it is not without risks.

Lip ties

Some parents worry that their baby has a lip-tie.  The upper labial frenulum is a normal structure with poor evidence for intervention improving breastfeeding (Academy of Breastfeeding Medicine).  Oftentimes, skilled lactation support may help with latch and position in these cases. 

Conclusion

If you are concerned that your baby has a tongue-tie or is having difficulty breastfeeding, it is best to start with your most trusted resource, your pediatrician’s office.  There is a lot of inaccurate information on the internet and social media and your pediatrician’s team can help address any questions or concerns you may have.

Please give us a call to schedule an appointment with your Annapolis Pediatrics provider or one of our Lactation Consultants to discuss further if you are concerned about tongue-tie, lip-tie or any other feeding concerns.