Diagnosing Tongue-Tie in a Breastfed Baby
Tight Frenulum Can Cause Painful Breastfeeding and Poor Weight Gain
Nov 15, 2008
During the decades where bottle-feeding was the norm, medical professionals fell away from diagnosing and treating tongue-tie, a common and easily-remedied breastfeeding problem. As a result, today’s breastfeeding moms may have trouble finding a doctor who can recognize and treat the problem. However, left untreated, tongue-tie can not only destroy the breastfeeding relationship, but may cause additional health problems as the baby grows.
What is Tongue-tie?
Tongue tie is a congenital malformation where the membrane attaching the tongue to the bottom of the mouth (the frenulum) is too tight and restricts proper movement of the tongue. The abnormally tight frenulum does not allow the baby’s tongue to move properly during breastfeeding, and can cause pain and nipple damage. If the baby is not able to extract enough milk, he may go hungry and be at risk for poor weight gain and dehydration.
Types of Tongue-tie
- Classic Tongue-tie. This is diagnosed when the frenulum is attached to the tip of the tongue or 2-4mm behind it. Many midwives, doctors and lactation consultants can easily spot this type of frenulum restriction. It may create a heart shape or notch in the tip of the tongue as the baby tries to lift or extend it. The tongue may also appear to roll forward.
- Posterior Tongue-tie. With posterior tongue-tie, the frenulum is tightly attached between the mid-tongue and the middle of the floor of the mouth or is attached at the base of the tongue and is very thick, shiny and inelastic. This type of restriction is more difficult to spot as the tip of the tongue does lift, but not as much as it should.
How Does Tongue-tie Affect Breastfeeding?
Restriction of the tongue makes breastfeeding painful and can result in the baby not getting enough to eat. In their new book, The Breastfeeding Mother’s Guide to Making More Milk [McGraw-Hill, 2008], International Board-Certified Lactation Consultants Diana West and Lisa Marasco explain why:
“A baby's ability to draw milk from the breast depends on his ability to move his tongue freely. In order to grasp an adequate amount of breast for latching deeply, his tongue must comfortably extend past his lower lip. To stabilize the breast, the sides of the tongue need to be able cup it. Finally, the tip of the tongue needs to be able to lift higher than halfway when the mouth is open, while the back of the tongue needs to lift and then drop to create the vacuum that pulls out milk.” [permission granted by Diana West, 2008]
If the baby is not successfully emptying the breast and triggering the supply-and-demand function that sustains breastfeeding, the mother’s milk supply can suffer as well. Low milk supply combined with latch problems associated with tongue-tie can cause a mother to lose confidence in her ability to breastfeed and to ultimately quit.
Symptoms of Tongue-tie
How can a struggling breastfeeding mother know if her baby is tongue-tied? In their book, West and Marasco list a number of clues, including:
- latch trouble
- sucking blisters on the lips
- chronic sore nipples
- "clicking" or "popping" sounds during breastfeeding
- a persistently abraded nipple
- flattened nipple when baby unlatches
- baby tires at breast, then awakens soon, hungry again
- consistent, long, “marathon” feedings
- tongue tremor
Treatment for Tongue-tie
If a breastfeeding mom thinks her baby might have tongue-tie, she should see a medical professional as soon as possible to have it diagnosed. Treatment for tongue-tie is usually a simple snipping of the frenulum, called frenotomy. Because the frenulum tissue has few nerve endings and blood vessels, the procedure does not usually cause the baby much pain or bleeding. Nursing right after the procedure is often enough to comfort a baby after frenotomy.
How to Diagnose Tongue-tie
Unfortunately, if a baby has posterior tongue-tie, even a medical professional may not be able to properly diagnose it. West and Marasco suggest, “In discussing the possibility of tongue-tie with your baby's doctor, it may be helpful to refer him or her to Supporting Sucking Skills in Breastfeeding Infants by Catherine Watson Genna, BS, IBCLC [Jones & Bartlett Publishers, 2007], for detailed tongue-tie diagnostic criteria and treatment information.”
In their book, West and Marasco also describe the Murphy Maneuver, which involves running a finger along the underside of the baby’s tongue to assess possible frenulum restriction. West also provides a list of care providers familiar with tongue-tie on her website.
Other Tongue-tie Complications
Even if a mother is bottle-feeding, she should still have her child’s tongue-tie treated. Unclipped tongue-tie can lead to several health problems in childhood and adulthood such as reflux, speech impediments, snoring, sleep apnea, dental problems and indigestion. While tongue-tied babies can often bottle-feed without issue, some will still be unable to feed effectively without a frenotomy.
Mothers who are having trouble breastfeeding should consult a midwife or lactation consultant about the possibility of tongue-tie. Treatment is usually quick and relatively painless, and catching the problem early can save the breastfeeding couple days, weeks or even months of painful nursing, poor weight gain, unhappiness, and eventually low milk supply and early weaning.
