One in seven babies are born with this condition, which can make it difficult (but not impossible) for a baby to breastfeed.
By Karen Gordon
Looking after a new baby can be overwhelming, but when an infant has problems breastfeeding due to tongue-tie (also known as ankyloglossia), it can feel all the more stressful for a new mother. Some babies with tongue-tie can breastfeed perfectly, while others may experience difficulty.
With so much talk and conflicting information on the subject, we speak to lactation consultant Katherine Fisher from Kings College Hospital, about tongue-tie and how to feed your baby:
What is tongue-tie?
We all have a frenulum, which is the string of tissue underneath the tongue. Tongue-tie is present when this piece of tissue, which bridges the gap between the underside of the tongue and the floor of the mouth, is abnormally short and tight, restricting the tongue’s movement. This can prevent the baby from feeding properly.
‘Frenula tissue only becomes a tongue tie when it stops the baby from moving their tongue in a particular way,’ says Fisher. ‘So babies can have frenula tissue right to the tip of the tongue, which you can see very clearly, but if they can move their tongue perfectly then it wouldn’t need to be treated.’
The types of tongue-tie
There are two types of tongue-tie: anterior and posterior. Anterior tongue-ties are attached to the tip of the tongue and are very obvious to see. Posterior are thicker and further back and you don’t see the restrictive tissue because it’s hidden by a sheet of tissue at the back of the tongue.
Do doctors check newborns for tongue-tie?
Checking for tongue-tie is no longer part of the newborn examination, although the NCT and Unicef Baby Friendly are trying to change this.
‘The examination of the new born is to check that the palate is complete and that the baby is able to suckle,’ says Fisher. ‘Discovering tongue-tie is usually done by accident by either the midwife, health care assistant or parent themselves. But at this stage they they would only really notice an anterior tie.’
Is tongue-tie common?
One in seven newborn babies will have tongue-tie and 20 per cent of these will have posterior tongue tie. It’s also more common in boys than girls and there’s also a strong genetic tendency for it. But one of the main problems with tongue-tie is the limited evidence that babies actually need a tongue tie division.
‘NCT is aware that some parents do not receive adequate assistance if their baby is experiencing problems feeding which are related to a tongue-tie,’ says NCT Senior Policy Advisor, Rosemary Dodds. ‘There is a wide variation in provision across the UK, with some areas having no NHS provisions and apparent over-diagnosis in others.’
Does tongue-tie affect breastfeeding?
Breastfeeding can be affected because the baby isn’t able to elevate their tongue, stick it out beyond their lower lip or move it fully up and down or side-to-side. This can affect latching onto the breast and also feeding. Some babies will suck extra strongly to compensate for their restricted tongue movement.
Other potential tongue-tie issues
Alongside breastfeeding, there are other potential issues for mother and baby if tongue-tie is present, such as:
- Pain and trauma of the mother’s nipple.
- The baby having multiple attempts at latching.
- The baby taking in a lot of air.
- Colic and reflux symptoms.
- Problems with feed frequency – the baby feeding very frequently and not appearing satisfied.
- Poor weight gain.
- Too much weight gain.
- The baby generally being unsettled.
- Problems with the milk supply. The baby can up-regulate the increase of milk supply or down-regulate it, so there is less.
- The baby doesn’t sleep well because it’s not feeding enough.
Is tongue-tie always a problem?
The good news is that if the tissue of the tongue-tie is quite thin and delicate, and the baby can move their tongue properly, then the baby will be able to make adaptations and will manage to breastfeed, so tongue-tie is not necessarily cause for concern.
‘The main thing is that while you’re waiting to see if the baby adapts to feeding, is to make sure that you’re maintaining a regular supply of breast milk to your baby, so they are still getting the calories they need,’ says Fisher.
Can you fix tongue-tie?
Tongue-tie division (also known as frenotomy) involves cutting the short, tight piece of skin under the tongue. ‘In my practice we use an instrument that lifts the tongue and protects the tongue and under tongue blood vessels from trauma,’ explains Fisher.
‘The tongue is raised and then the frenula tissue is put under tension and then divided using some blunt tip curved scissors. The procedure is not complete unless a diamond shaped wound under the tongue is achieved. Other practitioners may use other methods.’
Frenotomy risk factors
The potential problems with this procedure is that tongue-tie can reoccur again. ‘The major risk is reoccurrence, so in our centre we advise parents to do wound care, frequent feeding and to avoid bottles and teats in the early days following the surgery,’ says Fisher.
‘The frenotomy is not an instant fix, and should be included in an individualised plan to improve breastfeeding. The baby may have adapted to feeding in a certain way because of their tongue tie, so it can take days or even weeks to relearn how to feed.’
Breastfeeding help and support
Most GPs will not be familiar with anterior variants of tongue-tie. If you feel that despite all the support you’ve had that your breastfeeding still isn’t right, then you should see a breastfeeding specialist or a lactation consultant.
‘Women can go to drop-ins and are told that the latch looks perfect, but actually the mother may be still experiencing pain and distortion of the nipples,’ says Fisher. ‘If a mother feels like she has done everything she can and her feeding still isn’t quite right, then she should get some expert advice from a breastfeeding specialist or a lactation consultant.’