One in seven babies are born with ankyloglossia, which can make it difficult (but not impossible) for a baby to breastfeed.
Medically reviewed by Dr Juliet McGrattan (MBChB) and words by Karen Gordon
Is your newborn infant experiencing problems breastfeeding or just seems unsettled? Tongue-tie, also known as ankyloglossia, is a condition present at birth that can restrict the range of motion of your baby’s tongue and may impact breastfeeding.
However before you start panicking, tongue-tie won’t necessarily cause any problems at all and some babies with tongue-tie can breastfeed perfectly, while others may experience difficulty and require a simple surgical procedure for correction.
We speak to lactation consultant Katherine Fisher from Kings College Hospital, about tongue-tie symptoms, treatments and how to effectively feed your newborn 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, although some babies can get along fine with it.
‘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.’
Posterior tongue-tie or anterior tongue-tie
There are two types of tongue-tie:
• Anterior tongue-tie
Anterior tongue-ties are attached to the tip of the tongue and are very obvious to see.
• Posterior tongue-tie
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.
🍼 If you have concerns about tongue-tie or your baby experiences problems feeding, speak to your midwife or healthcare advisor.
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, healthcare 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. But 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, including the following:
- Pain and trauma of the mother’s nipple.
- The babyhaving 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.