Untangling Tongue-Tie

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Lactation consultants are very skilled at identifying the causes of infant latch difficulties, and helping moms find ways to breastfeed comfortably. Sometimes baby’s latch just needs some minor adjustments, or mom may need some additional physical supports to bring infant closer while baby learns to breastfeed. If you’re struggling with persistent nipple pain despite all your efforts to position baby carefully, the problem maybe that baby can’t improve his latch because his tongue movement is restricted by a frenulum, a band of tissue connecting his tongue to the floor of his mouth. The lingual (floor of mouth) and labial (upper lip) frenulum forms early in gestation, and most of the time recedes. However, in as many as 15 percent of babies, the frenulum does not recede enough to allow baby full tongue function. The resultant restricted tongue function, called tongue-tie or ankyloglossia, can cause a host of breastfeeding difficulties including nipple compression, pain and bleeding, poor emptying of the breast leading to very frequent feedings, low milk supply, slow weight gain, gastroesophageal reflux and lots of frustration for mom. Many babies with tongue restriction also have a band of tissue connecting the upper lip to their gum called an upper lip tie, which reduces baby’s ability to flange his upper lip during feeds, contributing to a restricted latch.

It’s important to know that healthcare providers are very unlikely to have had any specific education regarding the impact of infant tongue-tie on babies ability to latch and transfer milk effectively at the breast, or to know how to assess for tongue-tie. Lactation consultants have extensive education and background in infant tongue and upper lip restriction. Assessments include not just the appearance of baby’s tongue, but the function as well. We look (and feel for) the lingual frenulum under the mucosa and assess baby’s palate, which is often narrow with tongue-tie. We assess how well baby can use his tongue muscle while suckling and measure how much milk he transfers at the breast. If latch can be made comfortable, baby transfers milk well, and does not struggle with reflux, then a “watch and wait” approach can be taken. But it latch is painful and cannot be improved or milk transfer is poor, the infant with tongue-tie is referred for release of tongue-tie, called a frenotomy.

Dentists, periodontists, oral surgeons, and some ENT’s perform frenotomies. The procedure can be done with scissors, a quick procedure to cut or remove the frenulum, which releases the tongue and allows the full range of motion. Some use lasers, which have the benefit of minimizing the amount of bleeding during and after the procedure, provide a more aesthetically pleasing result with lip ties, and allow for a more complete release of tongue restriction. General anesthetic is not necessary. Many practitioners use a local topical anesthetic, which wears off quickly, to numb the area before the procedure. This allows baby to breastfeed shortly after the procedure, which is wonderful because breastfeeding reduces pain and anxiety in little ones. With a “newly mobile” tongue, many moms notice an immediate improvement in the depth and comfort of baby’s latch.

All babies have a “learning curve” after frenotomy, as they learn to use their tongue muscles effectively. If baby is still struggling with latch, the speech and language pathologist (SLP) can help babies improve tongue strength and coordination. A pediatric chiropractor can also be helpful in resolving oral facial tension, which can limit latch.

It’s important to work with an experienced lactation consultant before, and especially after a frenotomy to release tongue and lip-tie. They play key roles in maximizing infant latch, maintaining mom’s comfort and milk supply, and providing support to breastfeeding moms. Babies are born to breastfeed. If they are struggling to latch effectively, tongue-tie might be the reason why.


by Theresa Hardy, pediatric nurse practitioner/lactation consultant







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