Tongue-tie (ankyloglossia) is a condition in which the thin piece of membrane under the baby’s tongue (the lingual frenulum) extends further than usual towards the tip of the tongue. This can limit the forward and upward mobility of the tongue. Tongue- tie is often hereditary, being more common in boys (60%).
Sometimes tongue-tie causes no problems at all and requires no action. If your baby has Tongue tie, yet is still feeding well and gaining weight, it may not even be noticed.
Tongue-tie can interfere with a baby’s ability to suckle efficiently at the breast. This may lead to nipple pain and trauma, poor breast milk intake and a decrease in milk supply over time.
The decision to release a tongue-tie often depends on a clinician’s belief about the possible impact on feeding. Currently, clinicians are divided in opinion, which can lead to confusion for parents. Clinicians who work closely with breastfeeding mothers and babies, will base their decision following assessment of the baby’s mouth, breastfeeding ability and maternal nipples and comfort during the feed.
If breastfeeding is painful for the mother, if there is poor milk transfer, poor weight gains for baby and there is a significant tongue-tie, then release has been found to improve the baby’s ability to breastfeed.
The most immediate impact of tongue-tie is on the baby’s ability to breastfeed effectively.
Long term the impact of Tongue tie for some people can include;
- There may be an effect on ongoing oral hygiene,
- the ability to lick an icecream,
- the articulation of sounds such as’t’, ‘d’, ‘l’, ‘th’, and ‘s’( because it restricts the ability to elevate the tongue)..
Indications of Significant Tongue Tie
- nipple pain and damage
- a misshapen nipple after breastfeeding
- a compression / stripe mark on the nipple after breastfeeding
- the baby often loses suction while feeding and sucks in air
- a clicking sound may be heard while the baby is feeding
- poor weight gains
- tongue cannot protrude beyond the baby’s lips
- tongue cannot be moved sideways
- tongue tip may be notched or heart-shaped
- with tongue extention, the tongue tip may look flat or square instead of pointed.
A Lactation Consultant or experienced clinician will conduct a thorough assessment of breastfeeding and infant tongue mobility to determine whether release is required.
If the frenulum is thin and the baby is less than four months of age, the frenulum can be released as an outpatient procedure without any anaesthesia. A baby who is older than four months of age or one whose frenulum is thick, will usually need to be referred to a specialist.
The baby is held firmly and the clinician places a finger and thumb under the baby’s tongue to gain clear access to the frenulum which is released with a small pair of sterile scissors.
A drop or two of blood at the release site is normal and is rarely a problem. Following the procedure, the infant will be returned to the mother for feeding. The feed will be assessed by both the mother and the clinician.
Possible complications of the procedure are bleeding or infection, but the incidence of these occurring are extremely rare. Occasionally, during the healing process a small white patch may be seen under the tongue of some infants, this is normal and should resolve within two weeks of the release. If you have any concerns following the procedure, please contact your Lactation Consultant, Maternal and Child Health nurse, Paediatrician or your general practitioner.
Thank you to Katrina Christ Photographer for providing the images in this post.