Soleak Sim, MD, a pediatrician with Children’s Pediatricians & Associates Foggy Bottom/Capitol Hill, discusses tongue-tie in infants for new parents.
Is my baby tongue-tied? This has become a very common question posed by new parents.
The most recent Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card indicates that 79 percent of newborn infants born in 2011 started breastfeeding. Compared to a rate of about 30 percent in the 60s and 70s, 79 percent is a great achievement. As more moms are initiating breastfeeding, primary care providers are seeing more moms with breastfeeding difficulties. Pain with breastfeeding is a barrier to breastfeeding success, and tongue-tie (medically known as ankyloglossia) is often identified as a potential cause of breastfeeding pain. Tongue-tie is a condition that is present at birth restricting the tongue’s range of motion because of an unusually short, thick, or tight membrane (lingual frenulum) that connects the bottom of the tongue’s tip to the floor of the mouth.
Breastfeeding and latch problems
When evaluating difficulties with breastfeeding, the first step is to evaluate the latch, as a good latch is essential to breastfeeding success. When latched-on well and breastfeeding effectively, a baby uses her tongue to pull her mom’s breast - nipple and areola included - into her mouth. Using her tongue and lips, she forms a seal over the breast allowing her to suck and transfer milk from mom’s breast into her mouth. A good and deep latch allows baby to breastfeed and gain weight appropriately. Meanwhile, mom does not experience too much pain.
A shallow latch, on the other hand, puts a lot of pressure on mom’s nipples as the baby tries to breastfeed. This usually causes mom significant pain. A shallow latch also leads to inefficient breastfeeding, which causes baby to experience fatigue and sometimes poor weight gain. A baby who is not latched on deeply also tends to slip off during breastfeeding causing breastfeeding to take a long time.
Many latch problems can be corrected with proper positioning of the infant’s head and body in relationship to mom’s breast and by ensuring that the baby’s mouth is open wide before latching on the baby. Along with primary care providers, lactation consultants are great resources for new parents who are working through breastfeeding difficulties. Many parents have access to counseling with a qualified lactation expert at a low cost through their insurance. Check with your insurance provider for details related to your specific plan.
What should you know about tongue-tie?
Some moms continue to have breastfeeding pain despite doing everything right, and this is when the tongue-tie question usually comes up in conversation.
There was a time when the medical community believed that tongue-tie did not cause breastfeeding problems, so the issue was not addressed. Moms either suffered through painful breastfeeding or just gave up and switched to bottle-feeding. However, recent research and much anecdotal experience from pediatricians and lactation consultants have indicated that tongue-tie can adversely affect breastfeeding.
Some tongue-ties are easy to see. In a severe tongue-tie, the lingual frenulum (the piece of tissue underneath the tongue) is attached at the very tip of the tongue. As the newborn tries to extend his tongue, the tongue becomes heart-shaped as the tight frenulum prevents the tongue from extending past the gums, causing an ineffective and painful latch. Most tongue-ties are less obvious. The lingual frenulum may be placed more towards the tip of the tongue but not at the very tip.
It’s important to note that not every baby who has a tongue-tie will have difficulties breastfeeding or be impacted in any way. Some babies who look to have somewhat tight lingual frenulums are able to breastfeed just fine. When evaluating a tongue-tie, it’s the baby’s ability to transfer milk and mom’s level of comfort that is more important than how the tongue looks.
For a mom who is having ongoing breastfeeding pain, the biggest question is whether releasing the tongue-tie will make breastfeeding better. According to a study published in the Journal of Pediatrics and Child Health in 2005, only 83 percent of women reported improved breastfeeding after tongue-tie release. The procedure to release the tongue-tie itself, called frenotomy, however, is fairly straightforward. It is usually done by pediatric otolaryngologists (ear, nose, and throat specialists), oral surgeons, or dentists in their offices. Babies can breastfeed immediately after the tongue-tie release.
If you are having persistent breastfeeding difficulties, talk to your primary care provider. He or she will start by evaluating the latch and looking at your baby’s tongue. Your provider can refer you to a specialist who will further evaluate if there is a significant tongue-tie and perform the release, if needed.