Recently the subject of tongue ties has become more ubiquitous than ever. Not because there are more cases, but we’re finally starting to understand their link to breastfeeding. We asked Mary Thomas, MD, a Board Certified pediatrician well versed in the subject, to explain a bit more about when to intervene, when not to and what they are in the first place.
Dr. Molly Thomas:
Tongue-tie (medical name Ankyloglossia) is a hot topic in recent years as more and more new mothers are understanding the importance of breast milk and breastfeeding—and even the most minor case of tongue tie may interfere with it. Often it’s diagnosed on the baby's first physical in the newborn nursery, noticeable when a short piece of tissue (the frenulum) is restricting the movement of the baby's tongue either from side to side or outward past the bottom lip. In severe cases the baby's tongue may be notched or heart-shaped when protruded. If the tongue tie is minimal or very subtle it may not be noticed at birth and may only be detected as the baby tries to breastfeed.
Why do tongue ties interfere with breastfeeding? A baby needs to have mom's breast further back in the pharynx than a synthetic nipple from a bottle and the tongue needs to protrude from the mouth further in order to breastfeed. So if you’re bottle feeding your baby, you may have a child with a tongue tie but not even notice because it doesn’t present any issues. For breastfeeding, however, a tongue tie can cause feeding problems as the baby is not able to create a seal around the breast and/or motion of the tongue is limited while sucking. Feedings will be slow because of an ineffective suck or latch. Babies can get tired from the extra work this requires and may fall asleep during a feeding before they’re finished, therefore failing to gain weight in the first few days of life. They also, no surprise, struggle to keep a pacifier in their mouth.
An early sign that this might be an issue for a new mom is that she notices her nipples are irritated or skin around the nipple because is chafed because there is too much friction from feedings. Her baby may also keep dropping the pacifier out of their mouth.
Reported prevalence of tongue tie varies depending on the population studied and the criteria used to diagnose but experts agree that tongue ties affect between 1-10% of the general population. It is widely believed to be more common in boys and can either be inherited of spontaneous.
There is a lack on consensus among clinicians regarding how, when or even if to treat it. Most pediatricians agree that if there is no feeding issue, it is best not to intervene. For severe tongue ties there are potential consequences that may come if it is not clipped. For example although it does not cause a delay in onset of speech, it can cause problems forming certain sounds such as “T”, “D” and “Z”. There can also be problems with oral hygiene as a child may not be able to lick their lips or sweep food debris from the side of the teeth. This can lead to cavities or gum disease. Difficulty licking an ice cream, playing a wind instrument or kissing can also be issues.
Oftentimes, because of these challenges with tongue tie or breastfeeding, mothers will opt to pump breast milk and feed with a bottle or may abandon breastfeeding altogether and use formula. What saddens me most about that this is often accompanied by a feeling of failure when a mom feels her original plan to feed her child is not achievable. The truth is, whether you are a mom with a tongue-tied baby or a mom with a great feeder, breastfeeding is hard. It's a task fraught with lots of challenges from waiting for your milk to come in (which can take more than 72 hours in a C-section) to painful nipples when your baby starts teething. It is both one of the most challenging and most rewarding things we do as new moms.
I often see women give up when they don't have enough support. For this reason it is a good idea to consult your pediatrician or even a breastfeeding consultant if you are having trouble. Mixed messages from mother-in-laws and sisters and even best friends can make a new new mom feel even more hopeless. Trust the experts. Get support from your pediatrician or your local breastfeeding consultant. With a bit of help, most babies with tongue tie are able to breastfeed well even without minor surgery.