Tongue tied baby

Tongue tie

Usually, your tongue is attached to the base of your mouth by a piece of skin called the lingual frenulum.

If your baby has a tongue-tie, this particular piece of skin might be unusually short or tight, causing a restriction of the tongue.

Tongue-ties often run in families, and it can be more common in boys than girls. 

Studies show that between 3% to 16% of babies may have a tongue tie, and half of those babies may experience breastfeeding difficulties because of that.

Some may have problems when feeding from a bottle.

When feeding at the breast, a baby may come on and off, or not be able to latch properly.

It can cause trauma to nipples, and may even cause a problem with poor weight gain.

If your baby has an anterior frenulum, it’s usually quite easy to identify. Your baby may have difficulty raising his tongue upwards to the roof of his mouth.

Extending it forward can also be difficult, and even side to side movements of the tongue may be difficult. The tongue may appear heart-shaped in the process.

You may also have heard of the term ‘posterior tongue tie’.

This is a relatively recent idea that the tongue may be restricted further back and underneath the tongue, where it cannot be easily identified just by looking at it.

It usually is diagnosed by pushing back underneath the tongue at the base.

Mum and baby lying down while baby breastfeeds

During breastfeeding, your baby’s tongue needs to move in many different ways to be able to access milk – it’s a real workout! It needs to be able to freely move sideways, forwards, and upwards. 

There’s an oscillating movement as your baby is suckling.

Your baby’s mouth opens wide to attach at the breast. His tongue has to extend forwards over the lower gum and scoop up breast tissue. 

So you can imagine that if your baby does have a tongue restriction, it could impact on the mechanics of the feeding, and it might have implications for yourself too.

Look at the information relating to the possible signs that may reflect the presence of a tongue-tie.

If your baby has an obvious tongue-tie but is breastfeeding well and not causing any pain for you, there is no solid evidence to suggest he will have other related problems in the future if the tongue-tie is not released. 

However, for some babies, there could be an impact on dental development or speech difficulties. 

There is evidence that continuing to breastfeed after the procedure to release the tongue-tie can help to develop the baby’s mouth and palate correctly.

It also appears that the tightness of the frenulum can change over time.

If your baby is diagnosed with a tongue-tie, and you feel that it is impacting on breastfeeding, get a full breastfeeding assessment with a professional who understands about lactation.

Then you can work out a plan, and decide whether a referral for tongue-tie division needs to be made.

For some babies who have a tongue-tie, they feed well for the whole length of breastfeeding with no issues for baby or mum.

Other babies have real difficulties at the breast and have caused distressing issues for mum.

Equally, some babies who have had a tongue-tie division procedure carried out, have unfortunately had issues carrying on, suggesting that there were other possible factors.

So although we know that tongue-tie division can be a really successful procedure to help you to reach breastfeeding goals, it isn’t always the answer.

Clearly, tongue-tie does exist, and the gene identified for such.

Mum sat up in a bed while breastfeeding her baby

The procedure itself is a simple one that can potentially offer significant benefits to both mother and baby in their breastfeeding relationship.

An IBCLC and cranial sacral therapist, Hazelbaker, agrees with this and has put forward the idea that there are other causes of tongue-tie restriction too.

She has suggested that these restrictions may be caused by damage or strain to ligaments, tendons, muscles, or nerves while your baby is in the womb, or during the birth process itself.

Before she suggests a tongue-tie division, she encourages optimal positioning, which can help to realign babies, and also other therapies like cranial osteopathy or cranial sacral therapy.

Studies do seem to back up the idea that good optimal positioning, particularly laid back positions too, can help babies to become realigned, but it can take a few weeks for this to happen.

For some mother and baby pairs, with all the difficulties that a tongue restriction can bring, such as painful nipples and difficult feeds, waiting for weeks for things to improve can be too distressing. 

Those added therapies could make a difference, but it is also essential for an IBCLC to reassess again, and together with mum, decide whether a referral for tongue-tie division is perhaps useful.

So finally, if you are having breastfeeding difficulties, seek out skilled support to enable you to look at all of your options, and work out what is exactly going on, with a full breastfeeding assessment.

Review dates, references & further resources

Review Dates

Version 1.1 published in March 2019. Next review date: Jan 2022


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