Doctors’ Notes


Tongue Tie

Breastfeeding is the biological norm for babies, though it does not always come easily. Some mothers may encounter challenges with breastfeeding, ranging from sore nipples, latching difficulties and slow weight gain in baby.

Sometimes we hear parents voice their concern that these challenges may be due to a tongue tie. Clinically termed ankyloglossia, a tongue tie is a restrictive lingual frenulum (frenulum being a fold of skin that supports or restrains motions of a body part – in this case the tongue). It should not be defined solely by appearance, but rather how it interferes with normal breastfeeding. Simply being able to see a frenulum does not mean there is a problem.

The mobility of the tongue plays a vital role in breastfeeding. The baby’s tongue needs to extend past the gumline, lift upward and cup the breast tissue to transfer milk from the breast. Despite what the tongue may look like, if it cannot perform these functions, then the mother/baby pair may encounter issues with sore nipples and feedings that are long and ineffective (due to inability to transfer milk). All of this can lead to poor infant weight gain, low milk supply for the mother and the potential to stop breastfeeding before the mother had wanted.

The prevalence of tongue tie is estimated to be somewhere between 2-10% depending on the criteria used to diagnose. Research shows us that the majority of breastfeeding difficulties are related to latch and positioning, which is why it’s so important to observe the breastfeeding as a whole. How is the mother latching the baby at the breast? Is she bringing breast to baby rather than baby to breast? Is baby achieving a deep latch? There is not one standard position in which to breastfeed a baby, however baby should be latched well in whatever position is used.

The first step in the process is a thorough feeding evaluation to assist families with tips on how to get a good latch, and to know how to tell the baby is feeding actively at the breast while transferring milk.  A medical provider should fully evaluate the baby’s oral function including suck and tongue function and make recommendations if restriction in function is noted. If a frenotomy (the procedure to clip the frenulum) is performed, a follow up with lactation to observe the breastfeeding is recommended and encouraged.

If you are having any breastfeeding concerns, including nipple pain, poor latch or question if your baby might have a tongue tie, we’d be happy to see you in our office. Give us a call and one of our lactation consultants can help you determine the next best step.

Wendy Eson, IBCLC, CEIM, is the Manager of our Breastfeeding Center of Pittsburgh