How can tongue-tie affect breastfeeding?

Breastfeeding problems that may stem from a tongue-tie (but can have other causes) include:

• Nipple pain,deep breast pain, misshapen nipples, nipple blisters, nipple vasospasm or very sore nipples for mother
• A baby who has difficulty latching on, latching deeply enough, opening his mouth wide enough or staying latched on
• A baby who has very short frequent feeds because he has to work his tongue hard to pull against the frenulum and may get tired or fall asleep at the breast before the end of a feed or a baby who seems to feed all the time butdoesn’t gain much weight
• Sucking blisters on baby’s lips—because the lips are having to compensate for poor tongue function
• Clicking sounds during breastfeeding—the sound of losing suction with the breast a
• and/or difficulty coping with milk flow
• Refluxis sometimes said to be associated with a tongue-tie

Beyond breastfeeding

In later life restricted tongue movements could cause difficulty with licking the lips or an ice-cream, or keeping the teeth clean. Speech may be affected in a small number of children as well.

Rule out other causes

Breastfeeding issues sometimes attributed to tongue-tie could be from other causes. Your lactation consultant can help identify if there are any correctable issues that could be causing pain or difficulty breastfeeding such as:

• Positioning and attachment. A shallow latch or poor positioning can also affect how a baby breastfeeds and explain pain, sore nipples, blisters, low milk supply, and clicking sounds.
• Anatomy. Babies can have difficulty with variations of a mother’s anatomy such asflat or inverted nipples, or large breasts or their own anatomy e.g. a small mouth.
• Underweight baby. A hungry baby who isnot gaining weight can have high tone, fall asleep without feeding well and accompanying poor tongue function.
• Tension from the birth. Tension or compression from a baby’s birth is thought to influence tongue function through high muscle tone and with the idea that some types of restriction can be helped with physical therapy such ascranial work ^5 6.
• Reflux/allergy. Food allergy or intolerance can be associated with reflux, difficulty breastfeeding, high muscle tone, a baby seeming unable to latch and sore nipples due to a biting action at the breast including using the tongue as a piston against the nipple as a result of baby’s discomfort.⁷ In 2020 the Australian Dental Association concluded there was not enough evidence to link reflux to tongue-tie.⁸

Is my baby tongue tied?

Identifying a tongue-tie requires assessing tongue function in the context of breastfeeding, not just looking at the appearance of the tongue or ticking off a list of symptoms. A website or virtual breastfeeding forum can’t diagnose a tongue-tie, your baby needs a face-to-face consultation with a specialist. A good place to start is by seeing an IBCLC or SACLC lactation consultant who will take a full breastfeeding history—and assess both breastfeeding and tongue function. Where appropriate, your lactation consultant can arrange a referral to a tongue-tie practitioner or you might be able to self-refer depending on the referral system in your area. A tongue-tie provider might be a dentist, ENT surgeon, or other health professional trained in dividing tongue-tie.

Assessing tongue function?

Just because there is a membrane to see, even if it is pulling on the tip of the tongue to create a heart shaped tip, it may not prevent your baby from breastfeeding, it depends how much it restricts the tongue’s movement. Equally just because there is nothing to see under the tongue, doesn’t necessarily mean there isn’t an issue with the tongue function. Your experienced lactation consultant will know how to assess your baby’s tongue function alongside the appearance. They will assess whether your baby can extend his tongue past his lip or gums, whether he can lift his tongue, cup the breast, how the tongue moves during sucking and more.