Tongue-tied infants and breastfeeding

What is tongue-tie? 

Some infants are born with a medical condition called tongue-tie, whose technical name is ankyloglossia.

During pregnancy, the cord-like piece of tissue that connects the tongue to the floor of the mouth—called the lingual frenulum—guides the development of the structures of the mouth. After birth, it gradually thins and detaches from the front of the tongue.

But occasionally the frenulum stays thick and remains attached. For these babies, it’s either too short, too thick, or too close to the tip of the tongue, so it restricts the tongue’s movement. A common sign of severe tongue-tie is a “heart-shaped” or “v-shaped” tongue. 

Why it matters in breastfeeding

During breastfeeding, the tongue extends over the gum line and protects the breast from the bony jaw below. If movement of the tongue is restricted, the baby may not be able to form a tight seal, create positive pressure, and maintain a proper latch. Without a proper latch, the baby can’t remove milk from the breast and breastfeeding is often painful for the mother. 

When to consider treatment

Since tongue-tie generally causes no problems for bottle-feeding infants, and some breastfed infants also feed without problems, it may go undiagnosed.

But breastfed babies with severe tongue-tie—who can’t extend their tongue past their gum line or touch the roof of their mouth—may not be able to achieve a proper latch, and the condition may cause nipple damage and pain. Tongue-tie can also result in poor milk transfer and problems with infant weight gain and maternal milk supply.

Treating tongue-tie involves a simple surgery in which tissue is cut to allow greater movement of the tongue. It can usually be performed by your baby’s doctor or dentist. In most cases, it gives immediate relief—babies are able to latch on well, and breastfeeding is no longer painful for the mother. Some babies may need several days of practice to learn to latch now that their tongue can move freely in and out and up and down. The procedure has few complications.

Should your baby have this surgery?

The medical community still hasn’t reached consensus about the diagnosis and treatment of tongue-tie. Until more research is available, clear recommendations can’t be made about the procedure. Anecdotally, many mothers whose babies have the surgery report resolution of their pain.

If you experience poor milk removal and persistent pain while breastfeeding, you may consider treating your baby’s tongue-tie. Here are three factors to keep in mind:

  • Most cases of tongue-tie require little or no treatment other than paying careful attention to your baby’s latch. Most babies with short frenulums adapt over time, so health care providers are often reluctant to intervene surgically.
  • Nipple pain has a myriad of causes in addition to tongue-tie and usually resolves after several days or weeks. Some pediatricians now recognize 2–3 weeks of unresolved pain during breastfeeding as an indication that intervention is needed.
  • Infants with severe and ongoing tongue-tie may require treatment if it interferes with speech development.

What to do next

If you’re concerned that your baby may be tongue-tied and are experiencing persistent nipple pain despite your baby appearing to have a good latch, talk with your health care provider or lactation consultant to ensure that you and your baby get the care you need.

In the meantime, you should continue to offer the breast and supplement, if necessary, with expressed breast milk, using a teaspoon or cup. For guidance on proper positioning and latch, view this.

Last updated June 19, 2021

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