Let’s talk about Tongue Tie!
Tongue Tie - This topic can be confusing, although it really shouldn’t be!
So, I thought I would put it simply for parents, what I know, in order to help you understand it and potentially understand why it is impacting your breastfeeding journey.
Tongue tie or Ankyloglossia as it is officially known, is when a piece of frenulum (tissue) that holds the bottom of the tongue, to the floor of the mouth is too short or tight. There is also lip tie or labial frenulum or buccal / cheek ties. But more on those later.
Everyone has frenulum, but in some babies, that piece of tissue can be really tight, thick or forward closer to the tip of the tongue, restricting its ability to move freely, to lift, to cup and hold nipple, to obtain a deeper latch and to effectively transfer milk. All key ingredients in breastfeeding.
This can lead to some or all of the following feeding symptoms:
Painful feeding for the mother - cracked, damaged or bleeding nipples. Often described as toe curling pain.
Inability to stay latched to the breast - popping on and off / clicking sounds as their tongue loses suction.
Inability to latch at all - severe ties.
Low weight gain - because they aren’t able to coordinate their feeds and pull milk out from the breast effectively.
Low supply - Because breastmilk relies on supply and demand and if they aren’t able to demand it effectively, the supply drops off.
Feeding constantly - to get enough milk, or lethargic and not waking for feeds, because they aren’t getting enough milk.
Recurrent mastitis - from not draining the breast adequately.
Gassy babies, hiccups, reflux symptoms leading to early use of medications.
Poor sleep due to the tongue not resting in the palate.
There is also some evidence that ties can potentially lead to speech issues, dental issues such as teeth placement and orthodontic work, sleeping issues and issues with eating solids. Adults who have had their own ties released often report that their headaches, tension in their body, jaw pain and neck pain resolve with release of the tongue and subsequent rehabilitation.
Lip and Buccal (cheek) ties have a lack of research and evidence at this time. However, many lactation consultants see the impact that tightness and a lack of flexibility in these tissues have on feeding. In particular pain and comfort for the mother when they are tight and restricted as well as lip blistering for the baby.
How does it effect sleep? When your tongue is at rest, it should be sitting in your palette, filling that space at the top of your mouth, not just the tip behind your teeth. Try this exercise - put your tongue in your palate and now try to breathe through your mouth, you can’t! Now put it in the floor of your mouth and breathe through your mouth, you can but it’s harder to feel restful breathing and you pool saliva in the bottom of your mouth causing potential dental decay and disrupted sleep. A restricted tongue that does not rest in the palate can be the cause for mouth breathing and sleep disordered breathing.
So how do we fix it? Well, first you need someone qualified to assess your feeding, and ideally the sooner you can do this the better. An IBCLC with additional training in ties, can complete a functional feeding assessment. What is that? It is a complete and complex history taking to rule out other causes of feeding concerns like breast development, positional and latching corrections, supply concerns, and other effects on your feeding including torticollis, birth related concerns including trauma from instrumental delivery and initial feeding mismanagement. Then we complete a functional oral exam on your baby to assess their suck and tongue function including their range of movement. From there we do everything we can to correct feeding from all of the other issues. Bodyworkers such as Osteopaths and Chiropractors are often involved from here as well as tension in the body from other areas can be causing feeding issues so we rule them out as well as prepare the baby for a future release.
If we can resolve things from here, then we leave well enough alone.
If we are unable to resolve the issues, from there we are looking at potential releases of the tissues. Depending on the severity of symptoms and the type and degree of ties, releases can be done in Australia by scissors or by lasers and all options and providers in your area should be presented to you. An IBCLC has relationships with many of these and can often match you up with the best fit for the type of ties and providers who are suited to you and your family personally as well!
To exercise or not exercise? Stretches would involve stretching the wound so it doesn’t reattach and there is a variety of what is recommended from the various providers from nothing to quite a lot. Exercises on the other hand involve rehabilitating the tongue. I liken it to breaking your arm, you learn to compensate by using the other side of your body and then once the cast is off, you have to rehab it back to gain strength and full function.
So what do I recommend? Well depending on which ties and what function your baby has, I recommend a set of exercises done a few times a day and lots and lots of breastfeeding. Why - because breastfeeding is the best exercise they can do! The act of breastfeeding lifts, curls and strengthens the tongue and is done 8-12 times per 24hrs!
If you are breastfeeding, it is important to keep working with your IBCLC to reassess function over time and make sure feeding is back on track. At the end of this article is a client before and after example for you to look at the difference.
Are we seeing more of them? Is this becoming “a thing”? Technically yes, we are seeing more of them BUT I believe that is because women are finally seeking answers to their breastfeeding issues! Back in the day, there weren’t as many lactation consultants and women in the 1950’s-80’s were told to just start formula. In the caveman days the babies that couldn’t feed, would likely have died from starvation. In between, the invention of early primitive pumps helped to fill that gap. So whilst the prevalence is thought to be anywhere from 3-10%, it is hard to say as many people are still not getting the help they need. If you are interested in the history of infant feeding, this is a great resource.
IBCLC’s care about your feeding journey and getting you answers! I do everything I can to avoid tie release where possible because I don’t want to do anything to a baby that isn’t absolutely necessary. So every recommendation that I make, is very carefully considered in partnership with you, given your symptoms and severity. It is very much about treating what is presenting right in front of you at the time not treating what may or may not be in the future. That is particularly hard for the speech pathologists as they often wonder why they weren’t caught earlier but if they are feeding fine, just the presence of a frenulum isn’t enough for me to recommend having a release. So again, you can see why it can be complicated.
So who cares the most in the professional health space about ties! Lactation Consultants because of the impact on breastfeeding, Dentists for their impact on oral health and Speech Pathologists who are concerned with speech development and ability to eat solid foods.
The bottom line for parents - Ask lots of questions early. Talk to your local IBCLC. Remember, Not everything is a tie! You want to rule out a lot of things before that.
Every day with a newborn is different, things change rapidly! You can do this! I’ve got your back mamas!
Peta is an IBCLC based on the Northern Beaches of Sydney serving Mums on the Northern Beaches and North Shore. If you are from a different area and would like my assistance, you are able to make a clinic appointment. Breastfeeding classes are also held monthly in North Curl Curl. Consultations and classes can be booked here.
CLIENT / PHOTO EXAMPLE
This is an example of a tongue tie before and after release.
This was classified as mild and the Mum was told “not to bother with breastfeeding, it’s too hard” upon leaving the hospital after birth.
THIS IS NOT MILD!!! This is actually quite a severe tie. The kind you can see clear across a room! Please also note that all ties do not look the same so don’t use this as a comparison for all ties.
Thankfully, Mum had done my breastfeeding class and was able to manage in the interim with positional changes and some other tools including shields and pumping when the pain was too much.
This tie was released via scissors. We then did some exercises to rehab the movement of the tongue. Mum reported an instant relief in pain, easier positioning, better weight gain, shorter feeds in time and breasts feeling emptier and a more content baby.
Photo and story with thanks to Zoe and Wesley.
