Some babies are not able to move and stretch their tongues freely because they have a short, tight or thick frenulum (the skin attaching the tongue to the base of the mouth). This is known as 'tongue-tie'. Tongue-tie affects 5% to 10% of babies. It is more common in boys than in girls.
Not all babies with tongue-tie need treatment. Some will not have any feeding difficulties or challenges.
A tongue-tie may restrict the movement of your baby’s tongue and cause feeding challenges.
Tongue-tie may interfere with your baby attaching (latching) to your breast. It may also reduce the amount of milk your baby gets. This can result in poor weight gain and it can also reduce your breast milk supply.
Challenges for the baby with a tongue-tie may include:
- difficulty in getting a deep attachment to the breast
- difficulty staying on the breast
- weight loss or challenges to gain weight
- restless, tiring and unsettled feeds
- noisy or clicking sounds during the feed
- dribbling of milk during feeds
Challenges for the mother breastfeeding a baby with a tongue-tie may include:
- distorted nipple shape after a breastfeed
- bleeding, damaged or ulcerated nipples resulting in nipple pain
- baby doesn't feed enough resulting in breast fullness (engorgement) or mastitis
It's important for you to get good lactation support if your baby has a tongue-tie. Techniques like improved positioning and attachment can help with feeding challenges. If this is successful, further treatment may not be necessary.
Good positioning and attachment of your baby to the breast is important.
Midwife Susan O'Driscoll gives advice on positioning and overcoming breastfeeding challenges.
Your baby's tongue-tie should be assessed as part of lactation support. Find an international board certified consultant (IBCLC)
If you don't have access to a lactation consultant, you can also get help from:
- clinical midwife specialists
- public health nurses
Some babies may need a frenotomy. This is where the frenulum causing the tongue-tie is released in a minor operation.
A trained healthcare professional performs the frenotomy procedure. It's usually done without an anaesthetic, although a local anaesthetic is sometimes used. Your baby will be swaddled in a blanket and supported at the shoulders to stabilise the head. The tongue-tie is then divided by scissors. There should be little or no blood loss. You can continue breastfeeding immediately.
Follow-up and support
It is important that both you and your baby are checked on after the procedure. Skilled breastfeeding information and support is essential following a frenotomy.
There is a wide range of breastfeeding support available in Ireland.
Friends of Breastfeeding provide social support at their Mum2Mum groups.
If you are having difficulties with breastfeeding, get support from an International Board-Certified Lactation Consultant (IBCLC).