Tongue-tie in babies is characterised by a short frenulum under the tongue, which can restrict tongue movement and interfere with breastfeeding.
There are several frenula inside the mouth and the one under the tongue is known as the lingual frenum. If this is too short, the tongue may not move freely and the baby might not be able to draw the breast into the mouth adequately as a result, which can cause nipple pain and poor milk transfer.
About 2-3 per cent of newborns have a tongue-tie and more boys are affected than girls. Tongue-tie doesn’t always impact on breastfeeding and it doesn’t always require treatment, as many tongue-ties resolve on their own by age two or three.
How is tongue-tie a problem?
However, it is worth knowing the signs of tongue-tie, especially if your baby is struggling at the breast and doesn’t seem to be getting enough milk. Your baby needs to use his tongue to draw your breast deep into his mouth, so that your nipple reaches the soft palate area at the back. If tongue-tie is getting in the way of this, your nipple might be rubbed against the hard palate area, which can cause you pain during and after feeds. Additionally, tongue-tie can mean poor milk transfer, which leads to poor weight gain for your baby and inadequate milk supply for you. Tongue-tie can occasionally affect bottle feeding as well, because your baby may have trouble forming a seal around the bottle teat.
Signs of tongue-tie
If the tongue-tie is quite significant, you might notice the restricted movement yourself. Sometimes the tip of the tongue forms a heart shape due to the short frenulum, or you’ll see that your baby can’t poke his tongue out past his lips. It’s not always visibly obvious like this though. Often you’re more likely notice problems with the way your baby is feeding and the impact on your nipples.
Some signs to look out for include:
- Sore nipples during the feed
- Squashed or misshapen nipples after a feed
- Baby has difficulty latching onto the breast
- A compression mark on the nipple after a feed
- Baby fails to gain good weight
- Unsettled behaviour during feeds
- A clicking sound while your baby sucks
If you notice any of these signs, get your baby checked out by a lactation consultant, who has the medical training necessary to adequately identify if tongue-tie is an issue. Keep in mind that these signs could also be related to other feeding issues, such as poor positioning and latch. A health professional can help you identify what’s causing the problem and suggest a plan for fixing it.
Tongue-tie and speech development
Experts are dived on whether misdiagnosed or untreated tongue-tie affects speech development as your baby gets older. Not enough research has been done to suggest that tongue-tie causes speech issues or that treating the tongue-tie improves speech outcomes.
If your baby is diagnosed with tongue-tie, and it’s confirmed that breastfeeding is being impacted, your baby can have a straightforward procedure done called a frenulotomy or frenectomy, which snips or divides the frenum to free up movement.
If your baby is under four months old, this can usually be done without anaesthetic and involves a simple snip to divide the frenum. Occasionally a topical or local anaesthetic may be used. Your baby may be a little unhappy at having to be held still and have fingers placed in his mouth while the snip is made, but should settle easily afterwards with a cuddle and a feed. You will probably be advised not to feed your baby immediately before the procedure so he will want the breast right afterwards. A breastfeed will also help compress any bleeding that occurs (but bleeding doesn’t always occur and if it does, it’s usually minimal).
If your baby is older when the tongue-tie is discovered, he will need to be referred to a specialist surgeon and may require a general anaesthetic to have the procedure done. Older children and adults can take a little longer to heal and may require speech therapy afterwards.