Ankyloglossia

Question: I am having a lot of pain during breast feeding my first baby and someone suggested that it might because he has a tongue tie? What is that and what does it mean for my desire to continue to breast feed?

Response:

Ankyloglossia or tongue tie is a congenital condition in which the lingual frenulum (the ligament that connects the tongue to the bottom of the mouth) is too thick, too tight or too short and reduces tongue mobility (the ability of the tongue to move correctly). Restricted tongue movements can negatively affect breastfeeding by reducing the infant's ability to suck. In addition to poor milk transfer, incorrect sucking patterns frequently result in sore and painful nipples. Often a tongue tie and restricted lingual (lip) frenulum go together, so make sure that the lip frenulum is not also restricted. Restricted lip movement can make latching difficult. Good lip movement and good lip movement is vital for successful feeding.

If your baby does indeed have a tongue tie and or a lip tie, he will be referred for a simple procedure called a revision (frenulectomy). This very easy office procedure is often done by a pediatrician, ENT (otolaryngologist) or dentist. The doctor will evaluate the tongue and lip and confirm reduced range of motion. The physician will release the frenulum giving your baby instant tongue and lip mobility. Because the frenulum is not very vascular, there will be minimal blood. Many physicians will invite the parents to stay and hold your baby during the procedure. You will be encouraged to feed your baby right after the procedure and will be given simple exercises to do for several days to ensure that the incision heals correctly and does not re-attach.

If your baby is only a few days old, the procedure should instantly relieve breastfeeding pain as your baby now has the ability to use his tongue and lips correctly. If you do not experience instant relief or if your baby is older, he may need specialized feeding therapy to train the correct tongue patterns so that feeding difficulties and nipple pain are reduced or alleviated.

The prognosis for successful breastfeeding is very good especially if the tongue and lip tie is identified and remediated quickly and if indicated, specialized feeding therapy is initiated promptly. If the tongue is released and the tongue does not pattern correctly, your baby is at risk for future feeding difficulties, speech difficulties and may increase the need for orthodontia work.