Tongue-Tie: Symptoms, Treatment and Effect on Breastfeeding


You have endured forty long, long, weeks of pregnancy, the struggles of labor and delivery, and finally your sweet bundle of joy has arrived! You are all excited to follow through with your plans and hopes for how you are going to raise your child, and you feel as if you have prepared for everything, right? However, when you try and breastfeed your little ray of sunshine, you notice that he or she just is not quite latching correctly and someone mentions that maybe your child might be tongue-tied. Tongue-tied? What does that even mean? Isn’t tongue-tied normally used to describe someone who cannot speak without tripping over their own words? Unfortunately, tongue-tie is an actual medical condition that affects about four percent of all newborns and can have serious implications and complications for a breastfeeding baby.

What Is Tongue-Tie? (Definition, Symptoms)

Tongue-tie is a medical condition in which the movement of the child’s tongue is restricted. Also known by its technical name, ankyloglossia, this condition occurs when the frenulum (the band of tissue that connects the underside of your tongue to the floor of your mouth) is too tight or too short which in turn restricts the movement of the tongue. Tongue-tie is a congenital and hereditary condition, meaning that it is present at birth and it is a trait that occurs within the child’s family. As previously stated, it is somewhat common, in that it occurs in roughly four percent of all babies. In most cases, the tight frenulum will stretch and relax within the first year of the child’s life, which means the child will not face any long lasting concerns, including issues with feeding or speech. However, it depends on the type of tongue-tie present in your infant. There are four different types of tongue-tie that can affect your baby:

A tongue-tie baby's mouth

Class 1

  • Tongue-tie is the most well-known type. This is when the frenulum is attached to the tip of the tongue, creating a heart-shaped appearance to the tongue.

Class 2

  • Tongue-ties are further behind the tip of the tongue.

Class 3

  • tongue-ties occur closer to the base of the tongue.

Class 4

  • Tongue-ties are also known as posterior ties, due to the fact that they occur under the mucous membrane covering in the mouth. These ties cannot be seen so they must be felt, and unfortunately, this class of tongue-tie is often misdiagnosed as Short Tongue.

[Read more about Mucous]

What Does this Mean for Breastfeeding?

Tongue-tied infants can have difficulty with breastfeeding. Breastfeeding occurs when the baby is able to form a vacuum seal around the nipple of the mother’s breast and suck out the milk. In order to properly create this vacuum seal, the child must extend his tongue and be able to move it in several different ways. The baby’s tongue should move to cover the nipple so it cannot be crushed, stimulate the nipple to elongate and point in the right direction, and massage the breast to encourage milk flow. With a tongue-tied baby, he often cannot open his mouth wide enough and this can cause issues.

[Read more about Breastfeeding]

1. Nipple Damage

Conception of baby tongue tie
  • The inability to cover the alveolar ridge while breastfeeding can cause your baby to chew on your nipple with his gums. This can be incredibly painful and lead to cracking and bleeding of the nipple.

2. No Elongation

  • If the nipple cannot be stimulated properly, your baby can gag, choke, vomit, or breathe in the milk due to the nipple not pointing towards the back of the baby’s throat.

3. Improper Seal

  • If your baby is tongue-tied, he might not be able to form the seal properly which can lead to constant chewing on your breasts, or your baby losing most of the milk out the sides of his mouth.

All of these issues can lead to major health concerns for the baby. These can include malnutrition, constant hunger, stomach issues from swallowing too much air, sleep disturbances, acid reflux, and vomiting.

What Are the Symptoms?

Breastfeeding tongue tie baby

If you are concerned that your baby might be tongue-tied you should look out for several symptoms.

1. Suction Issues

  • If you are feeding your child and he constantly or consistently breaks suction while feeding, this may be due to the difficulty in latching caused by tongue-ties.

2. Noises

  • If your baby is making clicking noises while suckling, a tongue-tie might be the cause.

3. No Weight Gain

  • If your baby seems constantly hungry, wants to nurse all of the time, but does not seem to gain any weight at all, this can be a very strong indicator of tongue-tie. The inability to properly stimulate the milk flow, or inability to properly swallow the milk, can result in a malnourished baby.

4. Nipple Pain

  • One of the main symptoms of tongue-tie is the malfunctioning vacuum seal. Because of this, and the limited tongue movements in tongue-tied babies, you may experience a lot of nipple pain. Your baby is trying to encourage milk flow, which results in chewing and gnawing on your nipple to try to express the milk.

5. Long Feeding and Lower Supply

Proper latching position when breastfeeding
  • If feeding is taking upwards of an hour to two hours but your supply seems to be lowering, you might have a tongue-tied baby. Because he cannot express the milk properly, your baby may feed for long periods of time in order to receive the same amount of milk that other babies might receive in fifteen minutes. Your supply might also lessen because the baby is not eating the amount you are producing, resulting in your body thinking it does not need to produce as much.

6. Irritability

  • Another sign of tongue-tie is constant upset. If your baby is constantly crying from hunger, cannot sleep for long periods of time, or is just generally very fussy, tongue-tie might be a culprit.

If you suspect that any of these symptoms might be tongue-tie, however, be sure to consult your physician as these symptoms may also be caused by other disorders and will need to be diagnosed properly.

How Is It Treated?

Tongue-tie in infants can often be fixed by a surgery called a “frenotomy”, in which the doctor simply snips the frenulum in-office, and then immediately applies the baby to the mother’s breast. This procedure can be controversial, however, as tongue-tie does not often lead to long term health issues, and many doctors view the surgery as unnecessary.


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