Tongue Tie in Babies

Many new parents have heard of someone who’s baby had a tongue tie release but what exactly is a tongue tie and why does it matter when it comes to feeding a baby?

Under the tongue many of us have a stringy piece of tissue called a frenulum. For some of us it’s thin and stretchy while for others it’s thick and tight. A thick or tight frenulum can restrict the way a tongue moves. The tongue is really important for our health. It impacts our breathing, eating, speech and teeth. In babies the tongue is also important for shaping the palate and airway. When the tongue has full range of motion it rests on the roof of the mouth and helps to form a broad palate that is the best for breathing easily through the nose with the mouth closed. It also gives plenty of room for all the teeth to come in without being crowded or prone to cavities.

When a child starts to learn to talk a tongue with full range of motion can move well to make all the sounds of their language.

When breastfeeding, the baby has to coordinate suck, swallow and breathe. The tongue plays a large role in this sequence. It needs to take in a large mouthful of nipple and breast (a deep latch), cup the breast, lift up in a wave motion, and then move a portion of milk to the back of the throat for a safe swallow - the airway is temporarily covered so that milk is not inhaled into the lungs. If the tongue is restricted - commonly called a tongue tie - then it becomes harder for a baby to do all of these steps. This can lead to muscle fatigue where the baby can start off a breastfeed but they fall asleep within a few minutes and don’t get enough calories. It can also lead to a baby who isn’t latching deeply enough - this can cause nipple pain and even nipple damage such as cracks and bleeding. When a baby is not feeding effectively at the breast then the parent may not have enough breast stimulation to increase their supply to meet their baby’s needs. We also see some babies who struggle to latch at all - sometimes because they cannot open their mouths wide enough.

But this isn’t just about the tongue. We also see babies with other oral restrictions that can make it harder to breastfeed well. There can be frenula (ties) under the lips and cheeks. If these are tight then it may also make it hard for a baby to transfer milk well.

And this isn’t just about the mouth! A baby feeds with their whole body and they are often born with some tension in their bodies that impact feeding. At the end of pregnancy they don’t have a lot of room to move around. They may get stuck in a position that ends up tensing one side of their body. The process of being born whether vaginal or surgical can also cause tension in a baby’s body. The person who catches them and lifts them up as they are born may inadvertently cause some tension in their bodies.

It is common to see a baby who prefers to hold their head and neck turned to one side. This often leads to a baby who is more comfortable latching on one side than the other.

What can a Lactation Consultant do about all this?

As a Lactation Consultant I have taken extra continuing education on oral restrictions such as tongue tie, lip tie and cheek ties. This means I can assess the function of a baby when they are breastfeeding and bottle feeding. I look for muscle tension in their bodies especially their neck and shoulders. I look for common signs and symptoms in their face and mouth. I use a gloved finger to examine their cheeks, lips and tongue and feel for restrictions. I then do a series of exercises to see how they respond. Along with the history that the parent provides, I put together a picture of how a baby’s function might be impacted by any suspected ties.

Do you have to release every tie?

Absolutely not! Releasing a tie is a decision for the family to make. The best results take a commitment. Seeing a body worker (osteopath/OT/PT/chiropractor/craniosacral therapist) is usually beneficial before and after the release. There is also after care required for the wound. It’s important to follow the instructions of the provider who released the tie(s) to ensure it heals open without forming stiff scar tissue. This means that parents have to stretch the release site(s) every 4-6 hours. I also give my families exercises to do with the baby to increase the range of motion and improve the function of the newly released tongue.

What if we don’t want to release the tie?

As I said above, this is the family’s decision. I will support every family with whatever they decide. Movement is really helpful for releasing muscle tension and can help a baby improve their latch. Tummy time, infant massage, rhythmic movement are all supportive. Keeping time in containers like car seat, swaddle, swing etc to a minimum is also supportive. Daily opportunities to practice breastfeeding are important for the baby to improve their latch and milk transfer. During this time we also work to protect the milk supply and ensure the baby is receiving enough nutrition from a bottle or alternative method of feeding.

Signs that your baby might be struggling with oral restrictions include:

baby cannot latch

painful latch

falls asleep at the breast within minutes then wakes up hungry shortly after

damage to nipples

nipple looks creased after breasfeeding

not enough diapers

frequent clicking at the breast or bottle

excess gassiness: grunting, inconsolable

baby never seems satisfied

leaking milk from the mouth at the breast or bottle

low milk supply

What to do next?

If you think your baby might be struggling with oral restrictions then schedule an appointment with a Lactation Consultant (IBCLC) experienced in this topic. They will help you figure out what is going on and help assemble a team to support you as necessary.