Over the last decade, the World Health Organization and the American Academy of Pediatrics have touted the amazing benefits of breastfeeding. This campaign has increased awareness of the challenging impact of ankyloglossia, or tongue-tie, in breastfeeding infants.3 Many lactation consultants attribute breastfeeding challenges to this oral condition. But pediatricians, breastfeeding medicine doctors, and otolaryngologists (ENT) support that conclusion less frequently.6 Let’s dive into the nuts and bolts of ankyloglossia, including its complications and treatment.
What Is Tongue-Tie?
The lingual frenulum is a piece of flexible tissue that connects the underside of the tongue to the floor of the mouth. Tongue-tie (or ankyloglossia) is when the ordinarily present lingual frenulum limits the function and mobility of the tongue to some degree.1 The frenulum’s shortness and tightness will determine the tongue-tie severity.3 This condition may be identified during infancy or remain unevaluated or discovered later in life. Approximately 10% of newborns have some degree of tongue-tie at birth. Interestingly, only up to 2% of adults have it, suggesting that it may resolve independently.1
What Does Tongue-Tie Look Like?
Currently, there’s no standard tool for assessing and classifying tongue-tie, but several suggestions exist. Whatever assessment tool your doctor uses, impaired mobility and functionality of the tongue are defining features. Clinicians lack agreement on when/what treatment for it is necessary.1 Additional research is in the works to establish a consistent system for the future.
Classic (or anterior) ankyloglossia is when the lingual frenulum attaches at or close to the tip of the tongue. In posterior tongue-tie, the frenulum tightly attaches further back on the tongue.1 Both situations limit the tongue’s range of motion.
What Causes Tongue-Tie?
Experts don’t actually know the cause of ankyloglossia. While this condition can be associated with some rare syndromes, most ankyloglossia cases are seen in children and adults regardless of illness or disorder. Frequently, treatment is suggested if tongue-tie is causing issues with breastfeeding, speech, licking, or kissing or if it’s causing mouth discomfort.1
Complications of Tongue-Tie
The tongue is a muscle that’s critical for breathing, taste, speech, digestion, and swallowing. Untreated tongue-tie can cause complications in these areas.2
Breastfeeding and Tongue-Tie
During breastfeeding, a baby must stretch their tongue over their lower gum with a wide open mouth.4 Once the baby is suckling, the jaw muscles move rhythmically. Meanwhile, the tongue cups the breast to massage and compress the milk ducts and creates a vacuum, delivering milk into the baby’s mouth.5 Tongue-tie may result in breastfeeding difficulties. However, it’s important to note that many infants with this condition can successfully breastfeed with correct positioning and latch.4
A collaboration between a lactation consultant, pediatrician, and ENT may help determine the best course of action.1 Your provider(s) will thoroughly evaluate your breastfeeding experience to determine the impact of your baby’s tongue-tie. Newborns may have the following symptoms:2,4
- Unable to latch or poor latch
- Short intervals between feedings or seemingly constant feeding
- Clicking sounds during feeding due to lost suction
- Feeding irritability
- Inability to breastfeed
The breastfeeding parent may experience:4
- Pain during breastfeeding related to damaged nipples
- Engorgement that can lead to mastitis
- Decreased or increased milk production
- Discontinuation of breastfeeding
How Do You Treat Tongue-Tie?
There’s a lack of concrete evidence to guide the management and treatment of this condition. Treatment decisions are based on provider experience and symptoms. A frenotomy — when the frenulum is cut using scissors or a laser — is the most common procedure for tongue-tie treatment in children.3 More significant tongue-tie may require a frenectomy — an oral surgery involving the removal of frenum tissue — or a frenuloplasty-release and repositioning of frenulum tissue.2
A frenotomy is usually performed in the provider’s office. The procedure can be achieved with or without a topical anesthetic using scissors, laser, or electrocautery to snip the frenulum tissue.3 This procedure may restore tongue mobility, improve latch, and decrease parental nipple pain.6 Discomfort or pain is minimal with this quick procedure.4 Given that this procedure doesn’t improve the underlying concern, it’s important for providers to have a frank discussion with parents about the concerns prompting the procedure and offer parents breastfeeding support. Also, the inside of your baby’s mouth heals very quickly! You will be encouraged to breastfeed immediately for comfort.
The Bottom Line
Tongue-tie is a relatively common condition. But if you’re experiencing breastfeeding difficulties or pain, evaluation by a lactation consultant and an ENT may be a worthwhile endeavor for you and your baby. The solution may be simple!
