Tongue Tie

Tongue tie is such a controversial topic. Many health professionals in the breastfeeding area are quite against them being cut unless they are quite obvious, while those on the other side argue that not getting the less obvious ones released (posterior tongue ties) can lead to other problems such as difficulty cleaning ones teeth with their tongue, speech problems and some even suggest digestive issues.

I'm going to start out right away and tell you that this is my personal opinion on this page. I'm also going to tell you that whatever path you choose is the right one for you and you should be supported through your decision making process and final outcome.

Anterior tongue ties are the most easy to see - they lead to a baby's tongue looking a bit like the picture above. Basically the front of the tongue is just as anchored as the back of the tongue and it makes many things difficult including breastfeeding, but later on speech can be affected as well as an array of other problems.

Posterior tongue ties are another whole problem altogether.

In my practice I have seen both sides of the argument lead to good outcomes and bad.  By that i mean I've seen babies who potentially have posterior tongue ties who have breastfed better after having them released as well as ones who've done better after having a lactation consultant work closely with them to improve positioning.

I have also see babies who didn't improve from having a tie cut and ones who had ties which were undiagnosed for so long that their mother's nipple were so badly damaged that they couldn't breastfeed even once the tie had been cut.

So as you can see there's a whole gamut of responses and breastfeeding outcomes with tongue ties.......

Now for my advice part

If you have a baby who is potentially tongue tied, before thinking about whether or not to cut it, I would strongly recommend trying the baby led latch every feed for at least 3 days, preferably under the care of a lactation consultant who uses this practice. 

Frequently in my experience, tongue tie (posterior particularly) is a diagnosis of "I don't know what else to suggest and why things aren't working". For this reason I advise trying the baby led latch as it can make a big difference to how your baby is latching on.

If that doesn't work and you notice any of the following:

• Your baby does not open their mouth very wide
• Your baby does not poke out their tongue
• Your nipples are quite deformed in shape after breastfeeding
• Your nipples are damaged and breastfeeding is painful
• Your baby makes a clicking noise while breastfeeding (some also do this while bottle feeding, sometimes this can be improved with a better latch on though so be careful to do this first)

You may have noticed when your baby yawns that you never see underneath their tongue, or that it looks like it can't move much. This is caused by the lingual frenulum being too tight. Some pictures of this in older children can be seen here.

It is really important to see a lactation consultant or paediatric doctor if you are having these problems. Not all babies require their frenulum to be released as in some their frenulum though short, is still very elastic and allows their tongue to protrude past their gums. These babies may just need some work to improve their attachment in a different breastfeeding position or with baby led latch. 

For those with a severe tongue tie, without much elasticity in the frenulum, having it snipped can make breastfeeding much easier, helping to improve the latch on and also decreasing the nipple soreness.

These babies may still need some time for their coordination to improve before breastfeeding improves well. If your nipples are too sore to breastfeed fully some other feeding options to consider are using a spoon, cup or syringe to feed your baby so that they don't learn the different sucking motion used for a bottle feed

If you are keen to continue breastfeeding and need some help to cope, a nipple sheild can be useful. If your breast milk supply is diminishing, this is best used if you first breastfeed without it as long as possible then stop the feed to start using it. This will help you to stimulate the production of milk as much as possible. Remember to be kind to yourself too, pain can also decrease your supply, so a middle ground will be helpful.

For those with a severe tie, it is worth being aware that sometimes they may need more work done. In the longer term babies who have a severe tie may have some of the following signs:

• Excessive gagging when introducing solid food
• Excessive saliva production
• A dislike for more solid food as chewing is difficult without the tongue working properly

If your baby is having these problems it is worth seeing your doctor to discuss whether their frenulum is still too restricted and needs further release.

A great resource for parents is http://www.tonguetie.net.

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