Has Your Baby Been Diagnosed With Tongue-Tie?

If you and your infant are struggling with breastfeeding, it’s natural to feel concerned. A tongue-tie is one possible cause of these difficulties. A tongue-tie (ankyloglossia) may affect your baby’s ability to feed efficiently. To treat this condition, doctors may discuss a tongue-tie release procedure with you, which can help the tongue move more functionally. Other treatments options include feeding therapy and working with a lactation consultant.

Here, Children’s Hospital Los Angeles experts answer questions about tongue-ties, tongue-tie surgery and other treatment options that may help your baby feed more efficiently.

What is a tongue-tie?

The band of tissue that connects the bottom of the tongue to the floor of the mouth is called a lingual frenulum. In some babies, the frenulum may be too tight, too short, or too thick, and may restrict tongue movements.  “As a result, babies may not be able to breastfeed effectively,” says Sally Danto, Pediatric Nurse Practitioner and International Board-Certified Lactation Consultant at CHLA. “Babies with this condition can also have problems with bottle feeding,” says CHLA Pediatric Occupational Therapist and Internationally Board-Certified Lactation Consultant, Carole Lee.

What are the symptoms of tongue-tie?

Babies show many different signs and symptoms of tongue-tie, including:

• Crying while breastfeeding, pulling away from the nipple, or “popping off” the nipple frequently
• Poor weight gain
• Fussiness or gas
• Taking a long time to feed (and seeming unsatisfied even after a long feeding)

Parents who are breastfeeding or chest feeding may also experience symptoms if their baby has tongue-tie. These symptoms include:

• Declining or low milk supply
• Painful, damaged or cracked nipples

Why is a baby’s tongue movement so important?

“The tongue has eight muscles, and they are all important for breast and bottle feeding,” says CHLA Pediatric Occupational Therapist Carole Lee. “For a child to be successful at sucking and swallowing, the tongue needs to be able to move up and down, in and out and side to side,” she says. The tip of the tongue must also be able to extend over the gum ridge. The sides of the tongue need to curl up to allow “cupping,” which enables the baby to create an effective latch while sucking and swallowing.

What are the treatments for tongue-tie?

Danto and Lee recommend exploring the following treatment options for a tongue-tie:

• Working with a lactation consultant: It is always a good idea to meet with an international Board-certified lactation consultant (IBCLC) if you are having any issues with breastfeeding. A lactation consultant will evaluate you and your baby, help improve your baby’s latch and show you how to try different nursing positions. They can also refer you to the right health care provider if necessary.
• Meeting with an occupational therapist or speech-language pathologist: Occupational therapists and speech-language pathologists who are specialized in feeding therapy are skilled at evaluating and treating your baby’s ability to suck and swallow. Therapists also provide feeding strategies and exercises to help your baby.
• Physical and occupational therapy: Physical therapists and occupational therapists can rule out other health issues, such as torticollis (stiff neck muscles that make moving the head painful) that could affect breastfeeding.
• Trying alternative feeding methods: If your baby is not able to breastfeed effectively but can bottle feed, you may choose that option instead. Talk to your baby’s care team about trying alternative ways of feeding. Your care team will need to monitor your baby’s health and make sure that they are getting enough nourishment from bottle feeding.
• Tongue-tie procedure: Depending on your baby’s ability to feed, your care team may recommend a tongue-tie surgery.

Tongue-tie surgery

Pediatricians, oral surgeons, ear, nose and throat (ENT) doctors, and pediatric dentists may be skilled at performing tongue-tie procedures. Ask the care team about the right option for your baby. The two main types of tongue-release procedures are:

• Frenotomy or frenectomy: The doctor clips or removes the frenulum using surgical scissors. Some doctors use a special laser to release the band of tissue. Most often, doctors perform these procedures without anesthesia in the office during your visit. The baby is awake, the process takes just a few minutes, and stitches usually are not required.
• Frenuloplasty: Doctors may recommend this procedure, which is more extensive than an in-office frenectomy. Doctors use general anesthesia for a frenuloplasty, so the child is asleep during the procedure. Doctors perform frenuloplasty in a hospital. They use surgical tools to clip the frenulum and reposition the tissue, and they may place stitches under the tongue. The stitches dissolve in the mouth over time.

What can I expect after tongue-tie surgery?

“There is small a risk of bleeding from the procedure,” says Danto. “Your provider may recommend feeding your baby immediately after the procedure. This can help provide comfort for your baby.”

The care team may recommend follow-up visits to make sure the tongue is healing well. They may also recommend seeing a lactation consultant or a feeding therapist after the procedure, to assure your baby is feeding effectively. “These experts can help your child relearn how to feed functionally,” says Danto.

What are the risks of a tongue-release procedure?

Though complications of tongue-tie surgery are rare, they include:

• Excessive bleeding
• Infection
• Injury to the salivary glands
• Need for another procedure
• Reaction to anesthesia, if used
• Reluctance or refusal the child to be breastfed or eat
• The procedure does not help the feeding problem

What should I consider when deciding whether to get the tongue-release procedure for my baby?

“Not all babies with tongue-tie will need a tongue-release procedure”, say Danto. Talk to your child’s care team if your child:

• Has another health condition that could affect feeding, sucking or swallowing
• Has dysphagia (a swallowing disorder)
• Is not meeting growth or weight milestones
• Is often fussy or seems uncomfortable

“You may decide that a tongue-tie procedure is the best option if you have significant breast or nipple pain or if feeding is especially difficult. These challenges can affect both you and your baby,” says Lee.

Talk to your child’s care team about the best plan for your baby

Many babies and parents have benefitted from tongue-tie surgery. These procedures are generally safe and may help with:

• Alleviating nipple pain and discomfort in the breastfeeding parent
• Helping babies gain weight
• Improving a baby’s feeding efficiency
• Facilitating bonding between the baby and the parent
• Reducing fussiness and irritability that can result from feeding issues

It’s important to remember that everyone’s situation is unique, and tongue-tie release may not necessarily be right for yours. Talk to your child’s care team about the best plan for your baby. “Try to build a team of experts you can trust,” says Lee.