In recent times, there has been increased interest in the topic of tongue-tie and breastfeeding. With so much talk and conflicting information, it’s no wonder many mothers feel overwhelmed and confused about how tongue-tie may relate to any breastfeeding issues they may be experiencing.

Tongue Tie Fact #1: It’s Normal To Have A Frenulum!

Everyone has a string of tissue underneath their tongue. This is called the frenulum (or frenum). Merely the presence of a frenulum is not a cause for any concern. It’s only when the frenulum is short, tight, restricting tongue movement, and a functional problem (such as for breastfeeding) that it becomes a tongue tie.

Tongue Tie Fact #2: You Can’t Diagnose Tongue Tie Just With A Photo

You cannot tell if a baby has a tongue tie just by looking at a photo of their tongue. Again, it’s not the presence of the frenulum that’s an issue; it’s whether the frenulum is causing a functional problem or not.

Tongue Tie Fact #3: A Tongue-Tie Can Affect Breastfeeding

A baby needs to have good tongue movement to be able to:

• Achieve a deep attachment to the breast
• Remove milk well from the breast

If a baby’s tongue movement is restricted due to a tongue-tie, a baby can experience feeding difficulties.

Tongue Tie Fact #4: Signs Your Baby’s Tongue Needs To Be Assessed

There are several possible signs that a breastfeeding mother should consider for a tongue tie assessment:

• Painful breastfeeding
• Damaged nipples
• The baby loses suction while feeding
• Clicking noise while feeding
• Low weight gain in baby over time
• Recurrent blocked ducts or mastitis

Please note that all of the above signs could be due to a range of other breastfeeding-related issues. It is the role of a health professional, such as a lactation consultant, to assess why the above signs may be occurring.

Tongue Tie Fact #5: It Isn’t Always Clear-Cut If A Baby Has A Tongue Tie

Given that there is no universal and accepted tongue tie classification, one health professional may diagnose a tongue-tie, and another may not. Neither health professional is ‘wrong.’

Indeed, some health professionals seem to diagnose every frenulum as a tongue tie and assign every breastfeeding issue to a tongue tie. Other health professionals believe tongue-tie is a current craze.

Having no clear consensus amongst health professionals regarding tongue-tie diagnosis makes things even more confusing for parents to decide what to do.

Tongue Tie Fact #6: Diagnosing A Tongue Tie Needs A Detailed Assessment

Assessing if a baby has a tongue-tie needs a detailed assessment including:

• A physical examination of the baby’s tongue whereby the health professional puts their finger inside the baby’s mouth and assesses the baby’s tongue movement and suck
• Observing the baby breastfeed (or bottle feed)
• Talking in-depth to the mother about all the signs and symptoms and taking a detailed history

Tongue Tie Fact #7: Sometimes, A ‘Wait And See’ Approach May Be Best

Once a thorough individual assessment is done, and all the pieces are put together, the big-picture analysis may point towards the best approach:

• Do nothing about the frenulum (because the breastfeeding problems are rectified in other ways such as by optimizing positioning and attachment).
• Deciding to get the frenulum removed (because when breastfeeding basics like positioning and attachment are optimized, the breastfeeding problems, such as sore nipples, continue).
• Wait and see approach (issues such as an oversupply and fast let-down reflex deemed contributing to the breastfeeding problems and need to be addressed).

Tongue Tie Fact #8: Snipping Of A Frenulum Is Called A Frenotomy

When a tongue-tie is diagnosed, the procedure to remove the frenulum is called a frenotomy. This procedure is then performed with a laser.

Tongue Tie Fact #9: There Is Mixed Research About The Effectiveness Of Frenotomy

As more evidence emerges, there will likely be more consistent health professionals’ recommendations about when a frenotomy is best performed. This will help more breastfeeding mothers be able to reach their own breastfeeding goals. If you have breastfeeding difficulties and suspect your baby may have a tongue-tie, see a lactation consultant or contact our practice for an oral examination.