As any parent of a newborn can attest, one of the biggest challenges in your little one’s first days of life (aside from lack of sleep) is setting up feeding in a way that works for your family. For breastfeeders, this can be particularly challenging (especially if it’s your first-time), as it is a new skill that both you and your baby need to learn together — with the added pressure of having to keep your child nourished.
Tongue-tie is one of the most common issues that can interrupt breastfeeding in the early days – new research suggests tongue-ties affect just over a third of babies – and makes it especially difficult for a little one to establish an effective enough latch to be able to meet their feeding needs.
For a parent trying to feed their newborn, this can be stressful to navigate. To make things a little more clear, WH asked two experts, Carmelle Gentle, tongue-tie expert and founder of the Tongue Tie Clinic (a donation-funded centre), and Samantha Tanak, a tongue-tie practitioner and infant feeding specialist, for some advice.
What is a tongue-tie?
'A tongue-tie is where the frenulum linguae (the connective band) underneath the tongue is restricted in length, thickness or elasticity,' says Gentle, which 'impacts how the tongue moves and functions'.
According to Gentle, it has long been thought that only 4-10% of the population are tongue-tied, but the latest research suggests this number is actually more like 34.6% — making it extremely common. 'It can impact breast or bottle feeding in various ways,” says Gentle. 'Where the mobility and function is impaired, a baby will often have to compensate.'
When the jaw drops (needed for a deep breastfeeding latch) a tongue that is "tied" will not be able to perform the wave motion needed to transfer milk properly, says Tanak. It also affects bottle-fed babies, she says, as they can also find it difficult to latch to the bottle teat — although tongue-tied babies will usually find bottle feeding slightly easier than breastfeeding, as the artificial teat and gravity help them out.
What are the signs of a baby being tongue-tied?
Gentle says that signs and symptoms for a baby might include one or more of the following:
- Difficulty latching
- Reflux symptoms
- Colic symptoms
- Slipping off the breast
- Pulling on and off
- Hitting at the breast
- Shallow latch
- Clicking sounds
- Weight loss or plateaued weight
- Rapid weight gain (climbing centiles)
- Not satisfied at the breast or bottle or fussing
- Bottle or breast aversion or refusal
- Cows milk allergy symptoms
- Nasal congestion
- Erratic feeding
- Constipation
- Unable to lay flat
- Difficulty latching on one side
- Milk dribbling out the sides of the mouth
- Persistent lip blisters
- Long duration of feeding
- Short frequent feeds
- Persistent white coating on tongue
And signs or symptoms for the mother can include:
- Sore damaged nipples
- Blistered nipples
- Compressed/lipstick shaped nipples
- Recurring blebs or blocked ducts
- Mastitis
- Abscess
- Nipples that won’t heal
- Physical and mental exhaustion from feeding patterns
- Shooting breast pain
- Oversupply
- Feeling like something isn’t quite right (most important)
Can a GP check for tongue-tie?
'GPs are not specifically trained to assess for tongue-tie (unless they have received additional training),' says Gentle. 'Whilst they may be able to recognise particular symptoms, a referral should be made to see a trained infant feeding specialist or tongue-tie practitioner for further assessment and ongoing support.'
Are all tongue-ties the same?
How a tongue-tie presents varies, says Gentle. 'Thickness and elasticity of the frenulum and where it is positioned underneath the tongue will vary from being more posterior towards the underside of the tongue, or anterior more to the front or tip of the tongue.' This variation in how the frenulum presents explains why it impacts different people in different ways, she says, with some struggling more than others.
What are some of the longer-term issues related with tongue-tie if not resolved?
You don’t grow out of having a tongue-tie, says Gentle. Where it’s restricting the movement and function of the tongue, compensatory patterns occur throughout childhood and into adulthood.
'It can potentially impact eating, swallowing, speaking and sleeping patterns,' says Gentle, as well as causing 'a delay in developmental milestones, posture and/or impact the development of the craniofacial complex'. The impact of this will vary from person to person.
How do you fix a tongue-tie while breastfeeding?
A tongue-tie is fixed by surgically releasing the restriction by cutting through the membrane in a procedure called a frenulotomy, says Tanak, which can be performed from birth if absolutely necessary, or a few days after. 'It can be performed by using scissors or a laser, and is a quick and low-risk procedure that is considered very safe.'
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Who can perform a frenulotomy?
A frenulotomy or division can be performed by a licensed practitioner. The NHS does offer the procedure with a referral, but there can be long delays, depending on your trust. Otherwise, the Association of Tongue Tie Practitioners can help you find a practitioner.
How long after a tongue-tie division does breastfeeding improve?
'There is no magic timeline for this unfortunately,' says Gentle, 'and various factors can impact progress — healing isn’t linear and can speed up or slow down with growth spurts, teething or colds.'
Tanak says that for some people, though, breastfeeding can feel "softer" and more comfortable immediately afterwards, or a few days or weeks later. 'Ensuring good quality infant feeding support post division is key,' she continues.
'Many parents might see an immediate change to their feeding,' says Gentle, 'but commonly the challenges can sometimes seem to recur around 2-4 weeks post treatment or anytime later'. This, she says, can be due to the normal presentation of scar tissue that occurs during the healing period. 'Where appropriate, wound care and oral exercises are important to help support optimal healing of the wound and ongoing improvements to oral function,' she says.
'Breastmilk supply also needs to be adequate and the latch technique must be good [...] for exclusive breastfeeding to be possible,' says Tanak. She also recommends cranial osteopathy and tummy time to facilitate healing, post division.
