tongue tie breastfeeding

Essential Guide to Tongue Tie Breastfeeding: From Signs to Solutions

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Did you know that tongue tie, aka ankyloglossia, occurs in approximately 10% of newborns, a condition that can significantly hinder breastfeeding? Yet, only a fraction of these cases are promptly diagnosed and treated.

As a breastfeeding counselor, I’ve witnessed the growing concern among mothers about tongue tie breastfeeding latch difficulties. This isn’t just clinical data; it’s a reality I’ve lived through. My first child was born with tongue tie which led to bleeding nipples and intense pain during breastfeeding, a struggle familiar to many.

Drawing from both professional expertise and personal experience, this guide offers more than insights; it provides empathy and practical solutions. Having navigated the agony of feeding a baby with tongue-tie myself and witnessing the transformation post-frenotomy, I understand the nuances of this condition.

Join me as we explore the intricacies of breastfeeding a baby with a tongue tie. I’ll guide you through signs, solutions, and support systems. Read on to empower yourself with knowledge and take the first step towards a happier, healthier breastfeeding experience.

Key takeaways

  • Tongue ties can cause a range of issues for both breastfeeding and bottle-feeding infants.

  • Professional advice should be sought promptly if signs of tongue tie are suspected in an infant to prevent Complications.

  • Strategies such as experimenting with different nursing positions, using nipple shields, and consulting a lactation specialist may help provide relief when navigating infant feeding with a tongue-tied baby.

Identifying tongue tie symptoms and signs in infants

Tongue tie is a condition where the frenulum, a thin membrane, attaches the bottom of an infant’s tongue to the floor of their mouth, restricting normal tongue movement. This limitation can negatively impact breastfeeding, leading to pain, frustration, poor milk transfer, and feeding difficulties for both the mother and the baby.

If you suspect your baby might have a tongue tie, there are several indicators to look for.

Signs that may point to a tongue-tie in a child include:

  • Difficulty latching

  • Clicking sounds during feeding

  • Frustration and irritability

  • Frequent crying

  • Weight fluctuations or inadequate weight gain

  • Refusal to nurse

  • Difficulty lifting the tongue to the roof of the mouth

Other indicators of tongue tie in infants may include:

  • A misshapen, short, or heart-shaped tongue

  • A frenulum clearly pulling its center down and restricting its movement

  • Firm tissue where the tongue meets the floor of the mouth

Consulting with your doctor and a certified lactation consultant can help confirm the diagnosis and provide further guidance.

Observing the movement of your baby’s tongue can also provide insight. If you notice any of these signs in your baby, seeking tongue tie treatment is recommended. Remember, only a qualified practitioner can diagnose a baby’s tongue tie.

Understanding tongue tie breastfeeding challenges

anterior tongue tie
Anterior Tongue Tie – credit

Breastfeeding a baby with a tongue tie can present numerous challenges. Tongue ties can be a cause of severe trouble for both breastfeeding and bottle-feeding infants. Eating can become very challenging as a result. Addressing tongue ties is key to maintaining a healthy milk supply and achieving a positive breastfeeding experience for both mother and baby.

Some common difficulties associated with babies with tongue tie include:

  • Improper latch

  • Sore or cracked nipples especially for mothers with inverted or elastic nipples

  • Pain due to blocked milk ducts, engorgement, or even mastitis

  • Frustration for both mother and baby

  • Low or decreased breast milk supply

  • Emotional stress

  • Discomfort while breastfeeding

These issues can have a significant impact on a baby’s attachment and the breastfeeding experience and can lead to mothers considering ending their breastfeeding journey altogether.

Why can’t babies latch properly when they have tongue tie?

Babies with tongue ties often struggle to latch properly during breastfeeding due to the restricted movement of their tongue. An abnormally tight frenulum (the thin piece of tissue under the tongue) is shorter than usual, or abnormally tight, limiting the tongue’s range of motion.

Diagram showing anatomy of latch
Diagram showing the anatomy of latch

This restriction can impact breastfeeding in several ways:

  1. Inability to extend the tongue: For effective latching, a baby needs to be able to extend the tongue beyond the lower gum line. A baby with a tongue tie might not be able to extend their tongue sufficiently, making it hard to reach and properly latch onto the breast.

  2. Ineffective suck: Breastfeeding requires a baby to create a vacuum and use a rhythmic sucking motion. A restricted tongue can hinder this action, making it difficult for the baby to extract milk effectively.

  3. Poor seal: A good latch also involves sealing the mouth around the breast to maintain suction. A baby with a tongue tie may struggle to form this seal, leading to a shallow latch. This can cause the baby to take in air, potentially leading to gas and colic symptoms.

  4. Fatigue: Due to the extra effort required to feed, babies with tongue tie may tire more quickly and become frustrated, leading to frequent and prolonged feedings.

In some cases, babies with tongue tie can still breastfeed effectively without intervention.

4 Alternative infant feeding strategies with a tongue tied baby

Feeding a baby with a tongue tie might pose challenges, but certain strategies could provide relief.

1. Experimenting with different nursing positions and using nipple shields are viable options.

breastfeeding positions
Breastfeeding Positions

2. Paced bottle feeding is another technique for feeding breastfeeding infants that is designed to replicate breastfeeding. It helps to regulate the rate of feeding and prevent overfeeding. It involves:

  • Positioning, latching, and feeding the baby in a manner that is similar to breastfeeding

  • Preventing overfeeding and allowing the baby to regulate the rate of feeding

  • Using shorter or flatter teats facilitates a better fit in the baby’s mouth, making feeding more comfortable and efficient.

3. Alternative feeding methods such as spoon, cup, or syringe feeding, as well as nursing supplements, are popular with mothers of tongue-tied babies.

4. Exclusively pumping is another option for mothers who face challenges with breastfeeding due to tongue tie. This decision can depend on several factors, and finding the feeding method that best suits both mother and baby is important.

If your baby continues to struggle with feeding, it is recommended to seek advice from a pediatrician, lactation consultant, or speech-language therapist. These professionals can help ensure your baby is receiving adequate nourishment and support you in finding the best feeding method for your unique situation.

The procedure: understanding tongue tie division

Tongue tie division, also known as having a tongue tie divided or frenotomy, is a minor surgical procedure used to address a baby’s tongue tie. It is typically recommended if the tongue tie is inhibiting the baby’s ability to latch and nurse effectively. The procedure is performed by a healthcare professional, such as an ENT specialist or lactation consultant with additional training, who lifts the tongue and divides the frenulum using a pair of round-ended sterile scissors or by cauterizing it. This procedure is typically quick and safe.

Surgical division of tongue tie. Credit:

Studies suggest that feeding improves within 24 hours of the procedure for 80% of infants. However, a small percentage of babies might still face difficulties. Parents generally report positive outcomes in terms of feeding.

The availability of tongue tie division services can vary across the country, with some parents having to travel long distances to access such a service. A referral from a midwife, doctor, pediatrician, or any other healthcare professional is necessary to receive treatment. Without such a referral, the treatment may not be possible. A directory of tongue-tie practitioners can be found on the International Affiliation of Tongue Tie Professionals website.

Posterior tongue tie – special considerations

Posterior tongue tie is a relatively rare condition characterized by a short, tight frenulum that is more difficult to identify than its anterior counterpart. The key distinction between anterior and posterior tongue ties is their location; anterior tongue ties are situated near the front of the tongue, while posterior tongue ties are located near the back of the tongue.

Posterior tongue tie. Credit: posterior tongue tie

By hindering the baby’s ability to latch onto the breast and extract enough milk itself, the posterior tongue tie, just like the anterior tongue tie, can also cause nipple pain and discomfort for the mother, inadequate milk transfer, and poor weight gain for the baby.

Parents should be aware of potential signs such as difficulty with breastfeeding or bottle-feeding, trouble latching on to the breast, constant hunger, colic, fussiness, slow weight gain or lack of weight gain, inability to extend their tongue past their teeth, and a clicking sound during feeding.

Diagnosing a posterior tongue tie typically involves the observation of a short or tight lingual frenulum that restricts tongue movement. No unique methods exist for diagnosing a posterior tongue or lip tie. If you suspect your baby has this condition, consult with a qualified healthcare professional for further evaluation and treatment options.

Aftercare following tongue tie division

After a tongue tie division, infants often experience some distress during the initial days and may need extra comfort and nurturing. It is typically advised to keep breastfeeding to keep the wound clean and maintain the baby’s tongue mobility. A white patch may be observed underneath the infant’s tongue, which will take 24 to 48 hours to heal and should not cause any discomfort to the infant.

Some tongue-tie practitioners suggest engaging in tongue exercises and wound massage as part of the aftercare process. However, there is no definitive evidence for the safety or effectiveness of these practices. It is essential to follow the advice of your healthcare professional and monitor your baby’s healing and feeding progress.

If you have any concerns post tongue tie release, reaching out for support is advisable. You can contact:

  • A lactation consultant

  • A maternal and child health nurse

  • A pediatrician

  • A local doctor

  • A speech-language pathologist

When to consult a Lactation Consultant

If breastfeeding difficulties continue despite various strategies, consulting a lactation consultant could be the next step. These professionals can offer personalized advice and assistance, such as optimizing positioning with pillows, encouraging a deep latch, and ensuring effective sucking and swallowing.

A lactation consultant should possess the following qualifications:

  • Certification obtained through completing 95+ hours of lactation training

  • College-level health science courses

  • Clinical experience as a hands-on lactation consultant

They can provide invaluable support and guidance for parents facing tongue-tie and breastfeeding challenges.


Tongue tie occurs more often than many realize, and its impact on tongue function can be significant, leading to feeding problems and distress for both you and your baby. However, it’s crucial to understand that this condition doesn’t have to mark the end of your breastfeeding journey.

As someone who’s endured the challenges of a baby’s feeding difficulties due to tongue tie, I know firsthand the importance of supporting sucking skills and exploring different feeding positions. My personal experience, marked by initial breastfeeding problems and emotional distress, eventually turned into a story of triumph!

After seeking professional help for my first child’s tongue tie, we saw a dramatic increase in her ability to gain weight and maintain a good latch. Although it wasn’t an instant improvement, consistent efforts in enhancing her sucking skills (a pacifier really helped here) and my emotional support paid off. We successfully navigated through these feeding issues, eventually achieving exclusive breastfeeding for 14 months.

Remember, a baby’s tongue moves and adapts in remarkable ways, and with patience and the right strategies, many infants with tongue ties can still effectively breastfeed. If your baby loses suction or struggles to feed, consider seeking a lactation consultant’s advice. They can provide invaluable guidance on overcoming these challenges.

Tongue ties may present initial obstacles, but with informed care, persistence, and support, you can guide your baby toward successful breastfeeding. Embrace this journey with resilience and optimism. Together, you and your baby can overcome these early feeding issues and enjoy the bonding and health benefits that breastfeeding brings.

Frequently asked questions

Does tongue-tie affect breastfeeding?

Tongue-tie can significantly affect breastfeeding, leading to issues such as nipple pain and trauma, as well as poor breast milk intake.

Is tongue-tie release necessary?

Based on expert opinion, tongue-tie release is only necessary if your child experiences problems with breastfeeding, speaking, and swallowing. Otherwise, surgery may not be necessary.

What is the best breastfeeding position for tongue-tie?

For babies with a tongue tie, the best breastfeeding position is often the upright or koala hold, as it can help them relax, open their mouth wider, and get a bigger mouthful of breast. Shaping the breast into a ‘sandwich’ and sliding the baby’s chin further from the nipple can also help them get a deeper latch.

Can a lactation consultant cut a tongue tie?

A lactation consultant cannot cut a child’s tongue-tie, but they can help determine if a frenectomy is necessary. Healthcare professionals trained in providing frenectomies such as a pediatric dentist, doctors, neonatal nurse practitioners, midwives, or oral surgeons can perform corrective procedures.

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