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Home › Articles › Overcoming Difficulties › Tongue-tie By Any Other Name

Tongue-tie By Any Other Name

Does Ankyloglossia Affect Breastfeeding?

By Ann Calandro, RNC, IBCLC

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About four out of every 1,000 babies born are affected with a condition called ankyloglossia or tongue-tie. Tongue-tie is when the small piece of skin under the tongue is tight and holds the tongue fastened to the bottom of the baby's mouth. The tongue is restricted from upward motion. The small piece of skin, called the lingual frenulum, may in some cases reach all the way to the tip of the baby's tongue. The condition tends to run in families. It may persist into adulthood, causing additional problems.

In years past, it was understood that tongue-tie may affect a baby's ability to breastfeed. It is said that midwives used to keep one fingernail sharp for the purpose of cutting the frenulum loose to aid breastfeeding. Physicians routinely clipped the small piece of skin if the frenulum looked tight at birth. When bottle-feeding became the norm in our country, physicians were taught that clipping the frenulum was an unnecessary procedure, and physicians were no longer taught this procedure during medical training.

Now the tides have turned back, with more than 60 percent of all babies beginning life breastfeeding. However, there are still many physicians who do not feel that the tight lingual frenulum could cause problems with breastfeeding, and they discourage mothers from having the frenulum clipped.

In some cases, it does seem that breastfeeding can be successful even if the baby has a tongue-tie. In other cases, the tongue-tie may cause breastfeeding problems. In an attempt to draw the breast into the mouth and "milk" the breast with the tongue, the baby becomes frustrated and may "bite" at the breast or may not be able to fully compress the milk sinuses to remove milk. Baby's tongue normally cushions the breast from the bony lower jaw while breastfeeding, and when it cannot, breastfeeding is painful.

It is important to consider the role of the tongue in breastfeeding. When a baby attaches to the breast, his tongue extends and grooves to cup the breast, removing milk with a rolling motion while lifting up to compress the breast.

A tongue-tied baby may have difficulty extending his tongue over the lower gum line. When Baby's tongue is too tightly bound to the bottom of his mouth, forming a seal and creating a positive pressure can be a difficult maneuver. Mothers may find that their babies do not remove milk well enough to gain weight normally. They may find that the tongue action of the baby causes extremely sore nipples, because the baby cannot correctly attach to the breast.

Dr. Ruth Lawrence, in her book Breastfeeding: A Guide for the Medical Profession

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