Tongue-Tied
By Florence Bowen, DOMP
If you are a new parent, you have likely heard of the tongue tie phenomena. Social media and mommy forums are all talking about tongue tie because parents whom are struggling to breastfeed are searching for answers. This blog will discuss what being tongue tied is and how it impacts breastfeeding/chestfeeding.
During the first six-weeks of the postpartum period, the initiation and maintenance of breastfeeding is not always as instinctive or smooth as one might imagine. Despite a mothers desire to exclusively breastfeed, low milk supply, nipple pain and discomfort can lead to a new parent to choose to stop breastfeeding early.
A Canadian national survey published in 2009 reported that out of a group of over six-thousand women, 90% intended to breastfeed their newborn and 90.3% initiated breastfeeding after delivery. However at six-months postpartum only 14.4% of women reported to be exclusively breastfeeding (1). These rates have been reflected in places like Australia too, where a national survey found that breastfeeding rates fell from 80% of infants being breastfed at 1 week old to only 14% of infants being exclusively breastfed at six-months of age (Australian Institute of Family Studies 2008).
One condition that can negatively affect breastfeeding for some infants and negatively impact the experience of breastfeeding for mothers is tongue-tie.
What does it mean to be tongue tied? Lift your tongue to the roof of your mouth, do you see a band of tissue on the undersurface of your tongue? The anatomical name for this structure is lingual frenulum.
We all have a lingual frenulum, it is essential to both stabilize and allow for free movement of the tongue. The pliability of the tongue allows us to swallow and speak, it also plays an essential role in breastfeeding. A person or an infant is said to have a tongue tie when the lingual frenulum is found to be so tight or short that it negatively impacts the function of the tongue. Although the tongue tie has been described in the past as a separate band of tissue, string or rope – it is simply a central fold of the fascia that lines the floor of the mouth (2).
The reported prevalence of tongue tie varies across the literature, but ranges from 2% – 12% (3). Recent literature suggests that the true prevalence of this phenomena is much higher, one study found that out of 1392 newborns, 46% had tongue tie and 70.2% of those infants were symptomatic or had difficulty breastfeeding (4). Issues or difficulty with breastfeeding can occur due to a tongue tie because the restrictive lingual frenulum. Tongue tie can prevent the infant from taking enough breast tissue into their mouth to successfully draw milk from the breast. While some infants with tongue tie are able to attach but are less efficient at breastfeeding due to reduced tongue mobility (3).
Symptoms such as nipple tenderness, nipple damage and breast pain are common complaints experienced by mothers who are breastfeeding and infant with a tongue tie (5).
Other symptoms associated with tongue tie include, but are not limited to:
difficulty latching
falling asleep at the breast
milk or lip blisters
reduced milk production/ low milk production
blocked or clogged ducts
poor infant weight gain
The best way to confirm or rule out the existence of a tongue tie is to have a professional examine your newborns mouth. A certified lactation consultant or paediatric dentist can identify a tongue tie and should assess the tongue for both its appearance (anatomy) and mobility (function). If the tongue is very restricted due to the frenulum they may suggest a procedure called a frenotomy, also referred to as a tongue tie release.
There is evidence which indicates that frenotomy offers significant benefit, and is a simple, safe and effective procedure (3). However, there is a lack of consensus amongst medical professionals regarding the need to treat with frenotomy and there are many differing opinions related to tongue-tie. To demonstrate these differences, a large survey in Canada and the USA of otolaryngologists (ear, nose and throat doctors), paediatricians, speech pathologists and lactation consultants revealed that while 69% of lactation consultants believed that tongue tie was associated with feeding problems, only 30% of otolaryngologist and 10% of paediatricians believed the two were connected (3).
This discrepancy often leads to new mothers receiving conflicting advice from different health care providers when seeking guidance for breastfeeding difficulties. Which can contribute to more anxiety and stress postpartum. Breastfeeding is like a dance between mother and infant, the feeding dyad must rehearse repeatedly before effortlessly performing the routine. It takes time and should your little one have a tongue tie, it might take a few more early morning rehearsals and some extra hands on care.
There are less invasive management strategies available for newborns with feeding difficulties and tongue ties. Body work such as like osteopathy and cranial-sacral therapy are gentle and effective ways to alleviate tension and restrictions in the shoulders, neck, jaw and mouth that can effect an infant’s ability to latch. As an Osteopathic manual practitioner who has taken special interest in pediatric and maternal care I often see mothers and babies who are struggling to breastfeed. If you are seeking preparatory care or post frenotomy care (both are highly recommended) you can book here.
References
Chalmers, B., Levitt, C., Heaman, M., O’Brien, B., Sauve, R., Kaczorowski, J., & Maternity Experiences Study Group of the Canadian Perinatal Surveillance System, Public Health Agency of Canada. (2009). Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women. Birth, 36(2), 122-132.
Mills, N., Pransky, S. M., Geddes, D. T., & Mirjalili, S. A. (2019). What is a tongue tie? Defining the anatomy of the in‐situ lingual frenulum. Clinical Anatomy, 32(6), 749-761.
Edmunds, J., Miles, S., & Fulbrook, P. (2011). Tongue-tie and breastfeeding: a review of the literature. Breastfeeding Review, 19(1), 19-26.
Maya-Enero, S., Pérez-Pérez, M., Ruiz-Guzmán, L., Duran-Jordà, X., & López-Vílchez, M. Á. (2021). Prevalence of neonatal ankyloglossia in a tertiary care hospital in Spain: a transversal cross-sectional study. European Journal of Pediatrics, 180(3), 751-757.
Amir, L. H. (2006). Breastfeeding: managing’supply’difficulties. Australian family physician, 35(9).