Breastfeeding a Baby With a Tongue-Tie

Mother with newborn baby sleeping on shoulder
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A tongue-tie or ankyloglossia is a relatively common condition that approximately 4% to 11% of all newborns are born with. When a baby has a tongue-tie, the frenulum (the cord of tissue that connects the tongue to the bottom of the mouth) is short, tight, or thick and may impede the movement of the tongue.

In more severe cases, the frenulum may be attached close to the tip of the tongue, preventing the tongue from sticking out past the baby's gums. The tongue may even look heart-shaped when the baby cries or tries to push it out.

However, a baby with a tongue-tie may be able to breastfeed without any problems, or they may have trouble latching and sucking at the breast. However, these issues can often be resolved with simple treatments. Whether or not your baby has difficulty breastfeeding depends on the baby, getting effective lactation support, and the severity of the tongue-tie.

How Tongue-Tie Can Affect Babies

Babies use their tongue when they latch on to the breast. They extend their tongue out to take the nipple and some of the surrounding areolae into their mouth. They also use their tongue to form a good seal around the latch while drinking. Some babies with a tongue tie may not be able to extend their tongue or open their mouth wide enough to latch on and nurse effectively.

The tightness of the tongue may also keep the baby from making the movements necessary to squeeze the milk ducts under the nipple as they're breastfeeding.

The combination of a poor latch and difficulty sucking can prevent the baby from effectively removing adequate breast milk from the breast.

A tongue-tie can have varied effects on babies, such as breast refusal, irritability, trouble sleeping, and crying, and poor weight gain: Other issues may also occur as the baby grows.

For example, a short frenulum can cause problems with eating, swallowing, and speech. Additionally, if your child cannot latch on and breastfeed well, they will not get enough breast milk to grow and gain weight at a consistent rate.

Consequences for Mothers

A tongue-tie could potentially have some adverse effects on breastfeeding mothers.

  • A low breast milk supply: A poor latch and the ineffective removal of breast milk can decrease the breast milk supply.
  • Early weaning: Painful breastfeeding, perceived insufficient milk supply, a low breast milk supply, and coping with a frustrated, hungry baby who is gaining weight too slowly can all lead to early weaning.
  • Emotional stress: Breastfeeding difficulties can lead to frustration and a lack of breastfeeding confidence.
  • Painful breast problems: When the baby isn't able to breastfeed well, they can't drain the breasts of the breast milk, which can lead to breast engorgement, sore nipples, plugged milk ducts, and mastitis.

Help a Tongue-Tied Baby Breastfeed

If you think your little one has a tongue-tie, notify their doctor right away. The faster you can get a diagnosis, the faster you can get the help you need to make breastfeeding work better for you and your child. Make sure your breastfeeding technique is correct and learn about your options. This may include lactation support and discussing the pros and cons of frenotomy with your baby's healthcare team.

If you decide against frenotomy, you can continue to breastfeed but have your little one monitored to be sure they're gaining weight and getting enough breast milk. You may have to pump and give your baby expressed breast milk in a bottle as a supplement if necessary.

Try a Nipple Shield

If your child is having trouble latching on, talk to your doctor or a lactation consultant about using a nipple shield.

A nipple shield can be a helpful breastfeeding tool for babies who have difficulty latching on to the breast.

However, if you do decide to use a nipple shield, learn how to use it correctly, wear the right size, and work closely with your doctor. If you don't wear it as directed, a nipple shield can cause even more breastfeeding issues.

Trying a variety of breastfeeding positions may also help improve your breastfeeding comfort and success.

If your nipples are too sore to breastfeed and you need to rest them to heal, pump to maintain your breast milk supply and provide your child with your expressed breast milk in a bottle. Note that if your baby has dificulty breastfeeding, they may also have difficulty drinking from a bottle. If your supply of breast milk is declining, take steps to boost production and increase your supply.

Continue to see the doctor at regular intervals to monitor your baby's health and weight gain.

Does Cutting the Tongue-Tie Help?

Frenotomy (also called frenulotomy) is a minor surgery or procedure for babies with a tongue-tie. Essentially, it entails snipping the frenulum under your child's tongue to allow the tongue a greater range of motion. The doctor can use local anesthesia, but many newborns can handle it without any anesthesia. It does not bleed much, heals in a few days, and stitches are usually not needed.

In general, frenotomy is quick, simple, and safe.

However, there are risks for all procedures and some pediatricians discourage the routine use of the procedure, primarily because it may be done in some situations unnecessarily as use of the procedure has been rapidly increasing. Although it's rare, frenotomy can cause pain, bleeding, and infection. That's why, if having the procedure is necessary for your baby, it's so important to have it performed by a trained healthcare provider.

If your child's physician does not do this procedure, they can give you the name of a doctor, dentist, ear, nose, and throat doctor (ENT), or pediatric surgeon who does. A lactation consultant or a local breastfeeding group can also provide you with information on who to go to for this minor surgery.

If your newborn has a tongue-tie but doesn't have any trouble breastfeeding (or bottle-feeding), and isn't causing you nipple pain during feedings, then a frenotomy is usually not necessary. And, if your baby's tongue-tie is mild, you can wait and see how they do with nursing. However, if your child is having trouble latching on and you're finding it very uncomfortable to breastfeed, you may want to consider having this procedure done as it can be helpful.

If your baby gets a frenotomy, you'll be able to put your baby to the breast immediately after the procedure, and hopefully, your child will be able to latch on and breastfeed well right away.

Once your newborn is latching on better, they'll be able to get more breast milk, and breastfeeding should become easier and more comfortable for both of you.

A Word From Verywell

A tongue-tie may or may not cause breastfeeding problems, but if it does, know that there are options to help improve the situation. Often, the impact of a tongue-tie is mild and no interventions will be needed.

While a frenotomy may be the answer for some babies, it doesn't always solve all breastfeeding problems. So, there's always a chance that your baby will still have breastfeeding difficulties even after the procedure. However, for many newborns and moms, it can make breastfeeding more successful and last for a greater length of time.

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Article Sources
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Additional Reading
  • Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

  • Riordan, J., and Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2014.