Tied Mouth With A Towel

Tied Mouth With A Towel

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Tongue-Tie and Breastfeeding
19 Jun, 2020

Philippa is an International Board Certified Lactation Consultant (IBCLC) in private practice in the UK

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Editor in Chief Philippa Pearson-Glaze
If breastfeeding is painful for you and you have been looking on the internet to work out what is wrong you may have come across “tongue-tie” and be wondering if your baby has one. Although it is currently very fashionable on social media to blame everything on your baby’s tongue function, bear in mind not every breastfeeding problem involves a tongue-tie. Working with an IBCLC lactation consultant and checking Why Does Breastfeeding Hurt? will help rule out other causes such as the way a baby attaches to the breast (latch) or positioning.
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This article looks at what tongue-tie is, how it might affect breastfeeding, how to know if your baby has a tongue-tie, treatment options and where to find help.
If the tongue can’t move freely this could affect breastfeeding negatively. The movements the tongue is thought to make during breastfeeding are explained by Diana West IBCLC in the following article:
Having a tongue that is tied to the base of the mouth can make it hard for a baby to breastfeed because there are several motions his tongue needs to make to remove milk effectively. It must extend comfortably past the lower lip so that it can grasp an adequate amount of breast for latching deeply. The sides of the tongue need to be able to cup the breast to stabilize it in his mouth. The tip of the tongue needs to be able to lift higher than halfway when the mouth is open, and the back of the tongue needs to lift and then drop to create the vacuum that pulls out milk.
Breastfeeding problems that may stem from a tongue-tie (but can have other causes) include:
Breastfeeding issues sometimes attributed to tongue-tie could be from other causes . Your breastfeeding specialist can help identify if there are any correctable issues that could be causing pain or difficulty breastfeeding such as:
Identifying a tongue-tie requires assessing tongue function in the context of breastfeeding, not just looking at the appearance of the tongue or ticking off a list of symptoms. A website or virtual breastfeeding forum can’t diagnose a tongue-tie, your baby needs a face-to-face consultation with a specialist. A good place to start is by seeing an IBCLC lactation consultant who will take a full breastfeeding history—and assess both breastfeeding and tongue function. Where appropriate, your lactation consultant can arrange a referral to a tongue-tie practitioner or you might be able to self-refer depending on the referral system in your area. A tongue-tie provider might be a paediatric surgeon, midwife, or other health professional trained in dividing tongue-tie.
Just because there is a membrane to see, even if it is pulling on the tip of the tongue to create a heart shaped tip, it may not prevent your baby from breastfeeding, it depends how much it restricts the tongue’s movement. Equally just because there is nothing to see under the tongue, doesn’t necessarily mean there isn’t an issue with the tongue function. Your experienced lactation consultant will know how to assess your baby’s tongue function alongside the appearance. They will assess whether your baby can extend his tongue past his lip or gums, whether he can lift his tongue, cup the breast, how the tongue moves during sucking and more.
Although there is no substitute for an assessment by an experienced professional, Cathy Watson Genna has a website with a sequence of photographs to guide you through a basic self-assessment of tongue function.
If your baby’s breastfeeding problems are associated with a tongue-tie you will need to find the right help. Tongue-tie practitioners can vary in how they approach tongue-tie treatment. In some areas tongue-tie is over diagnosed whereas in others the health professionals do not believe tongue-tie is a problem requiring treatment.
enough tissue must be removed (without cutting into muscle) to restore optimal tongue mobility
A restrictive tongue-tie can be treated by a frenotomy (or frenulotomy), this is a medical procedure that involves cutting (dividing) the membrane under the tongue by scissors or laser. One review states there is not enough evidence to recommend one technique over another (Messner et al) while another suggests the age of the baby is important with scissors recommended for babies (ADA, 2020). A comprehensive approach for a restrictive tongue-tie might include a combination of improved positioning at breast, bodywork or tongue exercises if appropriate, and/or frenotomy. The most common method of dividing frenulums in the UK is to use sharp, blunt-ended surgical scissors. A tongue-tie practitioner describes the procedure:
The baby is wrapped securely in a towel or blanket so they cannot wriggle or put their hands to their mouth. The head is then held still by a parent, nurse or other helper. The practitioner performing the procedure lifts the tongue using the finger or fingers of one hand. (Some practitioners prefer to use a Brodie Director, a small metal spade shaped instrument with a central slit to isolate the frenulum and lift the tongue). With the scissors in the other hand the practitioner slides the blades under the tongue so they are on either side of the frenulum and snips.
There are said to be very few nerve endings or blood vessels in the lingual frenulum and a frenotomy is thought to cause only momentary stinging. Some babies sleep through the procedure or go straight to the breast for soothing. However some babies can be unsettled for a few days afterwards with difficulty feeding and with increased crying (Oakley, 2015). Complications from the procedure can be mild or occasionally more serious (ADA, 2020).
Frenotomy is not recommended for all babies. Contraindications include having a neurological disorder, hypotonia (low muscle tone), receding chin (retrognathia), small lower jaw (micrognathia) or a bleeding disorder (Messner et al, 2020).
A tongue-tie describes the situation where the membrane that joins the underside of the tongue with the floor of the mouth is said to be particularly short or tight and restricts normal tongue function. If a baby’s tongue can’t move normally, breastfeeding can be be painful for his mother, and it will usually be difficult for the baby to get enough breast milk which may lead to slow weight gain. Poor tongue function can also be frequently seen with a shallow latch, poor positioning or physical issues such as pain or tension from a difficult birth. If breastfeeding is not going well, an IBCLC lactation consultant will take a full history and assessment of breastfeeding to pinpoint the most likely causes of your difficulties and to find the right care plan for you and your baby. If a frenotomy (surgical division of the tongue-tie) is recommended, it is important to find an experienced and knowledgable tongue-tie practitioner. More research is needed regarding the best tool to use (scissors or laser), best wound care, the role of bodywork or the value of lip-tie frenotomy.
Messner et al. Clinical Consensus Statement: Ankyloglossia in Children . Otolaryngology–Head and Neck Surgery. 2020
Tongue-Tie in Babies , Sarah Oakley, 2015 (pdf)
Tongue-Tie in Babies , Sarah Oakley, 2015 (pdf)
Lip-tie – What’s it all about? Sarah Oakley Lactation, 2016
Supporting Sucking Skills , Cathy Watson Genna, 2016
Messner et al. Clinical Consensus Statement: Ankyloglossia in Children . Otolaryngology–Head and Neck Surgery. 2020
ATP Statement on Lip-tie , Association of Tongue-tie Practitioners, 2016
Lip-tie – What’s it all about? Sarah Oakley Lactation, 2016
This article should not be construed as medical advice. Information found online should always be discussed with your own IBCLC lactation consultant and doctor to ensure it is appropriate for you and your baby’s situation. Contact your doctor, paediatrician or health care provider with any concerns about your baby’s health and welfare.
Is lip-tie anything to worry about? This article discusses what a lip-tie is, whether it affects breastfeeding and answers frequently asked questions
This article looks at the reasons babies have reflux and answers frequently asked questions.
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In addition to owning and editing Breastfeeding Support, Philippa is a Professional Liaison Leader for La Leche League Great Britain (LLLGB) supporting La Leche League Leaders with medical queries. For more information see the About Page .

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