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Breastfeeding and tongue ties

Updated: Mar 19, 2021

Tongue-tie is a problem that occurs in babies who have a tight piece of skin between the underside of their tongue and the floor of their mouth. The medical name for tongue-tie is ankyloglossia, and the piece of skin joining the tongue to the base of the mouth is called the lingual frenulum. It can sometimes affect a baby's feeding, making it hard for them to attach properly to their mother's breast. The following article explains tongue-tie and the problems it can cause, and describes a quick and painless procedure to snip the skin, known as tongue-tie division, which should be considered if your baby is affected.

Tongue-tie is a birth defect that affects 3-10% of newborn babies. It is more common in boys than girls. Normally, the tongue is loosely attached to the base of the mouth with a piece of skin or the lingual frenulum. In babies with tongue-tie, this piece of skin is unusually short and tight, restricting the tongue’s movement. Many tongue ties cause no breastfeeding problems however, for some nursing mothers and infants it can lead to problems latching, sore nipples, and poor infant weight gain.

Successful breastfeeding depends on a complex interaction between mother and child. Where there are difficulties it is important that skilled breastfeeding support is available. Where a tongue tie is identified as a cause of problems with nursing, there are advantages to treating the condition early such as allowing mothers to continue to breastfeed rather than having to depend on formula. In new born infants tongue tie correction does not usually require a general anaesthetic unlike tongue tie correction in older children.

To breastfeed successfully, the baby needs to latch on to both breast tissue and nipple, and the baby's tongue needs to cover the lower gum so the nipple is protected from damage. Babies with tongue-tie are not able to open their mouths wide enough to latch on to their mother's breast properly. They tend to slide off the breast and chomp on the nipple with their gums. This is very painful and the mother's nipples can become sore, with ulcers and bleeding. Some babies feed poorly and get tired, but they soon become hungry and want to feed again. In most cases, these feeding difficulties mean the baby fails to gain much weight.

If your feeding specialist identifies that breastfeeding is affected by a tongue tie then it will need to be divided. Tongue-tie division involves cutting the short, tight piece of skin that connects the underside of the tongue to the floor of the mouth. It is a simple and painless procedure that usually resolves feeding problems straight away. The National Institute for Health and Clinical Excellence (NICE) supports the use of tongue-tie division, as it is safe and there is evidence that it can improve breastfeeding.

In babies only a few months old, division of tongue-tie is usually performed without any anaesthetic (painkilling medication), or with a local anaesthetic that numbs the tongue. A general anaesthetic is usually needed for older babies with teeth, which means they'll be asleep during the procedure. You can start feeding your baby immediately afterwards. Some babies sleep through it, while others cry for a few seconds. In small babies, being cuddled and fed are more important than painkillers. If you're concerned about your baby's feeding, you can schedule a consultation with Dr Daly

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