Let’s Talk About Tongue-Tie and Lip-Tie

Chances are good that you know someone who has been told they have a baby who is tongue-tied. That person may even be you. Babies who are affected by “tongue-tie” has always been an issue with breastfeeding. The approach to it has changed over the 23 years that I have been a lactation consultant. In recent years, I have noticed an increased number of moms who report being told they have a tongue-tied baby. More recently, moms are also being told that they have a baby with a lip-tie, and even cheek “ties.”

At the breastfeeding support group that I facilitate, and on the social media sites I am a member of, “ties” are very commonly reported, and seem to be responsible for every breastfeeding problem. Sore nipples? Many other mothers are replying that the baby is probably tongue-tied. Poor weight gain? Check for a tongue-tie. Unrelieved engorgement? You guessed it! Tongue-tie is probably the reason.

I am exaggerating. It’s not always blamed as the reason, but someone, and usually more than one person, will suggest that this might be the reason. The number of moms who are reporting that this was their baby’s problem is astonishing to me.

I agree that tongue-tie exists. I agree that treating it can help certain breastfeeding problems. I believe it should be treated sooner rather than later, especially when it appears that it could be the reason for a breastfeeding challenge. However, I am concerned that this is something that may be getting over-diagnosed, and worse, over-treated. On the other hand, nothing makes me crazier than a tongue-tie that you can see from across the room (again, I’m exaggerating) and the pediatrician or ENT says, “let’s see if it affects things.” I want to say, yes, we’ll know it affected things when breastfeeding has gone down the tubes.

Let’s look at how often tongue-tie occurs, and how it can be treated.

What is Tongue-Tie and Lip-Tie Called?

First, I want to talk about the different terms that you might hear that are used to talk about tongue-tie, as well as other ties.

A tongue-tie can be referred to by these terms: short or tight frenulum, lingual frenulum and ankyloglossia. That last one is one of the medical terms used to describe this condition and is almost certainly going to be used by someone who is trying to impress you. My dad used to say, don’t use a $5 word when a 25-cent word will do. Those amounts should probably be adjusted for inflation.

Photo credit: boyetboy via Visual hunt / CC BY-NC

Tongue-ties can be classified, but since this isn’t a medical article, I’m not going to go into that.

Sometimes moms will refer to it as just a “tie.”

The medical term for an upper lip tie is a labial frenulum. For a cheek tie, the medical terms are buccal frenna, lateral frenna or possibly just buccal tie.

How Often Does Tongue-Tie Happen?

When I am asked how often tongue-tie occurs, I always reply that it is not uncommon, but it doesn’t happen frequently. You’ve probably realized that I am the master of vague answers. In my personal experience, I may not see a tongue-tie for months and then it seems I’ll see several in a week, sometimes even in a day.

The research reports an occurrence rate of just under 5%. Some practitioners report a higher incidence. The reason they see a higher incidence is because they are seeing moms who are having problems. Most lactation consultants don’t see moms who are doing wonderfully. When I see a mom and baby in the hospital, I don’t check the baby’s tongue unless there is a need to. It is rare that a mom comes to me as an outpatient just to make sure everything is going ok. I love it when they do, but it’s rare. The vast majority of the time moms are trying to get help with a problem. This is even more the case with ENT’s and pediatric dentists. They only see babies who the doctor or the LC has concerns about, and suspects there is a tie that needs attention. That may account for some practitioners who think the rate is higher. I know a colleague who thinks that a very, very high percentage of babies have some kind of tie that needs to be corrected. I don’t agree, but I think there are enough LC’s out there who believe this and that accounts for the large number of moms reporting their baby had one.

What Effect Can Tongue-Tie and Lip-Tie have on Breastfeeding?

“Can” is the important word there. The impact that a tie can have on breastfeeding can be significant. Having it treated can sometimes make the difference between a successful breastfeeding journey and one that never gets going. Prompt treatment is also important. A mom I worked with early in my career had a severely tongue-tied baby, but her pediatrician told the parents that they didn’t do anything about ties, and initially breastfeeding was going well. Fast forward 2 weeks later and she came to see me because her baby was not gaining enough weight, and she was having severe nipple pain because her nipples were getting mashed flat every time she fed. She took a break from breastfeeding to allow her nipples to heal while they got the baby’s tongue-tie fixed. We were able to convince the pediatrician to refer the baby to an ENT who released the tie. Unfortunately, that baby would never go back to the breast. I firmly believe that if that baby had his tie released in the first few days, it would have been a different outcome altogether. I do tell parents that a tongue-tie that is that obvious almost always has some kind of effect on breastfeeding.

Ties can affect speech. Try to speak without extending your tongue past your lower gum, or lower lip. How well did that go? Ties can affect a baby being able to get milk out of the breast, which can affect weight gain and milk supply. Ties can affect nipple pain because the baby can’t get a proper latch, they can affect dental health because we use our tongue to get food out of our back teeth. A tongue-tie can even make it hard or almost impossible to lick an ice cream cone or lollipop. People with tongue-ties can also be terrible kissers.

There are also ties that just don’t affect breastfeeding at all. Usually they are not the ones that, as I put it, you can see from across the room. A posterior tongue-tie or most labial ties are what I believe fall in this category.

What Does Tongue-Tie Look Like?

A tongue-tied  may reach all the way to the tip of the tongue. It can cause a heart shaped or notched tongue which you may only see it when a baby cries, or you may notice he is unable to lift his tongue up very far when he cries.

Just about every baby has some degree of lip tie, which, in the opinion of a pediatric dentist who spoke about it, probably means that some degree of lip-tie is normal. Lip-ties can be the cause of nipple pain, and they can also result in a gap between the front teeth. Some moms will notice that their baby’s upper lip rolls under when he breastfeeds. If there is no other problem, I think these ties should be left alone. Lip rolling like this can also be caused by low lip tone. I have had a couple patients who had persistent pain and when they had lip ties released the pain went away. The patient that was most recent was a very tight lip tie.

To see what tongue-ties look like, Google the term and click on “Images.”

What Can Be Done About Tongue-Tie?

If you are told, or if you notice, that your baby has a tongue tie, you can choose to do nothing, and take a wait and see approach. Not every tie needs treatment. That said, some practitioners rarely refer a tongue-tied baby for treatment, or wait until there are significant problems.

Ties can be released surgically, with scissors. That’s not quite as scary as it sounds. It is usually only 1-3 snips, and some babies don’t even cry. Some practitioners use some local anesthetic while others don’t. Another treatment that is becoming more popular is using a laser to release the tie. Doing stretching exercises after the procedure can help, so be sure to ask about this.

Over-treating Tongue-Tie and Lip-Tie

Just as some practitioners won’t treat very often, others over-treat. We had to stop referring to one practitioner because he was lasering tongues, upper lips and cheeks  on every baby who was sent to him. All three, on every baby. We didn’t feel confident in him adequately assessing before treating. There are times when we are not sure if something needs to be treated, but we think they do need to be assessed. In my opinion, not every baby needs all of those things released. I guess I just have more faith in mother nature’s ability in getting it right most of the time.

What Should You Expect After a Tongue-Tie or Lip-Tie is Released

Often, improvement will happen right away, both for nipple pain, and how much milk your baby can get out. Practitioners usually like moms to breastfeed immediately because this can help minimize bleeding. You are probably thinking, wait, there is going to be blood? Any kind of incision can, and probably will cause some bleeding. It is usually not more than a cotton swab’s worth.

I do recommend following up with a lactation consultant if the problem was that your baby couldn’t get enough milk out of your breasts. If nipple pain was the only reason you were having and this goes away, there is no reason for follow-up.

One Last Thought

It never hurts to do some research on your own, especially if there is disagreement from everyone involved about what to do. If you are having a problem, getting your baby’s tongue looked at by a specialist who would treat it, getting educated is never a bad idea.

Next Time

Essential breastfeeding equipment, and how you don’t need most of it.