Tongue-ties: what can you do?

Do you suspect your baby has a tongue-tie?

What should you do if you suspect that your baby has a tongue-tie that is causing problems with breastfeeding?

There are a few options available to help you decide what is best for you.

Assessing the situation correctly

To make the most informed decision possible, it is important to carefully assess your situation.  

Is breastfeeding painful? Does baby tire quickly, unlatch frequently or not gain enough weight? A health care professional such as an IBCLC certified lactation consultant is best equipped to evaluate your situation.

Other professionals can also guide you, namely doctors, nurses at the hospital or CLSC, midwives and certain nutritionists. Don't hesitate to seek a second opinion or to consult an IBCLC if you are not sure of the advice you received from one of these professionals, as it is sometimes difficult to fully understand and evaluate these issues.

During an assessment, the health care professional will conduct a general analysis of the situation, a brief physical and oral examination of the baby, and a breastfeeding assessment. Other possible causes for breastfeeding difficulties will be considered, including the possibility of torticollis or other physical discomforts that may cause tension.

Basic strategies

In general, most breastfeeding dyads will be guided to implement certain solutions to decrease the impact of tongue-ties. 

First, care should be taken to improve the breastfeeding position. Second, try to achieve a deep, asymmetric latch. For babies who tire quickly, breast compression can be used to increase milk transfer during feeding. If production has decreased due to lack of stimulation, it is important to increase it again.

Knowing that a well-fed baby draws milk better due to a higher energy level and a better state of alertness, it is essential to encourage its growth. To achieve this, it is sometimes necessary to supplement with other means compatible with breastfeeding such as a breastfeeding aid, cup, spoon, etc.

The mother should not be overlooked either during all this! If nipple injuries or pain occur, it is important to take good care of the breasts and use strategies that relieve the mother. For less severe cases, with perseverance and time, these basic strategies will sometimes be enough to overcome the initial difficulties caused by tongue-tie.

More advanced strategies

If basic strategies are not sufficient to reduce pain or promote adequate growth, other solutions may be considered.  

Often, these will be carried out with support from an IBCLC that is specialized in ankyloglossia, as they require even more advanced knowledge. Tongue massages, or exercises that improve the positioning of the tongue can be performed.

If  muscular tension or physical discomfort occurs, which often results from the baby’s position in the uterus or during birth, a consultation with an osteopath or chiropractor may be recommended.

It should also be noted that additional physical particularities, such as a high-arched palate or a receding chin, can accentuate breastfeeding difficulties, even if the restriction of tongue movements is not severe. Other professionals such as occupational therapists can offer additional tools, especially when a pronounced gag reflex is noted, which often occurs when babies have a high-arched palate.

The frenotomy

Sometimes difficulties persist, despite best efforts and strategies.  

A frenotomy may be considered to avoid discouragement, reduce the mother's pain, promote the baby's growth and continue breastfeeding. Sometimes parents choose to perform the procedure from the beginning, when it is clear that other strategies will not be sufficient or to find quick relief.

This is often a difficult decision to make for families, as they do not want to see their baby suffer. However, it is important to know that the frenotomy is a fairly simple procedure, performed with small scissors or a laser, and has a low risk compared to the expected benefits. In general, there is little bleeding and for a baby of up to 3 months the area is not very innervated, which limits the pain.

Certain health care professionals use a local analgesic, especially for older babies. Baby experiences a pinching sensation and slight discomfort, which will be quickly relieved by latching onto the breast. To be effective, the frenotomy must be accurate and complete. Make sure it is done by a qualified professional who has received proper training (doctor, dentist or midwife).

Ideally, the parent should be accompanied by someone to support them or even by an IBCLC to facilitate latching after the procedure and to remind them of the exercises to be performed afterwards.

To help in the decision-making process, it may be interesting to discuss the possible long-term consequences of not intervening: speech difficulties, oro-facial muscular fatigue, suboptimal development of the palate and dentition, sleep apnea, etc. The history of untreated ankyloglossia is not well documented and often mothers decide to stop breastfeeding because of the implications of this condition.

It is therefore difficult to understand what will happen if an intervention is not performed.

In summary

The presence of a restrictive tongue-tie (or sometimes a lip-tie) can have short- and long-term consequences for mom, baby and family.  

Several strategies can be used to improve the situation. In most cases, the support of skilled professionals, breastfeeding consultants, mentors and caregivers is needed to make a decision, persevere and work through the difficulties encountered in order to stay on track with your breastfeeding goals, and have a positive experience.

Read the previous article : My baby has a tongue-tie, what does it mean?.


by Sophie Morel, IBCLC

Date of publication: March 13, 2019 - Republication : January 10, 2020


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