Have you been told your baby has a tongue-tie?
Not sure what it is or what you should do?
Here is some basic information to help you make an informed choice and guide you to the right resources.
What is tongue-tie?
In anatomy, the frenulum represents a fold of mucosal tissue that is more or less thick, which connects an organ to a part of the body and limits its movement. In the mouth, there is a tongue frenulum (or lingual frenulum), which can be situated on the back portion of the tongue (posterior frenulum) or extend to the front of the tongue (anterior frenulum). An additional frenulum is found on each lip (upper and lower labial frenula). Normally, during pregnancy, a remodeling of tissues occurs and these folds are largely resorbed.
However, for about 5 to 10% of babies, this remodeling is incomplete, and they have a congenital anomaly of the mouth frenula. They are sometimes too short or too rigid; in this case they are said to be restrictive, and this limits the movements of the tongue or lips. For some dyads (mother-baby duos), the difficulties that arise because of this can be overcome with small adjustments, while for others, more extensive interventions are required to ensure successful breastfeeding.
What are the signs and symptoms?
Several clues may indicate the presence of one or more restrictive frenula.
However, these are not specific, and it Is therefore important to perform a thorough evaluation to rule out other possible causes.
- Inability to latch on or hold the breast
- Inability to open mouth wide
- Excessive weight loss or slow weight gain
- Digestive discomfort (baby swallows a lot of air)
- Tongue clicking or loud sucking
- Sleepy at the breast or restless at the breast
- Baby "chews" the breast rather than having a sucking response
- Heart-shaped tongue, with a "notch" at the front; tongue is flat or deviating downwards
- Tender, sore or injured nipples
- Crushed or beveled nipples after feeding
- Sensation of tongue rubbing on the nipple
- Long, ineffective or very frequent feedings
- Insufficient or decreased milk production
- Engorgement or mastitis (resulting from insufficient milk transfer to the baby)
What are the impacts of restrictive frenula?
Tongue-ties can impact baby, mom and family
Evidently, the first impact will be on breastfeeding, with difficulties often appearing as soon as the baby is born or with the onset of lactation. Often, the mother tries multiple breastfeeding positions to improve comfort. She visits breastfeeding clinics or consults a doctor, midwife, birth attendant or CLSC nurse. She calls breastfeeding support organizations and tries to improve latching with all this good advice.
But the difficulties persist, the pain is always present. She tries using a nipple shield or creams to ease the pain. She even considers the breast pump. Meanwhile, baby is not gaining enough weight and is never full. She has to supplement with commercial formula or with milk she has pumped during the day.
She is exhausted, baby is exhausted, the family is exhausted. She may feel a sense of failure or guilt, and a form of distress may set in. Sometimes this is the beginning of the end for breastfeeding. It is also possible that the situation is temporarily resolved, but difficulties may resurface during growth spurts or periods of "intense" development (6 to 9 weeks, 3 months...).
In some cases, nature works well, and the fit is great within the dyad. The mom has a good production and baby adjusts to the reduced mobility of their tongue. In other cases, things will improve with time. One feeding at a time, the situation improves, breastfeeding becomes more comfortable and baby is doing well. To achieve this, it takes a good dose of perseverance and adequate support from family and health professionals.
In the next article, we will talk about what can be done to improve breastfeeding and increase the well-being of families whose babies are born with a tongue-tie. In the meantime, if you think your baby is in this situation, don't hesitate to ask for the support of a breastfeeding consultant or mentor who will be able to guide you toward useful resources.
Read our next article : Tongue-ties: what can you do?
by Sophie Morel, IBCLC
Date of publication: February 11, 2019 - Republication: January 10, 2020
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