Tongue-tie and Breastfeeding

A tongue-tie (ankyloglossia) occurs when the connective tissue (frenum) under the tongue causes restriction in the tongue movement or function. It occurs in 2.8 – 10.7% babies, more often in boys and can be hereditary.

Anterior tongue-tie occurs when the frenum is attached at the front of the tongue, close to the tip. When the frenum is attached further back, or behind the mucosa, the term posterior tongue-tie is used. This term does not have consensus and the topic of posterior tongue tie (and lip tie) is a controversial one. Research is limited and opinions are divided.

Photo courtesy of Monica Hogan & David Todd

Signs & Symptoms

A baby with tongue-tie may not be able to poke the tongue out beyond the gum line / lips;  and /or may not be able to lift the tongue, or move it side to side. The tongue tip may look notched or heart shaped. This may interfere with correct attachment at the breast, leading to some of these problems:

Mother:

  • Nipple pain and damage
  • Low milk supply
  • Blocked ducts / mastitis
  • Early weaning
  • Frustration, disappointment and discouragement with breastfeeding

Infant:

  • Baby can’t latch or stay latched
  • Fussiness and frequent arching away from the breast
  • Clicking sound while feeding or spilling (poor suction)
  • Poor milk transfer – frequent small feeds or long inefficient feeds
  • Low weight gain
  • Chewing or chomping at the breast

How to treat:

Frenotomy is a minor surgical procedure performed using scissors. It is quick and the baby will often settle soon after. It can be performed without anaesthesia. Scissors are often used when the frenum is thin and anterior and unlikely to bleed much.

Laser frenectomy is an effective method for “posterior” tongue-tie / submucosal tongue-tie and lip tie that controls bleeding well. This is generally performed by a paediatric dentist or surgeon. Different lasers are used: water-lase is commonly used with infants.

Risks:

Infection is rare. Some babies may become fussy at the breast for a period of time afterwards. Bleeding is common – sucking/feeding straight after the procedure usually resolves this. There is a small risk of reattachment and scarring that may require a repeat procedure. Wound stretches and other oral exercises are often advised for this reason but may distress the baby and lead to oral aversion.

My approach as an IBCLC/bodyworker:

Sadly, I have seen many parents (and babies) whose breastfeeding journeys have been negatively affected due to missed tongue-ties. Babies with feeding challenges need to have an individualised, comprehensive feeding and oral function assessment. An IBCLC can rule out nipple infections and positioning and attachment issues which may potentially avoid surgery. Since becoming a craniosacral therapist, I further understand how cranial nerve compression and tension in the body can also cause similar symptoms to tongue tie. The tongue may be restricted, but not specifically due to the presence of a tight frenum. A couple of sessions of cranio/bodywork beforehand may address these issues and have a positive impact on breastfeeding. A procedure may be avoided or it may become clearer that a release is necessary. Cranio after the procedure can help to resolve any stress and to optimise function.

There is so much controversy, and limited research, around tongue ties, that it can be difficult for parents to know whether to go ahead with a procedure to release a tie – especially with posterior tongue-ties and lip ties. Where there is doubt about the presence of a tongue-tie, cranio is a gentle, less invasive approach than laser frenectomy. But ultimately, treating the tongue-tie can make all the difference to breastfeeding success.

Contact me for a lactation consultation, tongue-tie assessment or cranio pre or post tongue-tie release.

Insufficient Glandular Tissue as a cause of low supply

This week I worked with two mothers who were struggling with low supply due to insuffient glandular tissue (IGT). They didn’t feel their milk come in, they had minimal breast growth during pregnancy and they were needing to top up with almost full feeds of formula. Noone had mentioned to them the possiblity of IGT.

IGT is not well known among health professionals working with mothers and babies, or other mums. They are often given well meaning advice that does not work and may feel as though they are doing something wrong or failing their baby. They are not! Unfortunately there is not a lot of research behind this heartbreaking condition. Diana Cassar-Uhl (IBCLC) has contributed to the field of knowledge through research and written a fantastic book. We do know that the glandular tissue, where milk is made and stored, is underdeveloped, but not necessarily why. It can be hormonal or due to circumstances surrounding periods of breast development (inutero and during the teenage years). Mums may make as little as a few drops of milk or up to 3/4 of the milk, but despite their best efforts to increase supply need to supplement with formula (or donor milk).

It is often not until they consult with an IBCLC that they understand the reasons behind their milk supply struggles and then get to set realistic expectations around increasing supply or to make peace with their breastfeeding journey. Understanding their body and its limitations clears any doubt or confusion. IBCLC’s do have tools up their sleeve to support mums to work out exactly how much milk they make and tools to support supplementing at the breast. Ultimately the diagnosis can be healing in and of itself.

If this resonates please seek the emotional support and knowledge of an IBCLC.

For a more detailed discussion of IGT see this resource.