Breastfeeding is one of the most natural and beneficial ways to nourish a newborn. A mother’s milk provides optimal nutrition, strengthens the baby’s immune system and supports bonding between mother and child.
But despite a mother’s best efforts however, some babies experience difficulty in breastfeeding.
One possible reason for this is a condition known as tongue-tie, medically called ankyloglossia.
For many parents, hearing that their baby has tongue-tie can be worrying. By understanding the condition, how it may affect feeding and when treatment is necessary may help parents make proper decisions.
What is tongue-tie?
Tongue plays an important role during breastfeeding. A baby will extend the tongue over the lower gum and create a sucking motion that draws milk from the breast.
When the tongue cannot move freely, the baby may struggle to latch or maintain effective sucking.
Tongue-tie is a common condition where there is presence of thick, short band of tissue that limits the movement of the tongue (lingual frenum).
Studies reported that it occurs in about 2%-10% of newborns. In most cases, the tongue-tie condition is mild and causes no problem. However, in some infants, it may interfere with breastfeeding.
How does tongue-tie affect breastfeeding?
Breastfeeding is a complex process that involves coordination between the infant’s tongue, lips, jaw and swallowing muscles. When the tongue movement is restricted, feeding difficulties may arise.
Among common signs that tongue-tie may affect breastfeeding include:
> Difficulty latching onto the breasts
> Frequent slipping off the breasts during feeding
> Clicking sounds during feeding
> Taking a long time to feed
> Frequent feeding but unsatisfied/appearing hungry
It is important to note that not all breastfeeding difficulties are caused by tongue-tie.
Sometimes the issue may simply be related to positioning or latching technique.
Diagnosing tongue-tie
Clinical appearance alone is not sufficient to diagnose tongue-tie issues. Some infants may have a visible lingual frenulum but has no feeding problems, while other infants with subtle, mild restrictions may experience significant difficulty in feeding.
Healthcare professionals such as paediatric dentists, paediatricians or lactation nurse will usually assess several factors, including:
> Baby’s tongue movement
> Baby’s ability to latch and feed
> Mother’s symptoms during breastfeeding
> Baby’s weight gain
A thorough feeding assessment is often the most important step before considering any treatment.
Can tongue-tie improve on its own?
In some infants, mild tongue-tie may improve naturally as the baby grows and oral function develops further.
The frenulum may stretch over time allowing greater tongue movement. Thus, not every baby with tongue-tie requires surgical intervention.
In cases where breastfeeding is going well and the baby is gaining weight adequately, doctors may simply monitor the condition without any treatment.
Parents should remember that presence of tongue-tie alone does not mean intervention is necessary.
When should intervention be considered?
Prior to considering any surgical intervention, a conservative approach will be recommended such as improving positioning and latch.
If feeding issue persists, and tongue-tie is proven interfering with breastfeeding, a minor procedure (frenotomy) may be considered.
A frenotomy involves careful releasing the restrictive frenulum to facilitate more tongue mobility. The frenotomy is usually very quick and may take only a few seconds.
In young, healthy infants, the procedure can often be done in a primary clinic setting.
Babies generally breastfeed immediately after the procedure, and many mothers indicate improvement in comfort and efficiency of feeding.
It is important that the decision for frenotomy is made carefully based on a thorough clinical assessment and discussion between parents and healthcare professionals.
Is the procedure safe?
Frenotomy is considered as a safe procedure. Although complications are uncommon, they may include slight bleeding, temporary discomfort or infection.
Parents should also be aware that while many babies improve following the procedure, not all breastfeeding issues are resolve immediately. Sometimes additional assistance from lactation experts is required to help the baby acquire more effective latch.
Avoiding unnecessary treatment
In recent years, awareness of tongue-tie has increased significantly, which is good because babies who truly need help can be identified earlier.
Not every feeding difficulty is due to tongue-tie, and not every tongue-tie requires surgery. Early assessment by qualified professionals is essential prior to any intervention.
Good communication between parents and healthcare providers helps ensure that the best decision is made for the baby.
Supporting breastfeeding success
Many mothers benefit from breastfeeding support during the early weeks. Lactation consultants can provide guidance on positioning, latching techniques and feeding cues.
Early assistance can prevent small problems from becoming bigger challenges.
Parents should also remember that breastfeeding is a learning process for both mother and baby. Patience, support and reassurance are often keys for success.
When should parents seek help?
Parents should consult a healthcare professional if they notice:
> Persistent pain during breastfeeding
> Difficulty with the baby latching during feeding
> Poor baby weight gain
> Long feeding sessions with little satisfaction from baby
Early evaluation by healthcare professionals is necessary to identify the possible causes and to provide appropriate guidance.
Tongue-tie is a real condition that can affect breastfeeding in some babies. But with proper assessment and support, most infants can overcome feeding challenges and thrive.
For many families, reassurance and breastfeeding guidance are all that is needed.
In some cases, a simple procedure can make feeding easier for both mother and baby.
Seeking advice early can make a meaningful difference in the breastfeeding journey for both mother and child.
Assoc Prof Dr Ahmad Faisal Ismail is the deputy dean, Kulliyyah of Dentistry at the International Islamic University Malaysia (IIUM). He is also a paediatric dentistry consultant at Sultan Ahmad Shah Medical Centre, Kuantan. The views expressed here are the writer's own.
