During pregnancy, the developing tongue separates from the floor of the mouth. Sometimes this process is incomplete and some of the tissue remains – this is called a frenulum. If the frenulum interferes with the normal movement or function of the tongue, it is called “ankyloglossia”, or “tongue-tie”.
For comfortable and effective breastfeeding, the baby must latch deeply onto the breast with the mouth wide open and the tongue forward. The tongue then moves in a wave-like motion, rising to compress breast tissue and dropping to create a vacuum to help draw out milk. Tongue-tie can make it hard for the baby to do these things and can contribute to:
Some tongue-ties are obvious, but many are more subtle and require an evaluation that goes beyond just looking. Most health care professionals have not been trained to assess for tongue-ties that can impact breastfeeding and may not recognize tongue-ties that are anywhere but at the tip of the tongue. At the Newman Breastfeeding Clinic we assess all babies for tongue-tie as it relates to breastfeeding. We do this by:
If we feel that tongue-tie may be contributing to your breastfeeding challenges, we will offer to release it. The procedure is called a “frenotomy” (also know as a “release”, “revision”, or “division”). Frenotomy takes only a few seconds and is done in your clinic room during your appointment. Your practitioner will go over all the details of the procedure, answer any questions you may have, and ask you to sign a consent form. Releasing a tongue-tie often helps with breastfeeding, but we cannot guarantee that it will. It is always up to you to decide if you would like to have the procedure done.
The procedure can be done during any of your appointments at the clinic. Your baby will be held securely by a supervising Lactation Consultant. She will lift your baby’s tongue firmly, exposing the frenulum and allowing for a precise incision. Using sterile scissors, the pediatrician will make a small cut into the frenulum followed by a quick push with his or her finger to release it completely.
Babies generally cry as soon as they are restrained and crying continues for varying amounts of time after the procedure is complete. Immediately after, baby is offered the breast, with assistance as needed. Many babies latch and calm quickly while others take a little longer to settle, perhaps while being walked by a parent or caregiver. There is usually bleeding, which often stops as the baby calms. Sometimes, gauze and pressure are used if blood pools under the tongue or bleeding continues for longer than usual. Rarely, other means will be used to slow or stop more significant bleeding; these will be discussed with you as necessary/if you desire.
Baby’s latch may feel different immediately or it may take a few days or longer for baby to use his/her tongue differently and for the breastfeeding situation to improve.
Most parents do not feel the need to give pain relief (acetaminophen or ibuprofen) following a release. Some babies are fussier than others and some may refuse the breast for a few hours after the release and, in these cases, a dose may be helpful. More information about giving pain relief medication will be provided to you after the release.
We occasionally hear that a baby is still fussy about feeding or refusing the breast the day after the procedure. Long-term breast refusal is very rare.
The tiny incision creates a diamond shaped wound, which turns creamy white, yellow, or orange for several days before healing completely. This is normal healing in the mouth and not a sign of infection. Infection does not seem to be an issue with tongue-tie releases in babies.
During healing, the surfaces of the wound tend to close together forming some degree of reattachment, which varies from baby to baby. Some practitioners recommend after-care exercises or stretches to help minimize reattachment. In our experience, exercises do not seem to be effective for preventing reattachment and they are often challenging and unpleasant for parents and babies. At this time, we do not recommend any exercises after tongue-tie release.
If there is significant reattachment (which is uncommon), a second release might be suggested.
Many babies have a small piece of tissue connecting the top gum to the underside of the top lip. If this tissue is tight and/or broad and seems to restrict the ability of the lip to form a tight seal at the breast or causes rubbing of the lip against the breast, it is called a “lip-tie”.
Lip-ties are a hot topic in breastfeeding right now, however, there has been no research in this area. We may offer to release a lip-tie, usually along with a tongue-tie release, if it seems to be contributing to your breastfeeding concern(s) (especially nipple pain and difficulty latching or maintaining a latch).
A lip-tie release takes only a few seconds and can be done immediately after a tongue-tie release. There will be bleeding from the area similar to what is described regarding tongue-tie release. As with the tongue-tie release, no after-care exercises are recommended. We cannot guarantee a lip-tie release will help with breastfeeding. It is always up to you to decide if you would like to have the procedure done.
A vitamin K shot to help prevent bleeding problems in newborns is routine in hospital births. Babies less than three months old who did not receive the vitamin K shot should have it prior to the clinic appointment if a release is anticipated. We cannot do the procedure if the baby has not had a vitamin K shot. For more information about this, please contact us at 416-498-0002 ext. 224 or firstname.lastname@example.org.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, November 2016
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.