Karine Clifton’s* midwife watched her breastfeeding newborn Paul* and reassured her that the baby was latched on well. But by day six, Clifton's nipples were, in her words, “a mess” (sore, cracked and bleeding), and Paul was dehydrated and losing weight.
“I was given instructions to feed him formula, and start pumping and finger-feeding him (using a feeding tube taped to a finger that the baby would suck on to get milk),” Clifton says. “So I did that, and we were weighing him daily, but getting him back to breastfeeding wasn’t going well. He would gain weight one week, then lose it the next.”
Finally, she was referred to a knowledgeable nurse who examined Paul closely and told her, “I think he’s tongue-tied.”
A baby is tongue-tied when the frenulum (the thin tissue that connects the bottom of the tongue to the floor of the mouth) is restricting his ability to move the tongue forward or up. According to New York lactation consultant Catherine Watson Genna, about six percent of babies may be tongue-tied, although in some populations it’s as high as 13 percent (the condition is inherited; Clifton also had tongue-tie as a baby). “About one-quarter to one-half of the babies who have breastfeeding problems will have some kind of tongue restriction,” Genna adds.
Tongue-ties interfere with breastfeeding because the baby needs to be able to move his tongue forward, over his bottom lip, to cup the breast and exert some pressure to extract the milk. When that motion is restricted, the baby’s attempts to get milk often lead to nipple damage and pain. Often, as in Clifton's case, it also means the baby won’t get enough milk.
“Tongue-ties are frequently missed by doctors, nurses and midwives,” says Genna. “Even the obvious ones get missed. And some are not obvious.” Parents may be able to identify the problem by observing the baby: When he cries, does his tongue go right up to the top of his mouth? If not, he may be tongue-tied.
“It’s a simple office procedure,” explains Genna. The physician cuts the frenulum in a snip or two with sterile scissors (sometimes using a topical anaesthetic). “The tissue doesn’t have a lot of nerves in it, and doesn’t bleed much either,” she comments. The mother usually puts the baby to the breast right away, and that’s it.
Genna adds that not all cases of tongue-tie will lead to breastfeeding problems. If the mother has a very abundant milk supply, baby may be able to get all the milk he needs with little effort. That wasn’t Clifton's situation, though. “I felt like I’d been living in a nightmare when I finally went to the breastfeeding clinic in Montreal. The doctor there took one look at Paul's tongue and said, “Yup, that’s way too tight,” and clipped it. I put him to my breast and just started to cry because it felt so different. It was like night and day. It didn’t hurt, and I could see him gulping down the milk.”
Even when tongue-tie is diagnosed, getting it properly treated can be a challenge. Kristina Wilson says that when she put her daughter Katie to the breast for the first time, two hours after her birth, “it was very painful and uncomfortable. It almost felt like she was cutting me. The nurses were making sure the latch was good—and she did have a great latch. It just hurt like hell.”
The first doctor who clipped Katie’s frenulum didn’t want to cut “too much.” Unfortunately, the frenulum grew back twice before Wilson saw another doctor who cut the frenulum more deeply.
“I could feel the difference,” Wilson says. “There was no pain at all. Within a few days, the blisters on my nipples were all healed. I went on to nurse Katie until she was 22 months old. The procedure—when it’s done properly—is so fast, and it made such a huge difference.”
Genna says that these experiences are not unusual—it often takes extra effort to find a physician who is knowledgeable and skilled in treating tongue-tie. However, she emphasizes that it is well worth it to protect the breastfeeding relationship.
“Adjusting latch and position to fix breastfeeding problems when you have a tongue-tied baby is like putting bandages on a broken arm,” says Clifton. “If you are having pain or your baby isn’t doing well, something is wrong, and you need to find someone who knows how to help.”
What if you are not breastfeeding? Is tongue-tie still a concern? It can be, says lactation consultant Catherine Watson Genna. Some tongue-tied babies have difficulty drinking effectively from a bottle. The restricted tongue movements can also cause problems with learning to speak clearly, and the eventual shape of the jaw and palate can be affected as well. She recommends having your baby assessed early on if you suspect tongue-tie.