Breastfeeding and Tongue Tie

Breastfeeding and Tongue Tie

Breastfeeding can be challenging, especially during the first few weeks after childbirth. It is normal to have some problems when you start to breastfeed your new baby, even if you have breastfed before.

Tongue tie is a condition that some babies are born with (congenital). With this condition, a baby’s tongue cannot move freely in his or her mouth because the band of tissue that connects the tongue to the floor of the mouth (frenulum) is too short or too tight. Having a heart-shaped tongue can be a sign that an infant has tongue tie. In some cases, tongue tie can interfere with breastfeeding.

How does this affect me?

If your baby has tongue tie, he or she may have trouble latching on to your nipple properly for breastfeeding. As a result, you may have problems such as:

  • Creased, flat, or white (blanched) nipples after feedings.
  • Cracked or sore nipples.
  • Discomfort while feeding.
  • Plugged milk ducts.
  • Breasts becoming overfilled with milk (engorgement).
  • Low milk supply.
  • Breast inflammation or infection.
  • Sleep deprivation. This can occur because the baby is not able to nurse as efficiently, so the mother often compensates by nursing more often, including at night.

How does this affect my baby?

Many babies with tongue tie can breastfeed successfully without problems. If your baby’s condition causes problems, the symptoms may include:

  • Difficulty latching onto the nipple.
  • Gumming or chewing the nipple while nursing.
  • Inability to fully drain the breast.
  • Gassiness. Babies with tongue tie often swallow a lot of air because they cannot maintain suction properly.
  • Poor weight gain.
  • Excessive drooling.
  • Choking on milk or coming off the breast to gasp for air while feeding.
  • Falling asleep during feedings, then waking a short time later to nurse again.
  • Sleep deprivation. This is due to the need for frequent feedings.
  • Long feeding times.
  • Inability to hold a pacifier or bottle.
  • Clicking noises while sucking.
  • Coming on and off the breast often.

How is this treated?

If tongue tie causes your baby to have problems breastfeeding, you should work with a breastfeeding specialist (lactation consultant) to find positions and strategies that will help make sure your baby has a good latch. Many babies grow out of the condition as they get older. If needed, a small cut can be made on the frenulum (frenotomy). This procedure will allow the tongue to move freely.

Follow these instructions at home:

Work with a lactation consultant to make sure that your baby is able to feed well. This may include:

  • Finding breastfeeding positions that work well for you and your baby.
  • Taking steps to help your baby latch. To help your baby latch, follow these steps:
    1. Stroke your baby’s lips gently with your finger or nipple.
    2. When your baby’s mouth is open wide enough, quickly bring your baby to your breast and place your entire nipple, and as much of the areolaas possible, into your baby’s mouth. The areola is the colored area around your nipple.
    3. Your baby’s tongue should be between his or her lower gum and your breast.
    4. More areola should be visible above your baby’s upper lip than below the lower lip.
    5. When your baby starts sucking, you will feel a gentle pull on your nipple, but you should not feel pain. Be patient. It is common for a baby to suck for about 2–3 minutes to start the flow of breast milk.
    6. Make sure that your baby’s mouth is correctly positioned around your nipple. Your baby’s lips should create a seal on your breast and be turned outward (everted).
  • Look for the following signs that your baby has successfully latched on to your nipple:
  • The baby is quietly tugging or quietly sucking without causing you pain.
  • You hear the baby swallow after every 3 or 4 sucks.
  • You see muscle movement above and in front of the baby’s ears while he or she is sucking.
  • Be aware of these signs that your baby has not successfully latched on to your nipple:
    • The baby makes sucking, clicking, or smacking sounds while nursing.
    • You have nipple pain.
  • If your baby is not latched well, insert your little finger between your baby’s gums and your nipple to break the seal. Then try to help your baby latch again.

Contact a health care provider if:

  • Your baby is not gaining weight or loses weight.
  • You have cracking or soreness in your nipples that lasts longer than 1 week.
  • You have nipple pain. Nipple cracking and soreness are common during the first week after birth, but nipple pain is never normal.
  • You have breast engorgement that does not improve after 48–72 hours.
  • You have a plugged milk duct and a fever.
  • You follow suggestions for a good latch, but you continue to have problems or concerns.
  • You have pus-like discharge coming from your breast.

Get help right away if:

  • Your baby is not wetting or soiling diapers as often as your health care provider told you to expect.

Summary

  • Tongue tie is a condition in which a baby’s tongue cannot move freely in his or her mouth because the band of tissue that connects the tongue to the floor of the mouth (frenulum) is too short or too tight.
  • If a baby has tongue tie, breastfeeding may be painful for the mother, and the baby may have trouble getting enough breast milk. This may lead to slow weight gain.
  • Many babies with tongue tie can breastfeed successfully without problems. Get help from a lactation specialist early on to prevent problems from occurring.
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