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Tongue-tie: breastfeeding and bottle feeding

tongue; tie; tongue-tie; breast; feeding; breastfeeding; suck; speech; frenulum; attachment;

Tongue-tie is when the thin piece of skin under the baby’s tongue is abnormally short.  This may restrict the way the tongue moves when feeding.

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There is a wide variation in how common tongue -tie it is thought to occur, but probably between 4% and 5% of babies have a tongue tie which affects the appearance and/or function of the tip of the tongue.

There are also widely differing views about tongue-tie, its effects on feeding (especially breastfeeding) and speech, and whether and how it should be treated.

Tongue-tie and breastfeeding

Sometimes a tongue-tie causes no problems with breastfeeding and requires no action.

While most babies with a tongue-tie can breastfeed well, some lactation specialists think that tongue-tie could be a problem in a baby who is having breastfeeding difficulties such as:

  • not being able to attach (latch on) to the breast well 
  • baby's mouth makes a clicking sound during feeding 
  • nipple pain during a feed 
  • nipple damage 
  • prolonged feeding 
  • feeding frequently but for short periods at a time 
  • poor weight gain

If there are breastfeeding problems, it could be useful to have your baby seen by a lactation consultant, paediatrician, oral surgeon, maternal and child health nurse, or your doctor to decide whether any treatment is necessary.

There is more about breastfeeding in the topic 'Breastfeeding - a new baby'.

Tongue-tie and bottle feeding

A bottle fed baby uses the middle part of the tongue more than the tip, and it is not so important to have a mobile tip of the tongue.

If the tongue-tie is affecting feeding the following signs may be present:

  • Excessive dribbling 
  • Poor weight gain
  • Taking a long time to feed

Releasing a tongue tie

A procedure to release a tongue-tie by making a small cut of the frenulum may be recommended if it is affecting breastfeeding or bottle feeding.

For a breastfeeding baby it is important that a breastfeeding clinician assess your baby while feeding and provide support initially to improve feeding. 

Speech

 Most children with tongue-tie have no speech problems, but some have articulation problems (difficulty making some sounds clearly). Around the age of three, these articulation problems may be noticeable, especially with the sounds of l, r, t, d, n, th, sh, and z.

It may be of value to check with a speech therapist if more than half of a 3 year old child's speech is not understood by people outside of the family. There are other reasons why a child may not speak clearly.

Although there is no clear way to tell which baby with tongue-tie will have speech difficulties later, the following are commonly found in children who go on to have speech problems:

  • V-shaped indentation at the tip of the tongue 
  • inability to stick the tongue out past the gums 
  • inability to touch the roof of the mouth with the tongue
  • not being able to move the tongue from side to side.

As a simple test, check if the child can lick an ice cream cone without much difficulty.

Appearance

 For older children with tongue-tie, appearance can be affected by: 

  • the V-shaped notch in the end of the tongue, which the child may be teased about 
  • a wide gap between the bottom two front teeth.

A dentist or oral surgeon would be able to advise you about what can be done.

Reference and more to read

Australian Breastfeeding Association
https://www.breastfeeding.asn.au/ 

Raising Children Network
http://raisingchildren.net.au/  

Reference

Women's and Children's Health Network (South Australia) Nursing Standard 'Breastfeeding: Tongue Tie Assessment and Management - Neonate / Infant' 2016

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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