Tongue-tie: breastfeeding and bottle feeding
tongue; tie; tongue-tie; breast; feeding; breastfeeding; suck; speech; frenulum; attachment;
Tongue-tie is when the connection between the lower surface of the tongue and the floor of the mouth (the frenulum) comes very close to the tip of the tongue. The tip of the tongue cannot move far and it may have a small V shaped indentation (notch).
Tongue-tie is fairly common and can limit the movement of the tongue. There are widely differing views about tongue-tie, its effects on feeding (especially breastfeeding) and speech, and whether and how it should be treated.
The tip of the tongue is used for many things including sucking while breastfeeding, making speech sounds and cleaning the inside of the mouth (including the space between the teeth and the inside of the lips).
There is a wide variation in how commonly 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.
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 loses suction and sucks in air
- 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 due to poor attachment and poor sucking action.
Many women in one study reported that there were improvements in breastfeeding soon after the frenulum was 'released' (2 to 3 millimetre cut made). However for some babies, releasing the frenulum did not lead to any improvement in breastfeeding.
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 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
- Swallowing too much air
- Taking a long time to feed
It is usually simple to cut the frenulum. There is some controversy about whether some anaesthesia is needed. It does cause some pain, but babies seem to settle down quickly, especially if they are breastfed soon after the treatment.
We recommend that a baby is assessed and treated by an oral surgeon, but some paediatricians may treat it too.
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 speech 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 upper gums
- inability to touch the roof of the mouth with the tongue
- difficulty moving the tongue from side to side.
As a simple test, check if the child can lick an ice cream cone without much difficulty.
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.
References and more to read
Australian Breastfeeding Association
Raising Children Network
Women's and Children's Health Network (South Australia) Nursing Standard 'Breastfeeding: Tongue Tie Assessment and Management - Neonate / Infant' 2016
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.