Can Tongue Ties and Lip Ties Interfere with Nursing?
Q: My mother thinks that our newborn has tongue-tie. Could this interfere with nursing?
A: Tongue-tie means that the membrane (the frenulum) that attaches the tongue to the floor of the mouth is shorter than usual. Some babies with tongue-tie breastfeed perfectly well; others have difficulty. If the tongue-tie is interfering with breastfeeding, it’s possible to clip the frenulum to release the tongue. While in the past it has been customary to leave tongue ties alone because most loosen with time, Dr. Bill Sears has for decades been clipping the frenulum if it appears too tight and baby is not latching on well. Signs that the tongue is tight enough to warrant clipping are:
- Latch-on is painful to mother
- Baby is not getting enough milk
- The tip of the tongue doesn’t protrude past the lower gum
- The tongue curls under when baby cries, opens her mouth wide, or tries to suck (it should curl upward and form a trough)
After this painless, thirty-second office procedure to release the tongue, mother almost immediately notices that latch-on is more comfortable and baby is able to nurse more effectively.
Clipping a frenulum is a quick and painless procedure that can be done in your doctor’s office. In the early weeks, the frenulum is so thin that it’s easy to clip and usually yields only a few drops of blood, or none at all. While baby’s mouth is open (either normally open or when crying), the doctor holds the tip of the tongue with a piece of gauze (sometimes if the mouth is open wide enough, holding the tongue is not necessary) and uses scissors to clip the frenulum back to where it joins the base of the tongue.
If your doctor or lactation consultant feels that you are having breastfeeding problems caused by tongue-tie, get the baby’s tongue clipped. Some doctors may be reluctant to do this procedure because most tight tongues loosen with time. However, these physicians are probably not aware of how a baby must use his tongue to get milk out of the breast. Enlist the help of your lactation consultant to persuade your baby’s doctor to clip the short frenulum. The LC may also be able to refer you to a physician who is willing to do this procedure if your doctor is not.
Lip ties, which occur when baby’s lip is tied via a thin piece of tissue to the middle of the upper gum, can interfere with latching on, cause nipple trauma, and even cause cavities. The tissue causes the lip to curl inward, which can rub on the nipple and interfere with baby’s ability to form a seal on the breast. Like snipping the frenulum, snipping the lip tie is also a simple procedure and is relatively bloodless and painless.
Martha Sears, RN