When my baby was around three to four months old, I was struggling with breastfeeding. It seemed like something wasn’t quite right—my baby was latching, but the feeding sessions were long, and she wasn’t gaining weight as expected. I decided to consult a lactation consultant, hoping to get some clarity. To my surprise, the consultant quickly diagnosed my baby with a tongue-tie and recommended a frenotomy—a minor surgical procedure to release the tissue under the tongue—right away.
I was surprised and skeptical. The thought of putting my tiny baby through a procedure was unsettling, especially when I wasn’t even sure it was necessary. Before agreeing to anything, I sought a second opinion from my pediatrician. They examined my baby and confirmed that she had a mild tongue-tie, but nothing that would prevent her tongue from moving freely. Importantly, my baby was latching fine; the real issue seemed to be that she wasn’t drinking enough milk.
As time went on, I realized that the problem wasn’t with my baby—it was with my milk supply, which had been dropping. Of course, it’s possible that the supply issue was partly because my baby wasn’t extracting enough milk due to the mild tongue-tie. But regardless, I chose to supplement with formula when she was five months old, and I continued to breastfeed until she was 11 months old, without any major issues.
Looking back, I’m relieved that I didn’t rush into that procedure. My experience taught me the importance of being cautious and seeking multiple opinions before making decisions about medical procedures for my baby. I want all moms out there to know that it’s okay to take a step back and consider your options before agreeing to any intervention.
What is a tongue-tie?
Tongue-tie, or ankyloglossia, is a condition where the tissue (lingual frenulum) that connects the underside of the tongue to the floor of the mouth is unusually short, tight, or thick. This can restrict the movement of the tongue, potentially leading to difficulties with breastfeeding, speech, and other oral functions.
What is the probability that your baby will have a tongue-tie?
The prevalence of tongue-tie in newborns is estimated to be between 4% -11%, depending on the population studied and the criteria used for diagnosis. Some studies suggest that boys are more likely to be born with tongue-tie than girls. In addition, not all cases of tongue-tie require intervention, and the severity can vary significantly from one baby to another. Despite being not a rare case, it’s not so common either. For example, your baby has higher chances to have an infant eczema (10%-20%), food allergies (6%-8% in infants under 3 years); Gastroesophageal reflux disease (GERD) in infants (8%-10%) than a tongue tie.
Signs that your baby may have a tongue-tie
Identifying tongue-tie can be tricky, but here are some signs to look for:
Feeding-related signs:
- Difficulty latching: Your baby might struggle to latch onto the breast or stay latched.
- Prolonged or frequent feeding sessions: Feedings may take a long time, or your baby might feed very frequently without seeming satisfied.
- Clicking sounds while feeding: Clicking noises during breastfeeding can indicate that your baby is having trouble maintaining suction.
- Nipple pain or damage: If you experience pain or notice damage to your nipples (cracking, bleeding), it could be due to your baby’s tongue-tie.
- Poor weight gain: If your baby is not gaining weight as expected, tongue-tie could be a contributing factor.
Make sure you read this breastfeeding guide for proper latching and feeding positions.
Physical signs:
- Heart-shaped tongue: When your baby cries or tries to stick out their tongue, you might notice that the tip of the tongue looks heart-shaped or notched. This can be a sign that the frenulum is pulling the tongue back.
- Limited tongue movement: Observe your baby’s tongue when they cry or open their mouth wide. A tongue-tied baby might not be able to lift their tongue to the roof of their mouth or stick it out past their lower lip.
- Frenulum visibility: In some cases, you might be able to see the tight frenulum (the band of tissue under the tongue) pulling down on the tongue when your baby tries to move it.
Treatment: should you undergo a procedure?
The primary treatment for tongue-tie is a frenotomy, a minor surgical procedure where the frenulum is cut to release the tongue. This procedure is typically quick and can often be done in a doctor’s office. However, as my story illustrates, not all cases of tongue-tie require intervention. The decision to undergo a frenotomy should be based on a careful assessment of the severity of the tongue-tie and the specific challenges it is causing.
Recovery time
Recovery from a frenotomy is generally quick. Babies often resume breastfeeding immediately after the procedure, and the wound typically heals within a few days. Some babies may be fussy or uncomfortable for a short period, but serious complications are rare.
Studies on the relationship between tongue-tie and breastfeeding
Research shows that tongue-tie can indeed impact breastfeeding, particularly if it is severe. Studies have found that frenotomy can improve breastfeeding success in cases where tongue-tie is causing significant latching problems, nipple pain, or poor weight gain. However, not all breastfeeding issues are related to tongue-tie, and in some cases, other factors—such as low milk supply or improper breastfeeding techniques—may be at play.
The problem with over-diagnosis
One of the growing concerns in the medical community is the potential for overdiagnosis of tongue-tie. A systematic review in the Journal of Pediatric Surgery (2018) highlighted the need for careful assessment before opting for surgical intervention, as other factors such as improper breastfeeding techniques or maternal breast anatomy could also contribute to breastfeeding problems. Lactation consultants and healthcare providers, eager to provide solutions to breastfeeding difficulties, may sometimes be quick to attribute problems to tongue-tie and recommend a frenotomy. However, as my experience shows, it’s crucial to consider other possibilities and seek additional opinions before agreeing to any procedure.
When to seek professional help
If you suspect your baby has a tongue-tie, it’s important to consult with a healthcare professional who can properly assess the situation. While lactation consultants can provide valuable insights, it may be helpful to seek a second opinion from a pediatrician, pediatric dentist, or an ENT (ear, nose, and throat) specialist, especially if surgery is being considered.
Questions to ask the professional
- Is the frenulum restricting tongue movement?
- Are there other potential causes for breastfeeding difficulties?
- What are the risks and benefits of a frenotomy?
- Can the breastfeeding issues be addressed with other interventions before considering surgery?
Advice for moms out there
If you’ve been told that your baby has a tongue-tie and a frenotomy is recommended, take a deep breath and consider your options:
- Seek a second opinion: Consult with your pediatrician or a pediatric dentist to get a comprehensive assessment.
- Observe your baby: Is your baby truly struggling with breastfeeding, or could there be another issue at play? Consider tracking feeding sessions, weight gain, and your own milk supply.
- Consider all factors: Remember that breastfeeding challenges can be multifaceted. Sometimes the solution might not be a procedure but rather support with breastfeeding techniques or addressing milk supply. I suggest making sure you have the right latching technique. In addition, read this breastfeeding guide, it might help with some of the issues.
- Trust your instincts: You know your baby best. If something doesn’t feel right, it’s okay to ask questions and explore other options before making a decision.
By being informed and observant, you can work with healthcare professionals to determine the best course of action for your baby’s feeding challenges