Tongue tie, formally known as ankyloglossia, is a condition where there is a membrane or webbing of tissue between the bottom of the tongue and the bottom of the mouth which retstricts normal movement of the tongue. Normally this membrane (known as the lingual frenum or frenulum) retracts during pregnancy, but when this does not occur, there can be serious implications for breastfeeding.

Tongue tie is an often misunderstood and not well studied condition. There does not seem to be reliable data on the incidence of tongue tie among newborns, some sources claiming as few as 4 in 1000 births and some as high as 10% (1 in 10) births. It does appear to be more common in boys and have genetic ties within families.

With the rise of formula and decline of breastfeeding in the 1940s, before which tongue tie was routinely diagnosed and treated, practical knowledge of this problem seems to have become rarer. To add to the confusion, there is no single presentation of tongue tie, which may have different levels of severity and a range of appearance. Some health professionals consider treatment of less severe forms of tongue tie to be out of date or unnecessary, although they may negatively affect breastfeeding.

Long-time consultants and midwives have told me that tongue tie used to be handled quite simply. Anecdotal stories tell of midwives having always a long, sharp, pointed pinky fingernail, and that after a birth, they would routinely check under and infant’s tongue in the course of their initial assessements of the baby and simply break any abnormal membrane with the fingernail (apparently there are few or little pain sensations or bleeding in this area).**

Now, it may take weeks or months to have this condition recognized (often after a prolonged painful start to breastfeeding with limited success), and then a wait for a formally scheduled “frenectomy” done as a surgical procedure sometimes under anesthesia. **NOTE: I am NOT recommending a DIY operation for tongue tie, as I do not have the medical knowledge to know what of these tales are medically accurate and what are apocrypahal, but it is interesting to see how understanding and treatment of this condition may have changed over time.

Tongue tie can cause breastfeeding pain due to the inability of the infant to properly latch on to the breast, causing friction against the nipple by the restricted tongue. Undiagnosed or untreated tongue tie can also lead to inadequate milk supply or newborn weight gain, due to limited stimulation of the breast by the restricted tongue and/or limitations by the mother on breastfeeding frequency in a conscious or unconscious effort to avoid the associated pain.

Mothers who suspect tongue tie in their infants should consult with their pediatrician, board certified lactation consultant and/or other health professional ASAP. The sooner this condition can be corrected, the better for the short and long-term success of breastfeeding. In the meantime, mothers may be advised to pump in addition to nursing on a hospital grade pump in order to assure sufficient removal of milk and breast stimulation. Mothers experiencing severe pain due to the tongue tie may need assistance healing the nipple and may be advised to pump exclusively in order avoid further damage and ensure adequate nutrition for the baby.

With appropriate support for baby and mother, tongue tie can be diagnosed and treated allowing for the resumption of or initiation of exclusive breastfeeding.