Tongue-tie and difficulty with latch on

I have a three-month-old son who is tongue-tied. He nurses, though he has had an occasional bottle. He has always been very hard to get latched-on and only sucks a few times in a row. Even when being fed by a bottle he has some difficulty. I breastfed my first child successfully. Could tongue-tie be causing this problem?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

It is unlikely that a baby with a tight or short lingual frenulum (the piece of tissue attaching underneath the tongue) will be able to nurse without some difficulty. Babies with this condition are described as being "tongue-tied." The medical name for this condition is ankyloglossia. It is inherited, so you may find it is present in one or more members of your family. Babies with a tight or short frenulum may be unable to extend their tongue past their lower gum line or properly cup (and anchor) the breast during a feed. Unresolved, it can lead to nipple pain and damage, inadequate milk supply, and slow weight gain, or failure-to-thrive in the infant.

To check for tongue-tie, stick your tongue out, while looking at your baby. Most babies (even newborns) will imitate this behavior. If you notice your little one is never able to extend his tongue, or if your baby's tongue appears heart-shaped on the tip, and he is having difficulty nursing, your baby should be evaluated by his health care provider. Function of the tongue is of more importance than appearance.

Though clipping of a newborn's frenulum (frenotomy) is a very simple and relatively painless in-office procedure, it may be difficult to convince your health care provider that it is necessary. Frenotomy is rarely mentioned in the pediatric literature. Below I have provided you with a few references that you could share with your physician:

  • Conway, A: Ankylglossia - to snip or not to snip: Is that the question? Journal of Human Lactation 6:101-102, 1990
  • Fleiss, PM et al: Ankylglossia: A cause of breastfeeding problems? Journal of Human Lactation 6:128-129, 1990
  • Marmet C, Shell E, Marmet R: Neonatal frenotomy may be necessary to correct breastfeeding problems. Journal of Human Lactation 6:117-121, 1990

Many times a general practitioner or pediatrician will refer your case on to an Ear, Nose and Throat (ENT) Specialist. A frenotomy can be quickly and easily performed by your health care provider, allowing your baby's tongue a full range of motion. Since your baby is older, it may take several weeks until he realizes that he can more easily extend his tongue, so be patient.

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