Tongue-tie and breastfeeding

Many parents look forward to breastfeeding their newborns – when all is going well, it can be a bonding experience. But for some babies, a condition called tongue-tie may affect their ability to nurse. Learn why and see advice for feeding tongue-tied babies from Children's Health℠ experts.

What is a tongue-tie?

Tongue-tie (also called ankyloglossia) is a congenital condition that limits the movement of a child's tongue. Every baby is born with a cord of tissue under the tongue, called a frenulum.

"The frenulum connects the bottom of the tongue to the floor of the mouth. If that tissue is too short or thick, it can restrict the tongue's range of motion," explains Felicity Lenes-Voit, M.D., Pediatric Otolaryngologist with Children's Health℠ and Assistant Professor of UT Southwestern.

Learn more about tongue-tie and what it looks like in babies.

Can a tongue-tie cause breastfeeding problems?

"Some babies with tongue-tie manage to nurse very well. For others, a tight frenulum makes breastfeeding difficult," says Rebecca Brooks, APRN, Clinical Nurse Specialist at Children's Health.

Some newborns with tongue-tie cannot latch onto their mother's breast effectively, which leads to:

• Reduced intake of breast milk
• Pain for the mother
• Reduced milk supply

"They don't get a good oral seal for suction, so it's hard for them to remove the breast milk," explains Kandi Trevino, SLP, a Speech-Language Pathologist at Children's Health who cares for babies with tongue-tie. "This means longer feeding times, increased air intake for baby, lower milk supply for mom and possibly blocked milk ducts."

How do you breastfeed a baby with a tongue-tie?

Start by breastfeeding a baby with tongue-tie like you would feed any other baby. If your baby has trouble latching onto the breast or sucking, try different feeding positions. Watch to see if your baby's latch and seal improve.

Your baby might catch on quickly. But if not, consult your pediatrician or a lactation consultant.

"Babies need a good assessment of their mouth and tongue," says Brooks. "Ask your pediatrician how much volume your baby should be drinking. In the first two weeks of life, that amount is different than if the baby is older."

Watch for other signs of feeding issues including if your baby:

• Always seems hungry
• Always seems sleepy
• Takes only light, fluttery sucks and doesn't swallow much

Frequent weight checks may be helpful in knowing if your baby is getting enough nutrients to grow.

What to do if your baby with tongue-tie doesn't get enough milk or gain weight

If your baby cannot latch well and you want to breastfeed, it's important to get a reliable breast pump and start pumping.

"Milk supply is hormone-driven, and the hormones are regulated by supply and demand. If milk is removed, then milk is made. If milk is not removed, the body will start to shut down the milk supply process," explains Brooks.

A knowledgeable lactation consultant can give you a pumping schedule. If needed, you can supplement with formula until your baby catches on. While the situation may feel stressful, have patience with yourself and baby, and keep your health a priority.

"Moms need to make sure they don't have other health problems that cause milk supply issues," advises Brooks. "Mothers also need rest, hydration and nutritional and emotional support from their families."

If your baby's feeding does not improve, your pediatrician or specialist may suggest an in-office procedure that releases the tongue-tie. This is called a frenotomy.

What to do if you experience pain while nursing your baby with tongue-tie

"Even if a baby is growing, if they can't latch deeply enough due to a tongue-tie and it's hurting mom, we can intervene and release the tongue-tie," explains Dr. Lenes-Voit. "Pain associated with eating makes it harder for mom to maintain milk supply. What's bad for mom is bad for baby too. Mother and baby are a team and need to be optimized."

To ensure your baby gets proper nutrition while tongue-tie issues are being resolved, your pediatrician may recommend nipple shields or supplemental bottle feedings. Be sure to discuss options to protect milk supply if these measures are being used.

What is the best bottle for babies with tongue-tie?

The best bottle for babies with tongue-tie is the one that allows the baby to remove the milk in an acceptable amount of time.

"It should not take hours for one feeding," explains Brooks. "Consider the nipple size of your bottle – wide mouth or narrow. Also, consider how the milk flows from the bottle."

Ask your pediatrician for guidance in choosing a bottle.

How do you breastfeed after a tongue-tie release procedure?

After a tongue-tie release, some babies will have an instant improvement in their ability to latch and nurse. Other babies need time to adjust.

"If you think about it, all their lives they've been sucking a certain way, and when we release the tongue-tie, we change the way their tongue moves. For some babies, it takes a little bit of time to figure that out," says Dr. Lenes-Voit.

Try the same breastfeeding methods you used before the tongue-tie release. A lactation consultant will help you:

• Use pillows to optimize positioning
• Encourage your baby to develop a deep latch
• Make sure your baby is sucking and swallowing effectively

What if baby won't latch after a tongue-tie release?

While the baby learns to adapt, the mom needs to pump to maintain her milk supply and supplement.

To make sure your baby gets the right amount of nourishment, consult your pediatrician, a lactation consultant or a speech language therapist who specializes in infant feeding.

"Get help right away," urges Brooks. "Some babies are several months old before moms ask for help, and their babies are underweight. Don't lose precious time."

Learn more

The Pediatric Ear, Nose and Throat program at Children's Health provides convenient, accessible ENT care to families. If you're concerned about tongue-tie in babies, contact us for a comprehensive evaluation or second opinion in our Multidisciplinary Tongue-Tie Clinic.