Ahhh the tongue tie. A sometimes controversial, often misunderstood aspect of breastfeeding. It’s also something I have firsthand experience with as a mum of three tongue tied babies.

So, what exactly IS a tongue tie and why is it something that’s gotten more attention in recent times? Read on to find out more mama!

You may have heard the term bandied around in Facebook groups or even by your caregiver but what exactly is a tongue tie? All bubs are born with a band of tissue beneath their tongue. This is called a ‘lingual frenulum.’ In some babies, the lingual frenulum is overly tight and can restrict the proper movement of the tongue leading to what we know as a tongue tie (or, if you want the medical term ankyloglossia).

The tongue is a super important part of breastfeeding as it helps baby to attach to the breast properly and effectively remove milk. If the tongue is tethered to the bottom of the mouth, it can’t always do that which can lead to issues with latch and milk supply.

A tongue tie can present itself in a bunch of different ways, often depending on the level of restriction as well as factors like the anatomy of your breasts and your milk supply.

If you suspect your baby has a tongue tie, you may be able to notice a restriction to their tongue movement when they open their mouth. Often, the best way to spot this is when they cry. Instead of the tongue lifting up and looking rounded, you may notice a ‘V’ or ‘heart shape’. You may also be able to see the lingual frenulum tethering the tongue to the bottom of the mouth.

Source: Children’s Health QLD

Breastfeeding challenges can often have a variety of causes which is why it is so important to speak with a qualified Lactation Consultant for assistance. Some of the commonly agreed upon signs of a tongue tie include:

• A flattened or compressed nipple or a white stripe on the nipple after breastfeeding. Your nipple should come out of your baby’s mouth the same shape as it went in. If it is flat, lipstick shaped or distorted in some way, it can mean it is not being taken far enough back into baby’s mouth due to restriction from the tongue.
• Pain during feeding that doesn’t improve – When you’re learning to breastfeed there may be some discomfort, especially when baby first latches. There is however, a big difference between ‘discomfort’ and ‘pain’, especially pain that doesn’t improve.
• Nipple damage – Nipple damage indicates that there is an issue with your baby’s latch. This could be due to a number of factors but can be caused by a tongue tie.

• A baby with a tongue tie may not feed as effectively as they need to which can lead to increased fussiness and slow weight gain. This is not always the case; for me personally, I had so much milk that my bubs gained regardless, but it can be an indication for some.

The most important action to take, if you suspect something isn’t quite right with your breastfeeding relationship, is to seek expert advice and support as soon as possible. A Lactation Consultant can help get to the bottom of your concerns and advise on the best course of action for you and your baby to get you back on track.

While opinions on tongue tie are changing, it can sometimes still be a slightly contentious issue with some medical providers who query its existence and/or its ability to impact breastfeeding. Indeed, when my son was born in 2012, it took us almost 6 months to get to the bottom of the issues I was having with many medical professionals dismissing the idea of a tongue tie. Today, the research and understanding is much better with plenty of experts taking action to assist mums and their bubs when a tongue tie is suspected. The best thing you can do if you do suspect that your baby has a tie? Do your research and push for answers. If your mama-instinct is telling you something isn’t quite right, chances are, it may not be. Seek out a medical professional who will assist you in getting to the bottom of your concerns.

Treatment for tongue tie can vary on a case-by-case basis but generally will involve the tie being revised (or ‘cut’) either using surgical tools or, increasingly, using a laser. The revision is performed by a qualified professional, often a paediatrician or GP who has undergone special training or, in some cases, a paediatric dentist who specialises in this field.

Do you have to treat a tie? Generally speaking, it is a good idea. This is not only due to the impact a tie can have on breastfeeding but also on other parts of life like eating and speech. Restricted tongue movement can impact both things as your baby gets older and you may find the revision needs to be done later in life.

Every case is different of course and the decision is one that should be made with your caregiver and based on your specific situation.

Breastfeeding a tongue-tied baby can be really, really tough. For me personally, the nipple damage was intense and made feeding incredibly painful. If you’ve suffered nipple damage or are finding your nipples are extremely painful during a feed, a nipple shield can help. These can be used to protect your nipples from further damage while letting you continue to feed. Your baby may also have an easier time latching on some types of shields due to their size and shape. It’s important when using a nipple shield to ensure that bub is latched well and that you’re still draining your breasts to safeguard your milk supply. Some mums will find they need to pump after a feed to fully empty their breasts if their baby is struggling to do so.

If you’re managing nipple damage and/or weight gain issues, you may also be considering introducing a bottle to bub. Try choosing one with an orthodontic teat to help mimic the shape of a nipple which can make it easier to swap back and forth between breast and bottle.