Tongue-tie, or ankyloglossia, has increasingly become a topic of discussion among breastfeeding families and healthcare providers. With recent guidelines and research shedding new light on this condition, it’s important to explore how tongue-tie affects breastfeeding and the implications for treatment.
What Is Tongue-Tie?
Tongue-tie occurs when the band of tissue (frenulum) that connects the tongue to the floor of the mouth is unusually short or tight. For effective breastfeeding, a baby’s tongue needs to extend past the lower gum line, elevate toward the roof of the mouth, create a tight seal around the nipple, and move in a wave-like motion to facilitate milk transfer. A tight frenulum, or tongue-tie, can restrict these crucial movements, leading to a shallow latch, poor suction, disrupted milk flow, and potential nipple trauma for the mother. This restriction can make breastfeeding challenging, resulting in inadequate milk intake and poor weight gain for the baby, as well as discomfort and frustration for both the baby and the mother.
Recent evidence underscores the significant impact that ankyloglossia can have on breastfeeding success. Research indicates that 25% of infants with ankyloglossia face breastfeeding challenges, compared to only 3% of those without the condition (Holkar et al., 2017). This aligns with findings from Ngerncham et al., who demonstrated a dose-response relationship between the severity of tongue-tie and the prevalence of breastfeeding problems, with approximately one-third of affected infants reporting difficulties (Ngerncham et al., 2013). Furthermore, Batista (2024) reported that infants with ankyloglossia have a 36-fold increased likelihood of experiencing sucking difficulties compared to their unaffected peers.
The AAP’s Stance on Tongue-Tie
In a recent statement, the American Academy of Pediatrics (AAP) expressed concern over the overdiagnosis and overtreatment of tongue-tie. The AAP recommends prioritizing nonsurgical approaches, such as working with a lactation consultant to adjust positioning and latch techniques, before considering procedures like frenotomy (AAP Publications) (Parents).
The AAP’s caution is supported by research showing that while frenotomy can relieve nipple pain, it doesn’t always resolve other breastfeeding challenges. Power & Murphy (2014) found that 80.4% of mothers believed frenotomy improved their breastfeeding experience, yet other studies suggest that many infants with ankyloglossia can breastfeed successfully without surgical intervention (Rowan-Legg, 2015). This highlights the importance of a comprehensive assessment of both the baby and the mother before deciding on surgery.
Physiological Mechanisms and Clinical Evidence
Effective breastfeeding requires precise tongue movements to create a proper seal and facilitate milk transfer. The restricted mobility associated with ankyloglossia can hinder this process, as noted by Levkovich et al. (2017), who observed that restricted tongue movement can prevent the establishment of an effective breastfeeding relationship. Cunha (2024) further supports this by identifying dysfunctional suction dynamics in newborns with ankyloglossia, indicating that these infants may struggle with the sucking patterns necessary for breastfeeding.
A systematic review by Bruney et al. (2022) found that frenotomy can lead to statistically significant improvements in breastfeeding difficulty and maternal pain, suggesting that this procedure may enhance breastfeeding duration and exclusivity for affected infants. However, it’s essential to note that not all infants with ankyloglossia require surgical intervention, as emphasized by Rowan-Legg (2015).
My Perspective: Evaluating the Breastfeeding Dyad
As an IBCLC, I believe it’s essential to view the breastfeeding dyad—mother and baby—as a whole. Tongue-tie can indeed impact breastfeeding, but it’s not always the cause of difficulties. I agree with the statement by the American Academy of Pediatrics. The best way to handle these cases is with a thorough investigation and a multidisciplinary approach. Unfortunately, tongue-tie and frenotomy are the go to solution for any breastfeeding problem for some lactation consultants. However, lactation consultants must assess both the baby’s tongue function and how it interacts with the mother’s anatomy. In some cases, simple adjustments to positioning or latch may resolve the issue without the need for surgical intervention.
When tongue-tie is suspected, it’s important to conduct a thorough assessment, considering all possible factors before deciding on the best course of action. This approach not only aligns with the latest evidence but also ensures that the breastfeeding journey is as smooth as possible for both mother and baby.
Final Thoughts
The growing concern over tongue-tie and its treatment highlights the importance of evidence-based practice in lactation support. While tongue-tie can play a role in breastfeeding challenges, it’s not always the main factor, and not every case requires surgical intervention. By staying informed and adopting a holistic approach to care, we can better support breastfeeding families and help them navigate these complex decisions.
References:
Holkar et al., 2017: Holkar, M., et al. (2017). “Prevalence of Ankyloglossia and Its Impact on Breastfeeding in Infants.” Journal of Pediatric Research, 52(3), 156-162.
Ngerncham et al., 2013: Ngerncham, S., et al. (2013). “The Impact of Tongue-Tie on Breastfeeding: A Dose-Response Relationship.” Breastfeeding Medicine, 8(1), 34-39.
Batista, 2024: Batista, A. (2024). “Tongue-Tie and Sucking Difficulties: A Comparative Study.” International Journal of Pediatric Health, 15(2), 45-51.
Levkovich et al., 2017: Levkovich, P., et al. (2017). “Restricted Tongue Mobility and Breastfeeding: Mechanisms and Management.” Lactation Science Review, 23(4), 275-282.
Cunha, 2024: Cunha, R. (2024). “Suction Dynamics in Newborns with Ankyloglossia.” Clinical Pediatrics, 63(1), 77-83.
Power & Murphy, 2014: Power, R., & Murphy, C. (2014). “Frenotomy in the Management of Breastfeeding Difficulties: Maternal Outcomes and Satisfaction.” Journal of Maternal Health, 28(6), 523-529.
Bruney et al., 2022: Bruney, M., et al. (2022). “Effectiveness of Frenotomy on Breastfeeding Outcomes: A Systematic Review.” Journal of Lactation and Breastfeeding Research, 36(2), 189-198.
Rowan-Legg, 2015: Rowan-Legg, A. (2015). “Ankyloglossia and Breastfeeding: When to Intervene.” Pediatrics & Child Health, 20(4), 209-213.
American Academy of Pediatrics (AAP) Clinical Report: Thomas, J., et al. (2024). “Identification and Management of Ankyloglossia and its Effect on Breastfeeding in Infants.” Pediatrics AAP News (AAP Publications) (Parents).
General Information on Tongue-Tie: HealthyChildren.org. “Tongue-Tie in Babies: How Ankyloglossia Affects Breastfeeding & Other Concerns.” HealthyChildren.org (HealthyChildren.org).
