Tongue Tie in Babies
Tongue tie in babies is the subject of much controversy within breastfeeding circles.
It’s almost like talking about politics or religion.
You could compare it to the anti-vax movement. Those that believe in the tongue tie are at extreme odds with those that don’t.
Tongue Tie in Babies: Hear Me Out
I pray that you will read this in its entirety, and with an open mind. I am a breastfeeding professional at extreme odds with most people in my career field.
Everything I advocate for is evidence-based, and studies are hyperlinked throughout.
But there’s more.
It’s also personal.
My first baby had a tongue tie. We went through everything the professionals told us to do. I know they genuinely believed it was the best for us. They love helping moms as much as I do.
And as a mother, I was doing my absolute best. I took what I heard and followed professional advice for tongue tie in babies. I wanted the best for my baby.
She was taken from my arms in a dentist’s office and a laser procedure was performed on her tongue. What followed was some of the worst 6 weeks of my life. Breastfeeding got worse afterward. She was colicky. Waking her up every 4 hours to stretch her tongue ruined her sleep (and mine too).
And her screams every time I had to do the stretches will forever haunt me. I had to press her tongue into the back of her throat HARD to prevent it from reattaching because of all the damaged tissue. One time I didn’t press hard enough; I went back to the dentist so she could rip my baby’s tongue off from where it reattached. It was bloody.
And after the stretches, when she would finally fall asleep… that 4 hours would come around. And I’d have to wake her up and do it again.
I’ll never do it to another one of my babies.
I would have done things differently knowing what I know now.
And I never want any mommy or baby to go through what I went through… especially if the evidence isn’t compelling when it’s all taken into account.
My experience led me down a rabbit hole of research. There’s a lot out there, and I want to share some it it here with you.
All this said I have a heart for moms and babies. While I’m critical of procedures surrounding tongue ties in babies, I’m not looking to condemn mothers for their decisions. I was there once too. Doing only what I thought was best with the information I had.
So without further ado, let’s talk about tongue ties.
What is a Tongue Tie?
A tongue tie, also known as “ankyloglossia” is the term used to describe a tongue that is tethered to the bottom of the mouth. There’s a small piece of tissue that connects the tongue to each person’s bottom jaw called the frenulum. With a tongue tie, the frenulum is tight, connected too far forward, or restricts movement of the tongue.
You might hear two words: anterior tongue tie and posterior tongue tie. Anterior is a medical term that means “front” while posterior is a medical term that means “back”.
When discussing tongue ties, an anterior tongue tie is one that extends all the way to the front of the tongue. An anterior tongue tie is very easy to see and diagnose. It is what you see when the baby’s tongue tip is attached to the bottom of their mouth. It’s a severe tongue tie that prevents the baby from lifting their tongue at all. They cannot push their tongue forward, and their tongue looks heart-shaped because the sides lift off but the rest of the tongue stays tethered.
A posterior tongue tie is only in the back – the front of the tongue can still move. People claim that a posterior tongue tie is tightness and strictures in the back of the tongue where it normally attaches.
Some people question the existence of posterior tongue ties (everyone’s tongue connects at the back). There’s extreme disagreement about tongue tie in babies today.
A true tongue tie only occurs in approximately 5% of babies. In the last 10 years, diagnosis of tongue ties in babies has exploded. It has increased by more than 800%. Such a drastic increase in diagnosis starts to bring with it some questions.
Do all of these babies have tongue ties? Did more babies have tongue ties in the past that were undiagnosed? And are they able to speak, swallow, and function normally as adults today? Are tongue ties in babies being overdiagnosed today? I hope that this article will give you some answers and things to think about considering tongue ties.
The Lie About Tongue Tie in Babies
Here’s what usually happens:
Starting in the mid 1900’s, women were told to just give a bottle of formula. In recent years, breastfeeding has become more popular. But women didn’t have the support from their mothers and grandmothers because they formula-fed.
So who did they turn to?
They’re told breastfeeding is best for their baby. They know their bodies and their babies were made to breastfeed.
But it doesn’t go the way they thought.
Just because breastfeeding is natural doesn’t mean it’s easy.
So they look for help. And they find a lactation consultant. And it’s a lactation consultant’s job to fix breastfeeding problems.
(As a lactation counselor myself, I believe in complete support of breastfeeding. But sometimes breastfeeding is just hard. One thing I DO know is that with support, knowledge, and sticking with it – moms will come out successful in the end. It just takes longer for some than others.)
When a lactation consultant can’t find a reason for breastfeeding struggles, they search for an answer. Of course they do, they want to help! They want to fix the problem.
Usually when everything else is ruled out the answer is: TONGUE TIE.
Even if you can’t see it.
They’ll call it a posterior tongue tie in babies. It’s different from an anterior tongue tie because the tip of the tongue isn’t tethered. They say that the frenulum at the back of the tongue is tighter than it should be.
So they send the mother and baby to a pediatric dentist for diagnosis.
It just so happens that these dentists get an average of $850 per tongue tie revision procedure.
So you go get your baby’s tongue tie cut. If you’re lucky, they just snip it.
But sometimes they recommend laser treatment.
And this is what they don’t tell you about tongue tie in babies…
The aftercare is so painful. For your baby. And for you.
Every 4 hours around the clock, you have to stretch your baby’s tongue or it will reattach.
Imagine waking your sweet, sleeping baby to press your fingers into their tongue, towards the back of their throat. HARD.
This is for 6 weeks straight.
When my daughter had it done, we were both in tears around the clock for 6 weeks. I wouldn’t ever recommend it to anyone unless it is absolutely necessary.
The Truth About Tongue Tie in Babies
So what is the truth about tongue ties in babies?
Well, everything I’m about to tell you comes from studies and from my own personal experience.
I’ve worked with countless breastfeeding moms. I’ve seen providers assess for and diagnose tongue ties.
I’ve seen first hand the outcomes of revising a tongue tie.
I’ve also worked with mothers who decided not to fix their baby’s tongue tie.
There’s a lot of reasons why tongue tie diagnosis has increased. It comes partly from lactation consultants and other providers wanting to help. They want to give moms an answer.
It also partly comes from the benefit to all from diagnosing them.
A lactation consultant will refer a mother to a pediatric dentist for diagnosis. These dentists make good money performing revisions. They then refer out to chiropractors for the infant to get work done.
The chiropractor will refer the mother to an infant massage therapist, who then refers her to a lactation consultant.
Any one of these individuals will raise concern about a tongue tie in your baby, and all benefit from the diagnosis.
Now I don’t want to accuse these providers of taking advantage just for the sake of money. They truly believe what they’re doing and teaching. But when there’s a whole network benefitting from these procedures it makes sense why it’s promoted at an exponential rate.
Here’s what should happen with a suspected tongue tie:
A mother has difficulty breastfeeding. She should take her baby to a provider that is trained to assess for function. It’s very difficult to find someone who genuinely assess function correctly so here is what they should do:
Can the baby push their tongue forward over their bottom gums?
If the baby can push their tongue forward over their bottom gums, they will be able to breastfeed. This study explains the tongue’s role in a feeding and it found that the tongue moves very little. The movement had almost no impact on the baby’s ability to expel milk, and the vacuum that the baby created with their mouth was more important.
Does the tongue attach all the way to the tip? When pulling the tongue up, do only the sides come up in a heart shape?
This is the true sign of a tongue tie in babies. When the tongue is tied all the way to the front, it cannot move up or forward at all. Be wary – some may tell you that your baby has a posterior tongue tie. They will say that the back of the tongue has tight strictures. But posterior tongue ties in babies weren’t even discovered until 2004, and that “discovery” was a newsletter, not an evidence-based study.
Some experts question whether posterior tongue ties in babies actually exist or if they are just a variation of normal attachment of the tongue – because everyone’s tongue attaches at the back of the mouth.
Does your pediatrician think the benefits of a tongue-tie revision will outweigh the risks and outcomes?
Perhaps the most important person to ask about your baby’s tongue is your pediatrician. They have something that other providers don’t.
Your pediatrician looks at your baby as a whole. They know your baby’s history.
They see what happens after tongue tie revisions. If your pediatrician believes it is indeed something that needs to be fixed, then your baby may be one of the 5% that truly has a severe tongue tie.
The good news is that there is a much better option than laser treating the tongue tie. Tongue tie in babies can be fixed with a tool that simply clips them. This revision doesn’t require stretches and painful healing. If your baby was struggling to breastfeed and the only reason was the tongue tie, this is a quick solution and immediately afterward they should feed normally.
And it shouldn’t require aftercare. Generally the front attachment isn’t very vascular (meaning not a lot of blood goes to it), so it shouldn’t heal back together.
A good breastfeeding supporter won’t jump to the conclusion of a tongue tie first.
Everything else should be ruled out. Sometimes a mom has flat nipples which makes latching difficult. Maybe the baby was born premature and doesn’t have as much energy as a full-term baby. The baby could simply not be positioned optimally.
Additionally, a breastfeeding supporter won’t claim that all breastfeeding problems will be fixed by tongue tie revision.
Often a frenotomy (tongue tie revision) won’t fix the breastfeeding problem. A good breastfeeding support person will acknowledge this and work to support the breastfeeding relationship throughout.
Be extra cautious if there is no clinical reason for a frenotomy. Some lactation consultants will warn that your baby will have braces in the future, will be colicky, or have sleep apnea if you don’t get the tongue tie fixed.
These claims are not evidence-based.
There is no way to prove these things WILL happen. And a baby and mother shouldn’t be put through the pain of a tongue tie revision without current evidence showing the need.
Some moms claim their baby makes clicking noises while feeding, or maybe their baby has a blister on their lip in the first weeks. Examples like these are normal findings and as long as the baby is feeding well and it doesn’t hurt – there is no need for an intervention!
Sometimes a weak suck is the problem.
I’ve worked with mothers whose babies had a weak suck and within the first 3 months, they grew and got much better at feeding.
Or perhaps a baby’s mouth is small and mom’s breasts are large. She could be oversupplied.
All of these examples are things that can cause breastfeeding problems. Support is what’s needed, not a SOLUTION.
With support and breastfeeding techniques, these problems will resolve and breastfeeding is generally successful by 3 months. Newborns need time! They are learning how to breastfeed, breathe, and live. It doesn’t mean there’s anything wrong with them or the mother.
An article from the Atlantic about tongue tie in babies states:
“Research from 2007 suggests that only 10 percent of pediatricians think tongue ties affect breastfeeding, compared with 30 percent of ENTs and nearly 70 percent of lactation consultants. So new parents might be left with very different impressions of the seriousness of their baby’s tongue tie, depending on whom they’re getting their advice from.”
To Sum It Up
Breastfeeding isn’t always easy for everyone. When problems arise, a tongue tie in babies can be a good scapegoat when there’s no other explanation.
But tongue tie revision for babies hasn’t been shown to significantly improve breastfeeding outcomes.
Seek out advice from your pediatrician before making any decision. Make sure you’re educated about tongue ties in a baby and what they really are and look like before you let someone cut your baby’s tongue.
Learn about the aftercare, and if you want to go through it with your baby.
Consider avoiding the laser procedure that creates much more scar tissue than a simple clipping procedure if you and your doctor find it necessary.
And know that it isn’t a fix-all. Some women have their baby’s tongue tie snipped and immediately afterward breastfeeding is easy. Others continue to have problems. This is especially true of “posterior tongue ties”.
And above all, from personal experience, avoid a laser revision.
If you have any questions, please reach out to me! I’m happy to help answer any questions and help you through your breastfeeding struggles.
My difficulties led me to become a Lactation Counselor so I can help other moms in a way I wish I’d had.
Myths and Truths about Tongue Tie in Babies
Myth: Your baby will have speech delays, colic, stomach problems, oral development issues, and braces in the future if you don’t correct the tongue tie.
Truth: You cannot predict future outcomes and base a painful procedure on what-ifs.
Myth: Clipping a tongue tie will solve all breastfeeding problems.
Truth: Tongue tie revision doesn’t solve all breastfeeding problems. I personally didn’t have any improvement with my breastfeeding problems after I got my daughter’s tongue tie revised. This study, done in 2017, concluded that there is no consistent positive effect on infant breastfeeding following frenotomy. Some have positive outcomes, others do not.
Myth: You need to see a chiropractor or body therapist for your baby to improve.
Truth: When frenotomy doesn’t resolve a baby’s colic or breastfeeding problems, often mothers are told they need to see an infant chiropractor or massage therapist. Unfortunately, this is often told to mothers after they continue to struggle with breastfeeding after performing the tongue tie revision. Personally, I continued to struggle and the pediatric dentist didn’t offer help other than to refer me to expensive chiropractors and masseuses.
Myth: You need to go to a pediatric dentist who’s done thousands of these to get an accurate diagnosis.
Truth: Pediatric dentists are diagnosing providers. However, they aren’t pediatricians. They don’t take your baby’s overall health into account – only their mouth. Consider talking it over with your pediatrician and before undergoing a frenotomy, you could even get a second opinion from another pediatrician. I’d be extra cautious of the dentists that have done thousands because that might mean they’re overzealous in diagnosing. To a hammer, everything looks like a nail.
Myth: See a Lactation Consultant to get diagnosed for a tongue tie.
Truth: Lactation consultants AREN’T diagnosing providers. They cannot legally diagnose. The only providers that are legally allowed to diagnose are midwives, nurse practitioners, dentists, and most importantly pediatricians. See a lactation consultant for help breastfeeding, that’s what they are trained to do.
More Helpful Evidence-Based Articles About Baby Tongue Ties
Kealy Hawk, BSN, RN, CLC
Kealy is a Registered Nurse, Lactation Counselor, and most importantly a mommy! Her own baby feeding struggles gave her a passion to help moms throughout their feeding journey. She specializes in breastfeeding support and evidence-based formula recommendations. To talk with Kealy or take one of her breastfeeding or formula classes, visit https://littlebearcare.com.