Breastfeeding possible with tongue-tie?

Is is possible to breastfeed if baby has a tongue tie? Yes, it is, although it can be challenging.

Fortunately, much more has been discovered in recent years that helps us understand how it can impact breastfeeding — and, just as important, what to do so that moms can reach their breastfeeding goals as much as possible.

According to Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics. 2002 Nov;110(5):e63 “. . . Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.”

Dr. Ghaheri, an American doctor who specializes in otolaryngology whose clinical interest is helping babies with breastfeeding difficulties, says, “Personally, I don’t like to do procedures if there aren’t active symptoms — ties can be treated if problems arise with time.”

Tongue tie can be accompanied by an upper lip tie as well as a high palate or cleft palate. Dr. O’Callahan and colleagues found in a 2013 study that 37% of babies with tongue tie also had an upper lip tie.

Sometimes it seems that babies are not always screened for tongue-tie, or at least this is not always communicated to the moms.

IBCLCs have the duty to provide comprehensive services to families, including performing comprehensive maternal, child and feeding assessments related to lactation, so a lactation consultant should be willing and able to assess the baby’s mouth for ankyloglossia.

Some moms do not want to have the tie snipped, although that procedure (called a frenectomy) might need to be done if the tie interferes with breathing, speech, or dental occlusion. So it’s a good idea to keep the baby followed by a doctor if the tie is not snipped — just to make sure to ensure that baby’s normal development is not being hampered and, of course, to see if you agree whether a procedure would be helpful or not.

The baby can breastfeed immediately after the snip if you do have it done. But even after a tongue tie snip, babies still might not use their tongues effectively and they should be taught how to exercise their tongue so that they can strengthen it and move it around properly, and that should help with latching too.

Babies need to know how to latch correctly if breastfeeding is to go smoothly, whether they have had a snip or not. Moms sometimes see me after they have not had success with getting their baby’s latch improved after trying for a while, and sometimes after seeing nurses or midwives who are not necessarily trained in latching or helping moms with babies who have this sort of challenge.

Babies with tongue-tie typically fuss at the breast and go on and off the breast in frustration if they are not able to get the milk transferring effectively. And a baby not well-latched is at risk of mom’s milk production lowering, and so the baby might be more likely not to gain weight as well as they should.

Babies can also be supplemented with a breastfeeding supplementer system at the breast. There are some professional devices on the market but moms can make homemade ones too. Again, the need for a nursing supplementer system would be indicated in the situation where the baby’s latch is shallow but parents do not want to get the tongue tie snipped, and if the latching is not producing completely adequate milk in the mom.

And bottle-feeding is not necessarily the solution either since it breaks the breastfeeding bond and babies with sucking problems can have problems with the bottle too, including the start of the many risks that are taken when parents decide not to breastfeed (increased risk of allergies, ear infections, respiratory infections, and increased health risks in the mom).

Even babies who have had frenectomies sometimes still need help in learning how to latch more effectively and parents should expect to do stretching exercises in the baby’s mouth to prevent the tongue or lip tie from returning and to teach baby how to stretch the tongue out and develop more tongue mobility and control.

The good news is that babies, even those with this kind of latching challenge, can learn how to latch effectively, whether the tongue-tie gets snipped or not. There are techniques I can show moms to use to get the baby to use their tongue effectively and get a better latch. I think these can be particularly helpful for situations in which parents do not want to or do not plan to have the tongue-tie snipped (or at least not right away).

If you do get the tongue-tie and/or lip-tie released, Fleur Bickford, BSc, RN, IBCLC reminds parents: “improvement is rarely immediate. The release of the frenulum is usually just the first step. Your baby will need some time to figure out what to do with the new mobility of their tongue.” And of course, she provides plenty of information on how parents can help their baby after the procedure(s).

Meanwhile, avoiding artificial nipples will always be better if babies have latching challenges. If moms need to be away from babies who are not yet eating solids, mom’s milk can be pumped and/or hand expressed and given to baby in a feeding cup. There are some especially designed for this purpose.

But the best thing is learning how to breastfeed effectively even with challenges. And perhaps with this sort of challenge, you will benefit from a consultation with an IBCLC.

Read more from Dr. Ghaheri here

And there are a bunch of great articles at Fleur Bickford, BSc, RN, IBCLC’s website here.