Breastfeeding a Tongue Tie or Lip Tie Baby

What is a tongue tie or lip tie?

Tongue tie is a congenital condition (present at birth) and occurs in 5-10% of babies. A tongue tie indicates that the frenulum (membrane) that attaches the base of the tongue to the floor of the mouth is unusually short, thick or tight.

During pregnancy, the developing tongue separates from the floor of the mouth. Sometimes this process is incomplete and some of the tissue remains – this is called a frenulum. If the frenulum interferes with the normal movement or function of the tongue, it is called “ankyloglossia”, or “tongue-tie”.

Lip tie is similar to tongue tie where a small piece of tissue connects the gum to the underside of the lip.  This tissue may restrict the ability of the lip to form a tight seal at the breast. It may also cause rubbing of the lip against the breast.

How can a tongue and lip tie affect breastfeeding?

For comfortable and effective breastfeeding, the baby must latch deeply onto the breast with the mouth wide open and the tongue forward. The tongue then moves in a wave-like motion which stimulates the breast to release its milk and flow to the baby. Tongue tie can make it hard for baby to do these things, therefore resulting in the following symptoms:

Infant symptoms	Mother’s symptoms
Poor or shallow latch Difficulty latching or maintaining latch, clicking sounds, or loss of suction Gumming or chewing nipples when nursing Falls asleep while nursing Long and/or frequent feedings and slow weight gain Lip blisters Difficulty coping with fast flow, pulling off, choking, sputtering, or swallowing air	Pain while nursing Nipple damage and soreness caused by compressed or pinched nipples (Lipstick-shaped nipples) Poor removal of milk causing blocked ducts, milk blebs and mastitis Increased risk of nipple and breast infections like nipple thrush Breast fullness from lack of milk removal resulting in low milk supply

 Are there other issues associated with tongue tie or lip tie?

Some difficulties may only be discovered as the child grows older. These can include:

• Inability to chew age appropriate solid foods
• Gagging, choking or vomiting foods
• Persistence drooling/ dribbling
• Delayed development of speech or deterioration in speech
• Loss of self-confidence because a child feels and sounds ‘different’
• Strong, incorrect habits of compensation being acquired

Even though lip tie may not cause speech issues as compared to tongue tie, children with tongue and lip ties are at an increased risk of developing tooth decay.

I am not sure if my child has a tie but I have difficulties breastfeeding. What should I do?

If you are having difficulties breastfeeding, arrange a visit with an International Board Certified Lactation Consultant (IBCLC). She will be able to assess your baby’s latch and if ties are present, your IBCLC will be able to refer you to a paediatrician or a paediatric dentist who is well versed in tongue and lip ties for a comprehensive examination. 

What can be done if my child has a tie?

If it is determined that tongue-tie is causing breastfeeding difficulties, a simple and quick procedure called a "frenotomy" can quickly correct the problem. In a relatively painless in-office procedure, the doctor loosens the restrictive membrane (frenulum) with laser, sterile scissors or scalpel blade. Completed within 5-10 minutes, anesthesia and stitches are not necessary. 

Is surgery really necessary for all tongue and lip ties?

No. Although the procedure is simple, the decision to proceed should only be made after careful discussion with your paediatrician / paediatric dentist.

Who can I see to discuss my baby's tongue and/or lip tie issue?

Speak to a paediatrician or paediatric dentist who is breastfeeding friendly and find out if they are well-versed in tongue and lip ties. This area of expertise is not usually part of the normal paediatric training and he/she would have specially taken the initiative to further their training in this aspect. 

Paediatric dentist specializing in frenotomy:

Dr Tabitha Chng is the only Paediatric Dentist in Singapore to be dually Board Certified by the American Board of Pediatric Dentistry and the Royal College of Dentists of Canada. As a paediatric dentist, she dedicates her practice to caring for the dental needs of children from infancy to early adulthood. While her love of kids spurred her on to pursue Paediatrics, it was her experience with her son, born with a tongue and lip tie, which fuelled her passion to educate parents on these oral issues. She is a strong advocate for breastfeeding and loves her supporting role to helping mothers reclaim the joy of breastfeeding.

Dr Chng currently practises at My First Dentist in Singapore.  
Visit www.myfirstdentist.sg for more information.

Article contributed by Dr Tabitha Chng.