Tongue ties, lip ties and breastfeeding

We perform tongue tie and lip tie surgery for infants and adults

Are tongue tied babies and breastfeeding problems really related?

Having pain while breastfeeding? It may be a tongue tie
Dr Strong's most recent baby girl!

I need to start out by saying I am a huge fan of breastfeeding babies. The research shows the health benefits to the baby are more numerous than I can list here.  Everything from immune system development to structural formation of the jaws. If you are struggling with breastfeeding, DON'T GIVE UP, GET HELP! Find an IBCLC (lactation consultant), they are the Jedi of breastfeeding. We would also be happy to provide a tongue and lip tie assessment of your baby in our office.


There is no substitute for the bond that forms between mother and baby via breastfeeding. When the breastfeeding process is painful or difficult, that bond can become strained. Often a consultation with an IBCLC can help mothers overcome their trouble with breastfeeding, often it does take surgical intervention to overcome the problems. Most of the time it is a team approach. 


So why do tongue ties and lip ties cause problems?

The baby can't form a quality seal around the breast because it's tongue and/or lip are tethered to the jaw. They just don't move far enough. So the baby can only get the end of the nipple in it's mouth (shallow or poor latch), it uses excessive sucking force, "bites" with gums and/or upper lip, keeps falling off, or just plain gives up on breastfeeding. Often the baby will swallow air while feeding, due to the poor seal, which can lead to acid reflux and "spitting up", or a colicky baby. Sometimes the babies tongue attachment will appear totally normal, but the symptoms of the mother and baby will lead us to a Tethered Oral Tissue diagnosis.  So even if you can't SEE a tie, the symptoms let us know the tongue and/or lip are NOT mobile enough to form a proper seal. This is so important. Some pediatricians look in the mouth and exclaim, "everything looks normal to me, I don't think your baby is tongue tied".  They are correct that everything may look normal, but the symptoms of the mother (see below, but PAIN) and the baby (see below, but poor weight gain) are telling us there is something wrong with the transfer of nutrition. 


 The following are some of the symptoms of a tongue/lip tie in a breastfeeding baby


-baby that is feeding for up to an hour with little to no weight gain, or weight loss (failure to thrive).

The baby spends a lot of time trying to drain the breast, but the tongue tie often causes difficulty with breathing and swallowing while feeding. So the baby struggles for a while and then gives up because he/she is exhausted. After all that time the baby still didn't get much milk for nourishment.


-baby that is "on and off" the breast multiple times during a feeding session

This goes along with what was stated above. The baby is on and off because it is struggling with swallowing and breathing while feeding. The poor thing has to come up for air, and take a break from all the hard work. Another reason for this is the baby latches on to the breast in shallow manner and the nipple simply slips out of his/her mouth easily. The baby compensates by biting the nipple and/or sucking very strongly in an attempt to keep the nipple in it's mouth.


-baby that is "colicky" with frequent spitting up

The poor seal around the nipple/areola can allow air to enter the babies mouth while feeding.  The baby simply swallows the air and ends up with a belly full of air. Some babies experience a lot of pain and discomfort from this bloating. They cry after the feeding for a while. Most will "spit up"  or projectile vomit to help relieve the pressure. Some will be very "gassy". The baby is often diagnosed with reflux and placed on prescription medication. In my opinion this is un-necessary about 98% of the time. A simple lip and tongue release resolves this problem (you guessed it) about 98% of the time.


-baby that has a bump or callous (nursing blister) on it's lip or both lips

I have seen everything from chapped lips to a huge callous right on the tip of the upper lip. The baby is using his/her lips to help hold on to the nipple. The lips are often turned down toward the nipple instead of flaring up and away from the nipple. 


-mom that has pain during breastfeeding

Think of all the ways that baby is trying to hang on to the breast. Lips, gums, suction, it's no wonder it hurts. 


-sore nipple or mastitis

-flattened nipple after feeding (baby using gums to get milk instead of sucking)

-full (un-drained) breast after breastfeeding

-clicking or loud sucking sounds when baby feeds or uses a pacifier


If you are experiencing any of these problems you should contact an IBCLC lactation consultant, we would also be happy to do a screening of your baby in our office and see if it has a lip or tongue tie. We do our best to help, but an IBCLC will be your best ally in the process.   


The best time to correct a lip or tongue tie is AS EARLY AS POSSIBLE.  That means even within the first 2 weeks after the baby was born. The longer the baby feeds with the tie the more it learns bad feeding habits. Also it is very quick for a newborn baby to have this procedure done. It takes much much less time than say a circumcision, and is relatively painless as there are few nerve endings in the frenal tissue when the babies are this small. 


Important points to remember when your baby needs to have their tongue tie released

-We swaddle the baby and place protective eyewear, this is enough for most babies, toddlers (ages 2-4) may need to be sedated (we do not provide sedation for children).

-This treatment can be performed on babies as young as 1 day old

-It takes time for the baby to learn how to nurse properly (many show immediate improvement, some take 2-4 weeks or longer)

-A laser is the best way to perform the procedure (In my opinion). Almost no bleeding, easier to see working, kills bacteria while it cuts, no stitches necessary. The CO2 laser is very fast (much faster than the Diode laser) and very safe.

-Your baby should resume feeding immediately after the procedure.

-There is post surgical "physical therapy" for the baby for 2 weeks after the procedure.


Lasers vs. Scissors for tongue tie surgery

There really is a difference, lasers are a beneficial medical advancement for surgeries of all types

Laser frenectomy in Utah County
Laser frenectomies for newborns

In my personal study and learning about frenectomies and tongue tie surgeries I have heard a lot of stories about doctors using scalpels, scissors, electrosurge units, and lasers to release tethered oral tissues.  One dentist talked about how when he was born the doctor grabbed some scissors, clipped his lip and his tongue right there at the time of delivery. It was definitely a different world at that time.


So do all these instruments work? Yes, they all work. So does it really matter which one your provider uses on your child?  Based on the surgeries I have seen, and the ones I have performed, I believe it does.  


Here are a few reasons why:


-Laser's cause almost no bleeding. The bleeding that does occur is usually from a small tear in the tissue while it is being release, not from the laser.

-Because there is no bleeding we can watch the frenum the entire time and make sure we are not removing areas of tissue that we don't want to remove. The blood vessels are sealed immediately, along with nerve endings and lymphatics. 

-The laser will sterilize the incision immediately.  While it won't sterilize the mouth, any bacteria at the site will be obliterated.

-No sutures are required. There will be some physical therapy to keep the frenum from reattaching.

-Certain lasers (like the DEKA which WE HAVE) are very very fast. The surgery will take 30-60 seconds. 

-No anesthesia is required. There is post operative pain no matter which instrument is used. If your doctor wants to put your baby under general anesthesia for a tongue tie, you should seek out a 2nd or 3rd opinion.  There are many unfavorable complications that could arise with putting a baby under for a simple procedure like this.

-The DEKA laser shows almost zero "charring" of the tissue (unlike the diode laser). 

How can a tongue or lip tie affect growth and development?

This is an area of ongoing study and new information is coming out routinely

-The pressure of the tongue, and the tongue with breast tissue, against the palate (roof of the mouth) can help properly shape and form the palate for the baby.  This can be as simple as helping the dentition to erupt in the proper position and reduce/prevent crowded teeth, and as complex as preventing nasal septum problems including deviation.

-A heavy lip tie and or tongue tie can affect the child's ability to properly clean the gumline around the anterior front teeth. It also can be painful to stretch the lip for the parent to properly brush the area. This can result in decalcification and decay on those front teeth. Waiting until the child is older can result in the child needed dental care that may have been avoided.

-Heavy tethered oral tissues can also result in teeth being turned or mal-aligned. This includes a gap or space between the front teeth.

-Children that are tongue tied often have trouble with speech and vocalizing certain sounds

-There is ongoing study on the effect of tongue tie and sleep apnea or poor sleep in children. This includes infants that struggle to breath while breastfeeding and older children that need proper sleep to be able to learn and act appropriately at school. 

-What about struggling to lick an ice cream cone?  HEAVEN FORBID!!