Is breastfeeding hurting?
Does your baby have a lip and/or tongue tie?
Does you baby have failure to thrive?

What is lip and tongue tie?

The normal development of a fetus includes growth of a band of soft tissue called a frenum, which attaches the lip and tongue to the jaw. This attachment usually partially disappears, and in most cases, naturally reduces away from the ridge of the gums or tip of the tongue.  We are all born with some of this tissue, but for some babies, it is so tight that they cannot move their lip and tongue properly. This can affect their ability to breastfeed or even take a bottle or pacifier. Babies who have lip ties almost always have tongue ties as well.

Lips and tongues are only considered tied (also known as ankyloglossia) if their movement is restricted, impairing mobility. It is important to note that many people have frenums which do not cause any problems at all. Each baby needs to be assessed on an individual basis. It is very common for children of lip/tongue tied siblings or parents to have the same condition. It is much easier and more predictable to have treatment early in a child’s life (first few weeks to months) and often these ties, if left untreated, can have other serious health effects later in life.

Problems for Infant with Lip/Tongue Tie

Lip Tongue Tie ReleasePoor latch resulting in:

  • Extended nursing episodes (baby feeds over 1 hour)
  • Unable to sustain latch causing a cycle of re-latching
  • Poor weight gain/failure to thrive
  • Falling asleep on the breast
  • Colic, excessive gassiness, reflux
  • Unable to hold a pacifier
  • Early weaning from the breast

Problems for Mother

  • Difficulty or unable to breastfeed
  • Painful compression of the nipples resulting in chapping, bleeding, and flattened nipples
  • Mastitis, engorgement, thrush
  • Low milk supply
  • Early cessation of lactation
  • Anxiety, stress, fatigue
  • Post-partum depression, feelings of guilt

What can be done to correct a lip or tongue tie?

Many of today’s practicing physicians were taught that treatment of a lip or tongue tie is an outdated concept; however, lactation specialists recognize that lip and tongue ties are one of the main causes of difficulty with breastfeeding and a very easily corrected one. Unlike in the past few decades, the American Academy of Pediatrics (AAP) is now recommending breastfeeding, over bottle feeding, due to its many health advantages for mother and baby. Since lip and tongue ties do not correct themselves, lip and tongue tie release (also known as frenectomy) is now being recommended more by the AAP to improve breastfeeding, stating that it is less traumatic than ear piercing and less invasive than circumcision.

Although frenectomies have been performed in the past with a simple “snip” of the scissors, the preferred method of treatment today is with a soft tissue laser which is not only faster and safer but results in little to no bleeding and no pain for the baby.

Advantages of laser surgery

  • Infant does not need to be sedated or in an operating room
  • Significantly reduces the risk of any bleeding
  • Reduced post-surgical swelling, pain, discomfort
  • Bactericidal: virtually no chance of infection
  • Procedure takes less than 1 to 2 minutes and baby rests in the arms of a parent during treatment
  • Ability of baby to return to breastfeeding almost immediately with little to no postoperative discomfort
  • Area of treatment is safely and mildly anesthetized so baby feels no pain

Long term affects of lip and tongue tie

The best time for treatment of a lip and tongue tie is in the first few weeks after a baby is born before they develop poor habits while feeding. However, infants, children, and even adults of all ages can be candidates for a lip and tongue tie release in order to reduce long term complications such as:

  • Orthodontic problems: large gaps between front teeth, relapse after orthodontic care
  • Difficulty in transitioning to solid foods
  • Dental decay on upper front teeth and/or lower back teeth
  • Speech problems
  • Esthetic problems resulting in improper smile line
  • Periodontal disease, poor oral hygiene

How to prepare for the procedure

Nursing – Please nurse baby within the hour prior to consultation and treatment (a private room may be available upon request). Baby may not be able to nurse for about 30 min following the procedure due to a minor local anesthetic used to eliminate any discomfort.

The best way to prepare for the procedure is to have the medications that you will need on hand so you can focus on your child following the procedure:

Tylenol – Dosage: Using the dropper in the manufacturer’s packaging; a dosage recommendation from the manufacturer is also given in our patient post operative gift bag. This can be given every 6-8 hours after the procedure.

You may use whatever works for your family. This includes homeopathic remedies like arnica, or nothing at all. Because numbing medicine is used during the procedure, and because the laser itself has some analgesic properties, not everyone needs a medication beforehand.

References & Resources:

Lawrence Kotlow, DDS

Breastfeeding should be fun and enjoyable: A book all about fixing abnormal lingual and maxillary frenum attachments 2013 updated version

Exposing the top ten myths(takes) concerning lip and tongue ties in breastfeeding 2015

The significance of the tongue and lip ties and why you should consider correcting them February 2013

Reflux & Colic due to tongue-ties and lip ties: Aerophagia Clinical Lactation, 2011, Vol. 2-4, 25-29

The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding  Infants: Prevention, Diagnosis and Treatment  Journal of Human Lactation 2010

Bobby Ghaheri, MD
Alison Hazelbaker, PhD, IBCLC, FILCA, CST, RSCT