Breastfeeding and Tongue Ties – Know when to get help!

“He’s not tongue tied, he can stick out his tongue!”

Have you ever heard this phrase about your own baby? Or said this to a patient, acquaintance, or friend? This post is for you!

When breastfeeding is not going well, one of the first things in an assessment should be to make sure that the baby is not tongue tied. A tongue tie is something that happens early in the baby’s development, at the embryo stage. It’s a tight little band of tissue under the tongue that prevents the tongue from being able to move in all of the ways it needs to for proper feeding, swallowing, and more. A tongue tie cannot stretch out and does not disappear over time, and we do not always see or notice all of the ways that a baby is affected by it right away.  (Click here to learn more!)

The big question most health care providers ask when checking a baby for tongue tie is : “Can she stick out her tongue?” If the answer is yes, the baby is usually considered to not have a tongue tie and it is ruled out as the problem.

I’m going to let you in on a little-known secret… Sticking out is NOT the only important job that the tongue needs to do for breastfeeding!

Babies do need to be able to stick out their tongues in order to breastfeed well, but an equally important job that the tongue needs to be able to do to work properly is to move up and down. And I’m not talking about just the tip. The entire length of the tongue needs to be able to lift and lower with every suck (in a wave-like motion) to create a nice strong vacuum to get the milk out of the breast and into the baby.

Many babies can stick out the tip of their tongue when they are not feeding, but still have a tongue tie hidden further back under their tongue (often called a posterior tongue tie).  These are the babies who usually do not get properly diagnosed and treated, but still have significant problems with breastfeeding because they can’t properly move their whole tongue.

“The latch looks perfect!”

This is my favourite drawing of what a tongue-tied baby vs a baby with normal tongue function looks like while breastfeeding. From the outside, both of these babies’ lips on the breast look about the same (“The latch looks perfect!”), but on the inside a whole different story is revealed:

Normal latch

Look at the baby in the first picture – See how high the middle and back part of the baby’s tongue can go?  And see how far back the nipple is in the baby’s mouth, nestled between the soft tongue and the soft palate? And that the tongue can also stick out far enough (even while the tongue is lifting and lowering!) to cover the baby’s gums while latched?  The baby in the second picture can’t do any of those things, and the nipple is being rubbed between hard gums and the hard palate (ouch!).

If we can’t see inside a baby’s mouth while they are feeding, how do we know how the baby can lift and lower their tongue?

There are two simple ways to check:

  1. Watch the baby crying – When a young baby gets upset and cries with an open mouth, their tongue lifts up towards the top of their mouth. When a tongue tied baby cries, the tongue either barely lifts up, or only the sides lift up and the middle stays down (creating a scoop shape). Click here to see some examples.
  2. Check inside the baby’s mouth– This may sound obvious, but I can’t even begin to count the number of babies I have seen in my practice who have significant tongue ties and have never had anyone check in their mouths! This is ideally done by someone experienced in assessment for tongue tie, such as an IBCLC, physician, nurse, or dentist with breastfeeding education and experience with posterior tongue ties.  Click here for a post on how it should be done.

Doing a thorough and foolproof assessment to diagnose or rule out tongue tie requires a good working knowledge of the physiology of how breastfeeding works, and a hands-on approach. There are several good resources available to parents and professionals who wish to learn more about breastfeeding and tongue ties– check out my tongue tie page.

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