Tongue-Tie and Nipple Pain

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Tongue-tie is a commonly diagnosed cause of nipple pain during breastfeeding. There are different types and degrees of tongue-tie, and some are easier to diagnose than others. The easiest form of tongue-tie to spot has a characteristic appearance. The lingual frenulum, the membrane attached to the center of the under side of the tongue, extends to the tongue tip and gives it a heart-shaped appearance.  If it is short, ti can interfere with a baby’s ability to lift the tongue to the roof of the mouth and to extend the tongue over the lower gum ridge.

When a baby breastfeeds, tongue mobility is very important to achieving good suction and a comfortable latch. If the tongue is restricted, the baby may not be able to create proper suction. The baby may bite down with his gums to try to hold on to the nipple.   Pain and nipple damage can result. The baby may have difficulty removing milk from the breast due to poor suction.

There is a lot of information on the Internet about tongue-tie. It’s important to acknowledge that tongue-tie is only a problem if it creating difficulty with breastfeeding.   In my practice, I have seen babies with classic heart-shaped tongues who breastfeed with no difficulty and cause no pain. I have also seen similar babies who cause nipple damage and are unable to remove enough milk to grow well.

Recently a pediatrician that I respect told me, “We never had issues with tongue-tie until we had lactation consultants!” Some pediatricians share this opinion, which is often based on the training they received. It’s true some babies with restricted tongue movement can get sufficient milk flow from a bottle by biting the nipple, so it can appear there is no feeding problem. Unwillingness to acknowledge there is a problem is very frustrating to a mother who is experiencing pain and nipple trauma every time she breastfeeds!

The Academy of Breastfeeding Medicine recently published a study that concluded frenotomy was positively associated with mothers continuing to breastfeed.  At two weeks after frenotomy most mothers stated their breastfeeding experience had improved.

Before deciding if a frenotomy is needed, it’s important to have a thorough breastfeeding evaluation. Is there nipple pain or trauma, and is tongue-tie the only cause? Is the baby unable to transfer milk well? If it is determined there truly is a functional problem, your pediatrician may be able to perform a frenotomy to correct the problem. The tongue can be freed by snipping the frenulum, which is usually a very minor procedure.   Most babies begin to breastfeed better right away. If your pediatrician does not perform frenotomies, or if the tongue-tie is more complex, a referral to a specialist may be your best option.

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