Lactation Consulting / Tongue Tie
Expert help with feeding challenges, including tongue tie assessment, to make breastfeeding more comfortable for you and your baby.
Help With Breastfeeding
Our lactation consultants and doctors see many families struggling with breastfeeding difficulties – pain, nipple damage, low supply and sluggish weight gain for babies to name a few. One of the common presentations we see are families concerned that their baby has been diagnosed with a tongue tie and there is a lot of non-evidence based information out there. We wanted to dive into what exactly a tongue tie is, when do they need treatment and what treatment for a tongue tie looks like, based on current evidence.
Ankyloglossia, commonly referred to as ‘tongue tie,’ describes restricted movement of the tongue (lift, motion and reach over bottom gum) causing limitations to the function of the tongue, accompanied by a visually restricted lingual frenum. The lingual frenum refers to the mucous membrane that connects the underside of the tongue to the floor of the mouth. Ankyloglossia is a congenital anomaly that has increasingly been suggested to be linked with a range of health issues, including breastfeeding, speech and dental problems, along with tension throughout the body, despite inadequate evidence supporting these links. It cannot be based solely on anatomic appearance. Functional impairment, such as difficulty in breastfeeding causing nipple pain and damage or poor weight gain in babies, and an anatomically restricted lingual frenum should also be present for a diagnosis of ankyloglossia. In the absence of a functional limitation, the lingual frenum should be considered functionally normal and requires no treatment.
Facts & Management
No available evidence demonstrates causative association between ankyloglossia and future dentition or speech problems, including a delay in, or lack of speech development, particularly in children who have not had feeding issues. There is no evidence to suggest that cheek or lip ties (buccal or labial frena) can lead to any problems with feeding or speech, nor should they be viewed as anything other than a normal anatomical variant.
Management of tongue tie depends on the assessment by an appropriately trained health professional such as IBCLC, midwife, child health nurse, speech pathologist or medical practitioner. Non-surgical intervention should be first-line treatment of any tongue tie. It is highly recommended to seek the support of an IBCLC (International Board Certified Lactation Consultant). Management can include advice on positioning, latch optimisation, feed frequency, supporting mothers to maintain milk supply, and the use of external tools such as nipple shields. Very often, support optimising position and latch on the breast will correct pain and improve milk transfer without requiring surgical intervention.
Frenotomy
Surgical management of a tongue tie, otherwise known as frenotomy, may be indicated in cases where conservative management is not successful in correcting nipple pain for the mother or milk transfer by the baby and also in cases where there is a significant functional impairment inhibiting the tongue motion required to latch to the breast. Surgical management should not be undertaken to prevent anticipated future dental or speech concerns. Options for frenotomy include scissor frenotomy and laser frenotomy. There is no evidence that laser is preferable to scissor frenotomy.
It is important to note that frenotomy may not be successful in resolving the issues associated with ankyloglossia.
All babies who undergo frenotomy due to breastfeeding difficulties should receive appropriate after-care, particularly breastfeeding support from an appropriately qualified IBCLC. Post-operative care of laser frenotomy wounds frequently advises stretching of the wound arising from frenotomy, allegedly to prevent ‘reattachment’ of wound margins. It is important to note that there is no scientific evidence to support the ‘active wound management’ stretches of soft tissue wounds following frenotomy. Stretching of surgical wounds is not recommended as it prolongs healing time and increases risk of scarring and infection.
How We Can Help
If you would like to explore whether your baby has a tongue tie or whether a frenotomy may be appropriate, you can book a consultation with one of our expert midwives and GP Dr Trudi Beck. Together, they will assess your baby and work with you to determine whether feeding concerns can be addressed using the evidence-based Possums approach, including fit and hold, positioning, and feeding techniques.
Dr Beck performs anterior frenotomy (tongue tie release) for babies under 8 weeks of age when clinically indicated. If a frenotomy is not appropriate or specialist assessment is required, we can refer you to specialist providers where the evidence suggests a frenotomy may be beneficial.
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