A Lactation Consultant's Guide to Understanding Tongue Ties and Frenectomies
Updated: Jan 25
Today I want to dive into a somewhat controversial topic: Tongue ties
Let's start with some definitions:
Ankyloglossia is another word for a tongue tie and is a condition where the tissue (frenulum) under the tongue is too short and restricts the movement of the tongue.
Frenulum or frenum is a small fold or ridge of tissue that supports or checks the motion of the part to which it is attached. Frenums can actually be found throughout our body and not just in our mouths. We have frenulums under our tongues, in the upper and lower lips, inside our cheeks, and in our genitals.
When does it cause a problem?
If a frenulum in the mouth is short and tight and causing restrictions, we call these tethered oral tissues (TOT's for short) or ties and know that they can cause difficulty with breastfeeding because they can impede the baby's ability to latch properly, leading to ineffective transfer of milk, pain for the mother, and poor weight gain for the baby.
Assessing for TOT's:
Restrictions in the mouth should be assessed by someone specifically trained to do so such as an IBCLC, midwife or pediatrician who have been specifically trained on oral assessments.
When I assess the mouth, I look at these things that tell me whether or not I should refer the patient for a possible frenectomy.
Oral anatomy (tongue, lips and cheeks)
The function of the tongue
Symptoms in the lactating parent and the baby
All of these things need to be assessed to make a proper referral. Just because a baby is gaining weight does not mean they don't have a tongue tie, or just because mom is having nipple pain also doesn't automatically mean there is a tie. This is where the skilled health provider comes in.
**Note that not all birth workers have been trained on how to do a proper oral assessment, so please ask them to be sure.
What is a frenectomy?
A frenectomy is a procedure to release oral ties by cutting or layering the frenulum. It is a relatively simple procedure, performed in the doctor's office with a laser or scissors. It can be done on newborns, babies, children and adults.
Once the oral ties are released, we don't typically see immediate results. The tongue is a muscle, and we have now just released a portion of that muscle that has never been used before. The next step is to strengthen and coordinate that muscle with oral habilitation and exercises, and it might take a couple of weeks of this retraining before we see signs of improvement. Please work with a health provider skilled in oral habilitation to get the most benefit from your child's frenectomy.
A frenectomy can also benefit the baby into adulthood.
The short-term improvements of improved breastfeeding and latch will make feeding more comfortable for the lactating parent and result in a more efficient milk transfer and improved weight gain for the baby. For breastfeeding mothers and their babies, a frenectomy can make a big difference in breastfeeding success.
Longer term benefits can include improved speech and oral hygiene for the child as well as better palate and airway formation and sinus cavity structure.
If your baby is having difficulty breastfeeding, it's important to reach out for help! Speak to a lactation consultant to see if TOT's are the issue. If it is, a frenectomy may be the answer.
It's important to keep in mind that frenectomies are not always the answer. Some babies are good candidates for the procedure; others are not. Many babies may require some bodywork such as chiropractic care, craniosacral therapy or rolfing before getting a frenectomy to release tension throughout the body so that we can optimize the release. And some babies may continue to have difficulty with breastfeeding even after a frenectomy, and in these cases, alternative solutions may need to be explored.
If you have any questions about tongue ties and frenectomies, please don't hesitate to reach out to your IBCLC. They can help you determine if a frenectomy is the right solution for your family.
Kelsey RN, BSN, IBCLC