Tongue or Lip Tie and Frenotomy

What are Tongue Tie and Lip Tie?

The frenulum is a small bit of tissue that secures the tongue to the muscle at floor of the mouth (lingual frenulum) or the lips to the gums (labial frenulum).  The oral frenulums assist in the movement of the tongue and the lips.

Posterior tongue tie in an infant struggling with breastfeeding

Sometimes the frenulum is too tight and restricts movement of the tongue or lip; this is called ankyloglossia or (more commonly) tongue tie or lip tie.  This restriction can result in a poor latch on the breast and may prevent baby from effectively transferring milk from mom’s breast; the lips or tongue are unable to “milk” the mother’s breast appropriately.  This restricted movement and poor latch can often also lead to sore nipples for the mother: since baby’s tongue cannot extend beyond his lower gums, the gum might be rubbing mom’s breast instead of the tongue and might be the cause of her nipple pain.  Additionally, a tongue tie might prevent an adequate suction being formed, and result in the baby latching on to mom’s nipple, instead of pulling the nipple far back in his mouth (as is required for effective milk transfer).  Because of this, some babies with tongue tie experience difficulty in gaining weight.

Effects from tongue and lip tie can be seen beyond a baby’s breastfeeding time, as well.  Tongue-tie is related to life-long issues such as speech problems and tooth decay.  Have a conversation with your health care provider to discuss these potential long-term complications of tongue tie and how they might be prevented.

What Causes Tongue Tie?

Some research indicates that tongue tie has a genetic component.  Some families of babies with tongue tie are able to list family members who have tongue tie.  Sometimes siblings, fathers, grandparents, etc., will have tongue ties; when mothers start to list family members they know who have had speech impediments or excessive tooth decay possibly related to tongue tie, they begin to recognize the strong family history.

How Do I Know If My Baby Has Tongue Tie?

There are varying degrees of tongue tie and lip tie and your Lactation Consultant or health care provider will perform an examination of your baby’s mouth and body and witness a feeding; they will discuss their findings with you.

Thick lip tie in an infant struggling to breastfeed

Among other things, they will assess the function and appearance of your baby’s tongue and lips.  They might listen for unusual noises that baby might make with his tongue during a breastfeeding.  Your Lactation Consultant will ask you to describe what you feel on your breast, too, and will be looking for descriptions of tongue movement.  She’ll also likely want to see the shape of your nipple after the feeding.

After this examination, your Lactation Consultant may make a referral to an ear, nose, and throat doctor (ENT) and/or other health care providers for further evaluation and treatments.  It is worth noting that, at times, infants with tongue or lip ties may require in-depth breastfeeding help and you may expect to have multiple visits with your lactation consultant to most effectively manage breastfeeding.

What is Frenotomy?

Frenotomy is a simple office procedure in which the frenulum in the tongue (lingual) or upper or lower lip (labial) is clipped to release a tongue tie (ankyloglossia) or lip tie.  Babies rely heavily on their lips and tongues to breastfeed and a frenotomy (also called frenectomy) can be performed to help the gain the full range of motion they need to effectively transfer milk from the breast.  Because babies might be unable to latch on to the breast effectively with a tight frenulum, many moms often experience pain while nursing; frenotomy can help to relieve their pain.

Most often frenotomy is performed by an ear, nose, and throat doctor, but many dentists, midwives, and other providers are able to perform the procedure, as well.  Your Lactation Consultant will provide a referral to the appropriate care giver in your area who has experience with this procedure.

During your visit with your ENT doctor, if he affirms that your baby has a tongue or lip tie, he should be able to perform the frenectomy on the spot.  Typically, a topical or local anesthesia is applied to the area to be clipped.  You might be left alone in the room with your baby while your physician waits for the anesthesia to take full effect.  Then, your physician will simply retract the tongue (or lip) and “snip” the frenulum; bleeding is minor.  You should be free to comfort your baby (if necessary) any way you see fit, including breastfeeding.

What Happens After Frenotomy?

There are generally no breastfeeding restrictions after frenotomy; you are free to nurse your baby as often as he needs to nurse.  While most babies will immediately have a corrected latch after frenotomy, some may need some time to learn how to nurse effectively with their tongue’s (or lip’s) newfound range of motion.  Be patient; you both are learning a new skill and it may still take some practice to master the skill of breastfeeding.  Ask your Lactation Consultant for the handout, “Frenotomy and Breastfeeding,” for tips to help you and your baby learn this new skill as well as to find some tongue exercises to help your baby’s frenotomy heal appropriately and to help your baby’s tongue utilize its new range of motion.

Some babies also benefit from manual or body therapy in dealing with limited tongue mobility and your lactation consultant may also make a referral to see a craniosacral therapist (CST), chiropractor, massage therapist, Bowenworker, or other similar manual therapist.

Additionally, some babies may experience some minor discomfort after frenotomy and you may want to ask your physician about the use of pain relievers for your baby, such as acetaminophen.

What Are the Risks of Frenotomy?

Frenotomy is considered a relatively risk-free and effective procedure.  Risks include excessive bleeding, infection, and trauma to the salivary glands.  These risks are not well documented, due to their low incidence, and you should discuss your concerns with your healthcare provider.

Local Resources

Mothers often need support outside of their healthcare provider’s presence for maintaining a healthy milk supply with a tongue tied baby and may benefit from the experiences of other mothers.  For this purpose, Melissa offers support groups throughout Spokane and North Idaho, free of charge.  In addition, she is currently available for consultations in the home setting where she can help you with positions and exercises to support you and your baby whether or not a frenotomy is performed and throughout all stages of lactation.

Melissa can work with your healthcare provider to
support your milk supply and healthy lactation
when working with tongue tie. 
Contact her here or by calling (509) 228-8710.

Additional Resources