Does My Baby Have a Tongue Tie?
Tongue ties are more common than most people think. On my lactation visits, it is the most common problem I see. Doctors and lactation consultants have known about anterior tongue ties for years, but posterior tongue ties are something that not everyone has been educated on, and so it often is under diagnosed and mother and baby continue to suffer and have a frustrating breastfeeding relationship. Anterior tongue ties are when the frenulum under the tongue goes almost to the tip, or all the way to the tip of the tongue. They are obvious and almost no one will question when a baby has an anterior tie. A posterior tie looks like a normal tongue where the frenulum is in the expected place, or may not even have a frenulum under their tongue. However, if they have the below symptoms, they can still have what we call a posterior tie which means the tether or extra mid-line tissue is causing restriction to the tongue’s normal function. All anterior ties also have a posterior component to them, so it is crucial that you find a provider that knows how to laser or clip the tie all the way, or it will be an incomplete revision which will often not improve symptoms.
Let’s look at the list the things to look for in a tongue tie. Please remember that a baby with a tongue tie may only have ONE of these signs, but they may also have MANY of these signs.
It hurts every time you breastfeeds. Breastfeeding is not supposed to hurt. If it does, then something is wrong. If it isn’t a latch issue (which is also often a tongue tie issue), it is most likely a tongue tie and/or lip tie. Tongue ties and lip ties often go hand in hand. If your baby cannot flange their upper lip over the breast, it could mean they have a lip tie and also a tongue tie.
Nipples are cracked and bleeding– this can be a symptom of tongue tie because the tongue is not able to draw the breast tissue into the baby’s soft palate causing nipple damage from rubbing on the hard palate. Positioning and a breast sandwich can help some of the time.
Misshapen nipples after a feed– it will often look like the end of a new lipstick or have a crease on the end.
Baby gets frustrated at the breast and breaks latch often – baby is frustrated because baby is unable to transfer milk efficiently, because the tongue is tied.
Clicking sounds – the baby is unable to keep a good latch because the tongue is not able to make the correct seal so you hear clicking sounds.
Unusually strong suck – due to baby using excess vacuum to remove milk. A normal “suck” is actually not a suck but a wave like motion of the tongue.
Sensitive gag reflex – this is caused from the palate not getting the normal stimulation from the tongue because the tongue is tethered to the floor of the mouth.
Poor uncoordinated sucking motion – when you put your finger in a tongue tied baby’s mouth, you often can notice that their tongue is uncoordinated and/or breaks suction.
Sometimes poor weight gain – if mom does not have a good milk let down, a baby will often have low weight gain. This is not always the case as sometimes a mother can have a great let down and a baby with a tongue tie can still thrive. (see more info below)
Digestive problems due to extra air being swallowed causing gassiness, and reflux like symptoms.
They can also have a recessed chin although some babies have this without a tongue tie.
Irritability or colic
High and/or narrow palate caused by the tongue not resting where it is supposed to which is the roof of the mouth.
Reoccurring Mastitis caused by baby’s inability to transfer milk well.
When you see even one or a few of these symptoms it is recommended to see an IBCLC (Internationally Board Certified Lactation Consultant), or physician that knows about posterior tongue ties. If the person you see says there is not a tongue tie, it is still possible that they have a posterior tongue tie and the person you saw only knows about anterior tongue ties.
Why we take care of tongue tie:
If we leave it alone because we are afraid to do the revision, or if we think that breastfeeding is going well enough there are a few things to consider before you make that final decision:
At 10-16 weeks, our milk supply starts to work on a supply and demand and will often suffer if the tongue tie is not revised. Before that period, the milk is being made because our hormones tell it to be made. Most tongue-tied babies that are doing well on exclusive breastfeeding do so because their mother has a great let down and the baby gets enough milk from the good let down. If the baby fails to continue to stimulate the breast and fails to remove the milk from the breast, then milk supply will most likely suffer at the 10-16 week period when the milk begins to be on a supply and demand.
When solids are introduced, sometimes these tied babies are unable to swallow, so you will see tongue thrusting, gagging and choking on foods.
Orthodontic work is a lot more likely with a baby that has a tongue tie or lip tie that were not revised. When the fibrous tissue is allowed to keep things tethered down it fails to allow the necessary growth in the jaw to make room for adult teeth coming in and increases the need for orthodontia work. The tether will often pull the lower teeth inward causing crowding.
Speech problems are a lot more likely in children with tongue ties because their tongue is not able to move correctly.
The tethering of the tongue can even affect posture causing lifelong back pain.
Bottom line is that posterior tongue ties are hard to see, but if you do have any of these symptoms, please see a specialist that can help point you in the right direction to consider a revision.
To find a qualified provider near you: