Tongue-tie/Frenotomy

To tell if your baby is tongue-tied, watch your baby stick out his or her tongue. Babies often imitate what others do, so try sticking out your tongue with your face about 12 inches from your baby’s face. If your baby is unable to fully extend the tongue or the tongue looks heart shaped, have your baby’s doctor or your lactation consultant examine your baby.

Things to look for when trying to figure out if your baby is tongue-tied:

• heart-shaped tongue
• baby is unable to extend tongue out past lower gums
• baby has a hard time moving the tongue side to side or up and down

Signs that your tongue-tied baby is having trouble breastfeeding

• baby has difficulty latching on the breast and keeping a latch
• baby becomes frustrated
• you have sore nipples that occur quickly
• baby falls asleep at breast
• very long feedings
• baby does not seem satisfied after feeding
• baby gums or chews at the breast
• baby loses a lot of weight or does not gain enough weight
• baby has reflux and/or colic
• baby has poor suction and makes a clicking sound while nursing

If your baby has tongue-tie, he or she may find it hard to latch onto your nipple. This can limit the amount of time your baby breastfeeds and the amount of milk your baby is getting. When a baby has tongue-tie it may be hard for him or her to breastfeed effectively.

Please see a lactation consultant if you are having any breastfeeding problems. A lactation consultant can:

• check for tongue-tie
• show you how to change your baby’s position during feeding
• help your baby with latch-on
• help you with other breastfeeding skills

Some infants don’t need treatment because they adapt to the way their tongue is or the problem gets better as they grow.

Some families may choose a “wait and see” approach to see if the frenulum will stretch over time. If you choose this option, get help from a lactation consultant for any breastfeeding problems.

If your baby has tongue-tie and is feeding okay, you may choose to wait and see if the lingual frenulum stretches on its own over time.

• Tongue exercises can help loosen the lingual frenulum. With a clean finger, lift your baby’s tongue on both sides and gently massage the “white area.” This can be done several times a day. You can also encourage your baby to stick his or her tongue out by mimicking you.
• Frenotomy is a method to clip the lingual frenulum. It can be done before your baby leaves the hospital or at the doctor’s office. There is usually very little bleeding and the baby can breastfeed right afterwards. After the clipping, tongue exercises may be recommended to prevent scar tissue.

You and your baby’s provider may want to just watch for a few days and see if your baby’s feeding problems resolve with improved management. Your provider may also refer you to a Lactation Consultant for help with latch-on and milk supply.

If the feeding problems don’t resolve after you’ve been evaluated for proper position, latch, and help with your milk supply, you may be referred to a specialist to see if a frenotomy is needed.

• Mom has nipple pain or damage that can’t be resolved with improved position and latch.
• Baby cannot extend tongue past the lower lip and is not able to stay latched at the breast. Baby might be continually letting go of the breast.
• Baby may have slow weight gain although mom’s milk has come in and she has a plentiful milk supply.
• Mother might have low milk supply because baby is not able to empty the breast. Milk removal tells mom’s breast to make more milk and create a full milk supply.

Use your clean finger to stretch the site:

• Place your finger horizontally under the tongue at the new diamond opening and lift the tongue towards the roof of the mouth for 1 to 2 seconds. Make sure you can see the diamond opening.
• Stretch after feeding every 4 hours for at least 2 weeks. These stretches should also be done after any nighttime feedings. It is not unusual to see some oozing of blood for the first few days, so do not be alarmed. It will stop with sucking or feeding or with an ice-cold wet piece of gauze.

During the first 2 days, the area where the tongue was clipped will look like a beefy red diamond-shaped opening and then start to fill in with healing grayish/white tissue. We want the opening as large as possible, so keep stretching.

If the upper lip procedure was performed also, then use your fingers to lift the upper lip so that the area above the teeth is visible and you see the opening.

It may take several days or up to 2 to 6 weeks for you feel a difference in latch and pain. New muscles are being used and they need to develop strength. It is recommended to follow up with a lactation consultant within the first week. If your baby has a tight mouth, neck, or upper trunk then a referral to Occupational Therapy or physical therapy might be done.

Yes! It’s important to breastfeed as much as possible to help your baby learn how to use their tongue’s new abilities. Your baby will probably be free from pain and may have just a few drops of blood or no bleeding at all from the frenotomy.

So, you can begin to breastfeed your baby right after the procedure. Most mothers notice an immediate improvement in breastfeeding and baby’s improved ability to stay latched at the breast.