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• Frenulum, frenulums, frenula
• Frenum, frenums, frena
• Frenotomy, frenectomy
• Tongue-tie, tongue-tied

Tongue-tie occurs in 4.8% of the population, occuring more frequently in males by a 3:1 ratio.    It is significant for breastfeeding infants as well as young children as these children may have feeding difficulties as well as speech problems.  Sometimes it is the pediatrician, lactation professional or dental hygienist who first assesses a tight lingual frenum.  Labial frenums can also cause breastfeeding difficulties.

Ankyloglossia Symptoms include:

• Heart shape of tongue when raised.
• Cannot extend tongue out to a point (significant for breastfeeding infants).
• Tongue curves down when extended.
• Usually leads to a deviate swallow.
• Possible speech problems.
• May have trouble swallowing pills.
• May have digestive problems.
• Difficulty in licking ice-cream cones.
• Difficulty in kissing

Barabara Wilson Clay, BS, an International Board Certified Lactation Consultant, has written an article on the subject for Medela, Inc.  She has noted that with ankloglossia, the tip of the tongue may appear heart-shaped rather than round, especially when the tongue is lifted. If this piece of skin, called the lingual frenulum, is very tight, it prevents the tongue from being able to move normally.

Barbara recommends this educational tip for getting the ponit of togue-tie problems across.  Think about the last time you had a kernel of popcorn stuck in one of your back teeth. A severely tongue-tied person can’t move their tongue around to dislodge the popcorn. Some people have mild cases of tongue-tie and are not much bothered by the condition. Others develop speech problems and their dental health may be affected.

As lactation professionals, we see that tongue-tie is a problem for some breastfeeding mothers and babies. This is because the breastfeeding baby relies upon the tongue and the jaws to compress milk from the breast. The tongue normally extends over the lower gum ridge to provide some padding. If the tongue-tie prevents tongue extension, the mother may feel a painful pinch from the baby’s jaws during breastfeeding. If the tongue is stuck to the bottom of the floor of the mouth and can’t lift to compress milk out of the breast, the baby may not get enough milk. Mothers often complain about very sore nipples if their baby is tongue-tied, and the baby may be hungry and fussy.

Often mothers are given the advice to just put the baby on a bottle. Bottles are easier for many tongue-tied babies to manage. But while this solution may get food into the baby, it doesn’t really deal with the fact that the tongue muscle doesn’t move normally enough to permit normal feeding. The loss of the opportunity to breastfeed has consequences to the development of the face and jaw. Breastfeeding promotes good dental health, clear speech and facial development precisely because it makes babies use the muscles of the face and mouth.

Sometimes a tight lingual frenulum will stretch over time, allowing the tongue to move more normally as the baby grows. Occasionally tongue-tied toddlers fall down and bite through the lingual frenulum, accidentally clipping their own tongue-tie! In the old days, midwives and doctors recognized that tongue-tie could cause breastfeeding problems. They performed a simple procedure called a frenotomy to free the tongue. Today, pediatric Ear, Nose, and Throat (ENT) specialists, children’s dentists (pedodontists) and many pediatricians can evaluate tongue-tie and perform this simple outpatient procedure.  

Treatment can be accomplished in an outpatient setting, either with or without administration of a local anesthetic. General anesthe­sia or deep sedation is not usually necessary unless an extensive revision or a muscle reattachment procedure is required.   In these instances, the services of an oral surgeon are needed and, depending upon the age and medical condition of the child, surgery may be done on an inpatient or outpatient basis.  Infants are treated with only a local anes­thetic solution. Older children may be given a sedative such as Versed (midazolam) or chloral hydrate and Vistaril (hydroxyzine), in combina­tion with nitrous oxide or other suitable regimens with appropriate monitoring by a registered nurse or CRNA. Your local lactation professional may be able to refer you to more information on specialists in your community.