Madi did not have a tongue-tie and I struggled with breastfeeding her. George had a mild tongue-tie and I found it easier to get him to latch on during feeds, but found feeding him more painful. Does tongue-ties in infants make it more difficult to breastfeed and/or cause pain during breastfeeding?

What is Tongue-Tie?

Tongue-tie (ankyloglossia) is something that 4-11% of newborn babies are born with.  There is a band of connective tissue under the tongue called the lingual frenulum that is shorter than usual and causes restricted tongue movement. 

Most infants with tongue-tie can breastfeed normally.  However, up to 25% of infants with tongue-tie can have breastfeeding difficulties.  The most common adverse effects of tongue-tie on breastfeeding are poor latch and maternal nipple pain.  

Poor latch can cause low milk transfer and poor weight gain in breastfed infants.  Maternal nipple pain can cause early discontinuation of breastfeeding.  It is important to have the infant assessed for tongue-tie if breastfeeding continues to be difficult after lactation is established.  

What is Frenotomy?

Frenotomy is the clipping of tissue under the tongue to release it and improve tongue mobility.  This procedure should only be done by a trained professional.  

Frenotomy involves the use of surgical scissors or lasers to “clip” the tongue-tie at its thinnest point.  Complications of the procedure include – bleeding that stops quickly, a small bruise, and possible need for a repeat procedure.  

There is no difference in success of the procedure whether it is performed by scissors or laser.  Laser offers no advantage over scissors and adds significant costs to the parents.   

Clipping of an upper lip tie is controversial. 

Does frenotomy help with breastfeeding?

Yes, in the short term, but not a consistent positive effect on breastfeeding in the long-term.  Tongue-tie clipping can help with latch and reduce maternal nipple pain in the short term.  Further studies are required to determine if frenotomy helps to improve duration of breastfeeding.

Did we Clip George’s Tongue Tie?

We decided not to clip George’s tongue-tie as it was mild and he had overall good movement of his tongue. George latched well from the start, and within 3 weeks the pain with breastfeeding improved significantly.

Frenotomy for tongue-tie is controversial. There are some some infants with tongue tie with no breastfeeding difficulty, while others do. There is also a is lack of evidence for long term benefits for frenotomy for tongue-tie with breastfeeding. In fact, the Canadian Pediatric Society (CPS) does not recommend frenotomy for all infants with tongue tie. The CPS recommend frentomy be performed when a clear association between significant tongue-tie and major breastfeeding is identified, and that frenotomy should be performed by a clinician experienced with the procedure.

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.