Frenula are little strings of tissue found in various parts of the mouth, such as underneath the tongue, inside the cheeks, near the back molars and under the top lip. While an embryo is developing in the womb, these strings guide the growth of some mouth structures. Once we are born, the frenula are largely unimportant, although they seem to help in positioning the baby teeth.
The frenulum under the tongue is called the lingual frenum. Tongue-tie is a condition where tongue movement is restricted due to a short lingual frenum. For example, some people have difficulty licking around their lips or raising the tongue tip inside their mouth. This can mean that they have difficulties with eating and pronunciation of certain letters of the alphabet. The medical name for tongue-tie is ankyloglossia.
Estimates vary, but around two per cent of babies may be affected by tongue-tie. Tongue-tie can resolve in early childhood if the frenum ‘loosens’ by itself, allowing the tongue to move freely for eating and speech. However, in some cases, the child may need to have a surgical procedure known as a frenectomy to release the tongue.
(The above information was obtained from the Better Health Channel
Tongue-ties can be either anterior (below picture on the right) or posterior (image on the left).
Both types of tongue-ties can cause breastfeeding issues.
Symptoms for the baby with a tongue-tie can include the following:
- Shallow attachment
- Baby tiring and falling asleep during the feed
- Clicking/sucking sounds
- Lots of wind
- Reflux symptoms
- Milk spillage
- Frequent feeds
- Poor weight gain
- Suck blisters on the lips
Other issues that may occur in the future include:
- Gaps or spaces between the front upper teeth (lip tie)
- Speech problems, lisping, because the tip of the tongue cannot rise high enough to make some sounds clearly, such as t, d, z, s, th, n, and l.
Symptoms for the mother may include:
- Grazed/cracked nipples• Compressed nipples • Incomplete milk transfer by baby resulting in engorgement and/or mastitis • Low milk supply
- Pain with attachment and throughout the feed
What causes tongue/lip-tie?
The cause of tongue-tie isn’t always known. It can run in families or may occur in babies who have other problems that affect the mouth or face, such as cleft palate.
If a tongue tie is impacting breastfeeding often a Frenotomy is recommended to correct the tongue-tie. There are two ways a Frenotomy can be performed either through laser or through cutting the frenulum with a pair of fine scissors. Both methods are usually effective however some professionals prefer one method over the other.
Who should I see for advice?
Lactation Consultant or experienced Midwife
It is important that you seek advice from an experienced lactation consultant or midwife if you suspect your baby has a tongue tie. As some babies are able to breastfeed without any issues even with a tongue tie or the tongue tie may not be the sole cause of your breastfeeding issues. An experienced Lactation Consultant will be able to assess your baby’s tongue tie and advise if a Frenotomy is required. If a Frenotomy is recommended it is often not an instant fix and your baby will likely require some practice to get used to latching after the procedure. Therefore seeing a Lactation Consultant or Midwife for ongoing support and assistance post-procedure is recommended.
Most paediatric dentists will offer laser services. A laser is a quick and simple procedure done without the use of anesthetic. The laser can be costly. Sometimes the Frenulum will grow back after it has been corrected. This is less likely to happen when a laser is used to perform the Frenotomy.
Often babies who have a tongue tie will also have a lip tie. A lip tie does not usually impact breastfeeding however some dentists recommend correcting this also mostly for cosmetic purposes.
A rebate can sometimes be obtained from your private health fund. No Medicare rebate for services provided by a dentist is available In Australia.
Paediatric surgeons will usually prefer to cut the frenulum to correct the tongue-tie. This is usually done in the Surgeon’s rooms and anesthetic is not usually required. As a lip-tie will not usually hinder breastfeeding most paediatric surgeons will not correct the lip tie.
No referral is required to see a Paediatric Surgeon for a Frenotomy however if you gain a referral from your General Practitioner this procedure may be bulk billed.
My aim in writing this blog is to encourage parents to be informed and empowered to check for tongue and upper lip ties and have them assessed and treated early.
Breastfeeding wasn’t easy for me. After birth, my son struggled to attach to feed. Despite doing well with his initial feed after birth my nipples became blistered and bled. When my son would attach, I was in absolute agony throughout the feed. I suspected he had a tongue tie (poor attachment, blistered and deshaped nipples) which resulted to a low milk supply because he couldn’t get a good latch.
The Breastfeeding Centre confirmed a posterior tongue tie (Sometimes the membrane under the tongue cannot be seen, but can be felt, these are commonly called posterior tongue ties). I was advised to express 3 hourly and finger feed him until my breasts healed. The lactation consultant recommended a Frenotomy (clipping the lingual frenulum to treat breastfeeding problems) and I was sent home with a pump. The pump and I became mortal enemies. Oh God how I hated the breast pump. It was so time consuming and unnatural.
However at the same time double pumping was my saving grace in maintaining my milk supply.
When you are pregnant, everyone tells you that nothing can really prepare you for parenthood. What they should also tell you, is that nothing can really prepare you for the sound of an electric breast pump. I felt like pumping has occasionally made me wish away the days until my son turned 1.
I made an appointment with the GP for a referral to get his frenulum cut only to be turned down by the doctor and be told he definitely doesn’t have a tongue-tie. I learnt over the years as a Midwife, not all Pediatric Doctors or GP acknowledge tongue ties & the negative impact it can have on breastfeeding. If this ever happens to you get another opinion. I was extremely upset about the mixed opinions from different health care providers and I went to another GP for a referral who confirmed a posterior tongue tie. Once I went ahead with the procedure my son was able to successfully breastfeed after 2-3 weeks. Snipping a tight frenulum is a simple procedure that takes only a second or two. No anaesthetic is needed. The baby usually breastfeeds straight after.
In the end, all 3 of my children required a Freonotomy. I have now had experience with both laser and scissors incision on all my children and personally found healing was faster with the scissors procedure as laser caused inflammation around the surrounding tissue, thus took longer to heal.
Doctor Liz Whan
Mccourt St Paediatrics Leederville
Bicton and Cockburn Paediatric Dentist
iKids Paediatric Dental Care
North Fremantle 9433 6082
The Smile Club
Mt Hawthorn 94433922
King Edward Memorial Hospital- Tongue Tie
BetterHealth Channel- Tongue Tie