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Breastfeeding and tongue-tie: what you need to know

Posted By Linda Dahl, MD
August 2, 2017

It seems like every time you bring up breastfeeding you hear the words “tongue-tie.” Lately, it seems like tongue-tie is shouldering the blame for nearly every breastfeeding frustration. Is there a new epidemic of tethered talkers or is something else going on?

Let’s first define what tongue-tie actually means. According to medical literature, the tongue is tied when the frenulum, or the connective tissue on the undersurface of the tongue, doesn’t dissolve while the baby is developing in the womb. The tongue starts as two structures that fuse together. The extra tissue is supposed to go away after the halves fuse, but when it doesn’t, it can cause a problem. No one knows why this happens to 4–10 percent of the population. We do know the condition is genetic, and you can see it when your baby cries or opens her mouth — the “tie” is that stringy thing that pulls the tip of her tongue back. Because the tongue is a muscle and the tie prevents free movement, it’s best to release it as early as possible so the tongue can develop into a normal shape. It is kind of like being born with your shoelaces tied: you can walk, but anything more than that is difficult.

How does tongue-tie relate to breastfeeding? The answer seems simple, on the surface at least. Babies are born with a special ability to dislocate their jaws and open so wide they can fit around their mama’s breasts. This is called the gape reflex. If they are also born with a tongue-tie, every time they lift their tongue, the jaw comes with it, making that dislocation, or gape, challenging or impossible. Releasing the tie solves the problem immediately, so babies can start nursing the way nature intended.

So what is it called when babies don’t have an obvious tongue-tie, but they still can’t nurse? This is where it gets confusing. Some in the breastfeeding community call this situation a posterior tongue-tie. This is perplexing because you can’t actually see a tongue-tie. I avoid using this term because it causes a tremendous amount of confusion. It frustrates mothers, lactation consultants, and nearly every pediatrician, because there is nothing to “see.” This situation has to do with the relative relationships of the head and neck anatomy, which are complicated to explain but result in the same outcome as tongue-tie: the baby can’t gape.

When babies have difficulty nursing, most of the time you — the breastfeeding mom — can diagnose the problem. If your baby opens his mouth wide, grasps onto the breast, then slides down to the nipple (or doesn’t open wide at all), then his gape is restricted. If a baby can’t gape, the problem can still be corrected, but the treatment is slightly different. Not all “tongue-tie” is actually tongue-tie. The real problem has to do with the gape.

About Linda Dahl, MD

Dr. Dahl is on a mission to educate mothers and health care professionals on her paradigm of breastfeeding. Follow Dahlfull on Facebook to read more or visit her at the Dahlfull Breastfeeding & Lactation Center located in New York City.

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