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Breastfeeding: How to seek help for tongue-tie in Singapore

Learning to breastfeed your newborn baby can be one of the most uplifting and bonding experiences of being a new mum. Conversely, it can be one of the most stressful. One reason put forward for why some babies have difficulty feeding is “tongue-tie”. We asked Mother & Child lactation consultant Jani Combrink all about it.

Some say tongue-tie affects up to 11 percent of babies 

What is tongue-tie in babies, and why do some babies get it?
The tongue of an infant plays an important role in breastfeeding. When a baby is born with a tongue-tie (medical term: ankyloglossia), the frenulum (the membrane that attaches the tongue to the floor of the mouth) is abnormally short, tight or thick. This can impede the movement and function of the tongue, especially when attempting to breastfeed.

Some studies say 11 percent of babies are born with ankyloglossia; others put the figure at between two and to five percent. It’s a congenital condition – something you’re born with. In most cases, one or more family members have a similar condition.

How can you tell whether your baby has a tongue-tie?
If a baby cannot extend the tongue beyond the lower gum ridge, or it has a heart-shaped tip, it may be a tongue-tie. If a mother has sore nipples, supply issues, problems getting her baby to latch after the first week (despite receiving help), or if the baby isn’t gaining weight well or feeds continuously, has reflux, colic, spends a lot of time crying at the breast, or clicks when swallowing while breastfeeding, it may be worth asking your lactation consultant to check for a tongue-tie. 

Unfortunately, not all tongue-ties are obvious, and some cannot be seen without doing a full oral examination. This is not painful for the baby, and doesn’t last long. It’s done with a gloved finger, to assess the anatomy, appearance, functionality and movement of the tongue. There are several grades of tongue-tie, and some do not require surgical treatment – other measures can be used to help keep the frenulum elastic and functioning properly. 

How can it affect breastfeeding, and are there any other issues that can arise?
Tongue-tie may prevent the baby from taking enough breast tissue into its mouth to form a teat, which can cause painful, cracked or bleeding nipples, too-frequent feeding and poor infant weight gain; some babies develop reflux and or colic, and are generally unsettled. If unresolved, it can lead to early cessation of breastfeeding, exclusive pumping or formula use. Later on, a tongue-tie can lead to speech impediments, restricted tongue function and even food intolerance, though this connection isn’t well understood as yet.

How can you address tongue-tie without surgical intervention?
Many babies with tongue-tie will breastfeed successfully with little or no intervention. Those who do experience problems, however, will firstly need to be assessed by a qualified lactation consultant (IBCLC) with experience in identifying tongue-ties. We always start with a conservative approach: certain breastfeeding positions can help mobilise the tongue, and suck-training exercises can be useful in improving tongue mobility and function. It may also help to visit an osteopath or chiropractor who is experienced with babies and tongue-tie.

Mother & Child lactation consultant Jani Combrink 

When should the surgical route be considered?
When it’s impossible to mobilise the tongue using the techniques described above, and breastfeeding is still affected. Bear in mind, too, that related symptoms, such as reflux, may not be relieved by medications alone. It may be that the tongue-tie is so severe that no other option is viable, as the long-term effects, especially related to speech, outweigh the risk and trauma of a minor surgical procedure.

Before making a decision, discuss it with your partner, your lactation consultant and your doctor or paediatrician. Sometimes, the anticipation of medical intervention is worse than the actual procedure. It is as important to find someone experienced with tongue-tie revisions, and who has extensive knowledge on the subject.  There is a fantastic international support group on Facebook, run by experts on the subject, that can provide a wealth of information and support, including the all-important aftercare.

The surgical procedure
The frenotomy can be done with or without anaesthesia, in a doctor’s office or hospital. The procedure involves the doctor snipping the frenulum free; it’s quick, and discomfort is minimal as there are few nerve endings in the area. Bleeding should also be minimal, and babies can usually breastfeed immediately after the procedure.