Ankyloglossia (tongue tie)


The tongue is key to effective breastfeeding. To suckle effectively, baby must be able to extend his tongue past his lower gum, lift the front of his tongue to the roof of his mouth, lower the back of his tongue, and form a groove with his tongue to collect the milk for easier swallowing.

Restricted tongue movements can prevent baby from breastfeeding effectively.

The frenulum is the string-like membrane that attaches the tongue to the floor of the mouth. A short frenulum, called tongue tie or ankyloglossia, may run in families and happens more often in boys than girls.

…may run in families and happens more often in boys than girls.

Not all tongue-tied babies have trouble breastfeeding. The most problems associated with tongue tie are difficulty taking or staying on the breast, nipple pain and trauma, inadequate milk intake, and continuous feedings. These problems are usually obvious when breastfeeding begins.

Any baby who repeatedly breaks the suction during breastfeeding should be checked for a short frenulum, but if weight gain is good and breastfeeding is comfortable, this is not a problem.

Four distinct types of tongue tie have been identified and are determined by where the frenulum attaches to the tongue and to the floor of the baby’s mouth:

  • Type 1: Frenulum is attached near the tip of the tongue, on or near the gumline.
  • Type 2: Frenulum is attached 2 to 4 mm behind tongue tip, just behind the gumline.
  • Type 3: Frenulum is attached to the middle of the tongue, and in the middle of the floor of baby’s mouth.
  • Type 4: Frenulum is attached behind the mucous membrane of the floor of the mouth, which can make the tongue look short.
Type 1 – tongue tie
Type 2 – tongue tie
Type 3 – often referred to as a posterior tongue tie.
Type 4 – often referred to as a posterior tongue tie.

To help a tongue-tied baby having problems, first try to get a deeper latch in a laid-back feeding position. If the tongue tie causes the tongue to retract or pull down,letting baby take his time going to breast and triggering his feeding behaviours will help him better organise his movements. Shaping the breast and a more asymmetrical latch may also help him get a better grasp.

If feedings are still painful or ineffective, discuss having the frenulum clipped. A frenotomy is simple, can be done in a doctor’s or dentist’s office, involves no stitches, little bleeding, and is usually done without anesthesia. After clipping, improvement can be immediate or within 1-2 weeks.

A nipple shield may help with comfort and feeding effectiveness.

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