A tongue tie can be accompanied by a lot of symptoms, difficulties with breastfeeding is one of the most common, and one of the most severe.
A consequence to these difficulties unfortunately often lead to mothers weaning their babies to bottles much earlier than what is healthy and expected.
The length of the frenum or the severity of the tongue tie does not effect the babies ability to breastfeed. Rather Mr Mervyn Griffiths found that “…the thickness, shape and percentage length of the tongue tie were not predictors of success or failure…”. This suggested that the function of the tongue is more important than simply the appearance of the tie.”
Breastmilk is produced in the mothers breast up-to and after birth. The supply of breastmilk is replenished and increased, as a result of the babies sucking and drinking of the breastmilk. If the tongue tie disables the baby from weaning and emptying the breast, breastmilk cannot renew, and breastfeeding will likely fail.
The infant needs to open the mouth widely enough (gaping) to allow the tongue to protrude forward, past the gum ridge. Then it must take a big mouthful of the breast. This ensures that:
- The milk sinuses are massaged by movements of the baby’s tongue and by pressure from the lower alveolar ridge. This causes the release of milk which is ejected through the nipple.
- The tongue protruding over the gum ridge protects the nipple from being damaged by being caught between the upper and lower gums.
- Peristaltic movement of the tongue, (rippling, from the front of the tongue to the back), strokes the breast, draws out and maintains the flow of milk.
- These movements of the tongue also stimulate the nipple to elongate, so that it is pointing down the baby’s throat, and directing milk towards the aesophagus. Most babies can empty a breast in 10 to 15 minutes with efficient sucking.
When there is a surge in the production of milk which flows more strongly for a while, it is called ‘let-down’.
The primary reason that breastfeeding is causing problems, is because of the baby not opening its mouth enough. This results in the baby latching on at an incorrect angle. Instead it may latch upon the nipple and chew it, causing severe pain for the mother, and eventually nipple dammage. The nipple dammage can be in the form of blanching, distortion or bleeding.
Another issue can be that the nipple does not elongate. This risk that the breastmilk is not correctly directed for swallowing. This makes the baby prone to aspiration of breastmilk, coughing, gagging, choking or vomiting. The sinus where milk is stored might also be incorrectly stimulated, which makes production of new breastmilk slow.
The baby may also have difficulties making a good seal around the breast, this is often seen by milk dripping from the mouth while breastfeeding. This can be due to the presence of a maxillary frenum, a tight frenum between the upper lip and upper gum (lip tie).
Noisy or clicking sucking can also be an indication. This is often when the frenum stretches to maximum to compress the nipple, and then snaps back like a rubber band.
Breastfeeding difficulties due to a tongue tie will often lead to babies breastfeeding for a while but eventually falling asleep, only to awaken hungry and wanting to feed even more.
The baby can eventually experience issues such as hunger, malnourishment, swallowing of wind, sleep disturbances, vomiting and crying and the inability to settle.
As such, breastfeeding can be a nightmare when the baby has a tongue tie, for both the mother and the baby. Consulting an IBCLC to diagnose if a tongue tie is present is very much recommended. Further treatment of the tongue tie should be performed.