Tongue and Lip Ties and Their Impact on Breastfeeding Success

Breastfeeding is often described as “natural,” but for many parents, it doesn’t come naturally at all—especially when oral anatomy challenges, like frenulum ties, come into play. Posterior tongue ties and labial frenum (lip ties) can significantly affect a baby’s ability to latch, transfer milk, and feed comfortably. Here, we’ll break down what frenulum ties are, how they impact breastfeeding, and what the research says about identifying and addressing these challenges.

What Are Frenulum Ties?

Frenulum ties occur when the thin bands of tissue (frenulum) under the tongue or inside the upper lip are unusually tight, short, or thick. These ties restrict the baby’s oral movement, leading to challenges with breastfeeding.

• Tongue Tie (Ankyloglossia): This is when the lingual frenulum under the tongue limits tongue mobility. Posterior tongue ties, which are subtler and harder to diagnose, can be particularly tricky.
• Lip Tie: A labial frenum tie involves the upper lip, where the frenulum restricts the lip’s ability to flange outward for an effective seal during feeding.

Both conditions can exist separately or together, compounding breastfeeding difficulties.

How Do Frenulum Ties Impact Breastfeeding?

1. Difficulty Achieving a Deep Latch

A tight frenulum prevents the tongue or lip from moving freely, making it harder for the baby to latch deeply onto the breast. This can lead to shallow latching, which often results in:

• Pain for the parent: Shallow latching places pressure on the nipples, causing soreness, cracking, or even trauma.
• Frequent nursing sessions: Babies with ties often fall off the breast or nurse inefficiently, leading to hunger and frustration.

2. Poor Milk Transfer

For effective breastfeeding, the tongue needs to cup the breast and create a wave-like motion to draw milk. A tied tongue struggles to move this way, resulting in:

• Low milk transfer: Babies may not get enough milk, leading to poor weight gain.
• Reduced milk supply: Inefficient milk removal signals the body to produce less milk over time.

3. Maternal Discomfort

Mothers of babies with frenulum ties frequently report:

• Nipple pain and damage.
• Blocked ducts and mastitis from incomplete milk drainage.
• Emotional stress from struggling to feed effectively.

What Does the Research Say?

1. Posterior Tongue Ties: More Than Meets the Eye

Posterior tongue ties are less obvious than anterior ties but can have profound effects on feeding. A study in Breastfeeding Medicine (2016) found that posterior tongue ties significantly impacted breastfeeding outcomes, including latch quality and milk transfer. Early diagnosis and intervention improved feeding success in the majority of cases.

2. Lip Ties: Controversial but Worth Considering

Lip ties are often debated in medical communities, but research suggests they may exacerbate breastfeeding issues when combined with tongue ties. A study in Clinical Lactation (2014) noted that addressing both tongue and lip ties improved maternal comfort and breastfeeding duration.

3. Frenotomy and Its Benefits

Frenotomy, a minor surgical procedure to release the tie, has been shown to improve breastfeeding outcomes. Research from Pediatrics (2015) demonstrated that parents of infants who underwent frenotomy reported significant improvements in latch, milk transfer, and nipple pain.

Signs of Frenulum Ties in Babies

Look for these red flags that may indicate a frenulum tie:

• For the Baby:
  • Clicking sounds during feeding.
  • Frequent feeds but low weight gain.
  • Gassiness or fussiness after feeding (from swallowing air).
  • A tongue that doesn’t extend past the lower gumline or lift properly.
• For the Parent:
  • Persistent nipple pain, even with proper positioning.
  • Misshapen nipples after feeding.
  • Low milk supply or recurring plugged ducts.

What Can Parents Do?

1. Seek Professional Evaluation

An IBCLC (International Board Certified Lactation Consultant) trained in oral anatomy can assess your baby’s latch, milk transfer, and oral function. They can refer you to a pediatric dentist, ENT, or other specialist if a tie is suspected.

2. Explore Interventions

• Bodywork: Techniques like craniosacral therapy or infant chiropractic care may help release oral tension.
• Frenotomy: If ties are confirmed and causing significant feeding issues, a frenotomy (or frenectomy) can be performed. This quick procedure often improves feeding outcomes.

3. Practice Feeding Techniques

Using alternative feeding tools like nipple shields or practicing laid-back breastfeeding can temporarily help while you seek a longer-term solution.

Advocate for Your Breastfeeding Journey

Frenulum ties are often overlooked but can be a major barrier to breastfeeding success. If you suspect your baby might have a tongue or lip tie, don’t hesitate to seek help. With proper support, interventions, and a little patience, many parents overcome these challenges and go on to enjoy a rewarding breastfeeding experience.

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References

Pransky, S. M., Lago, D., & Hong, P. (2015). Breastfeeding difficulties and oral dysfunction: Assessment and treatment of tongue-tie. Clinical Pediatrics, 54(10), 956-961. doi:10.1177/0009922814553430

O’Shea, J. E., Foster, J. P., O’Donnell, C. P., & Breathnach, D. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011065.pub2

Ballard, J. L., Auer, C. E., & Khoury, J. C. (2002). Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics, 110(5), e63. doi:10.1542/peds.110.5.e63

Goyal, A., Lee, A., & Duggan, M. M. (2014). Breastfeeding and tongue-tie: A review of diagnosis and management. Clinical Lactation, 5(1), 24-29. doi:10.1891/2158-0782.5.1.24

Read More:

• Understanding Tongue-Tie: Effects Into Adulthood
• On-Demand Lactation Support: How It Works and Why It’s a Game-Changer
• The Microbiome of Breast Milk: Building Your Baby’s Gut Health