Tongue-Tie (Ankyloglossia) and Its Treatments

Breastfeeding and Tongue-ties:

Tongue-tie or Ankyloglossia is a condition in which the bottom of the tongue is tethered or attached to the floor of the mouth by a membrane or frenulum. This frenulum can restrict the movement of the tongue and cause problems for a baby and mother by significantly affecting breastfeeding. Tongue-tie limits the range of motion of the tongue and it can lead to problems with speech, swallowing and feeding.

The prevalence of tongue-tie has been reported between 4.2-10.7% of all newborns (ref.1-3) and is reported to be genetic. Chances are if you or your husband had a tongue-tie, one of your babies will too.

This misunderstood condition is commonly overlooked and misdiagnosed. It can lead to a tired and hungry baby that does not gain weight and an unsuccessful mother infant breastfeeding dyad.

Types of Tongue-Ties

Dr. Larry Kotlow is one of the foremost experts on tongue-tie and he created the diagnostic criteria for clinically apparent tongue-tied infants.

Type 1 – Total tip involvement
Type 2 – Midline-area under tongue attached, creating a hump or cupping of tongue when the baby cries
Type 3-  Distal to the midline; the tongue may appear normal
Type 4- Posterior are which may not be palpable or obvious; submucosal frenulum

Type 1 and 2 are considered classical tongue-tie and are usually easily diagnosed.

Type 3 and 4 are often misdiagnosed and can lead to difficulties with feeding, handling food – liquid or solid – and swallowing. These can lead to the most difficulties for a newborn infant with breastfeeding.

How does a tongue tie affect breastfeeding?

The baby needs to open their mouth wide enough to allow the tongue to protrude forward and take in a mouthful of breast. If the tongue is tethered to the floor of the mouth, it cannot extend past the gums and take the full breast in and massage the milk ducts to eject the milk or protect the nipple from being squeezed between the upper and lower gum ridge. The back and forth motion of the tongue along the breast cannot happen and it cannot be emptied properly. This can lead to mastitis and decreased milk supply in the mother.

How to tell if your baby is tongue tied?

Maternal Indicators

  • Pain upon breastfeeding
  • Nipple damage, e.g. bleeding, blanching or distortion of nipple (lipstick shaped) after feeding
  • Mastitis: inflammation of milk duct(s) due to blockage because of improper draining of breast during feeding
  • Severe pain with latching
  • Losing latch mid-feed

Infant Indicators

  • Clicking noise during feeding
  • Chin retraction when mouth closed
  • Slipping off the breast during feeding
  • Dribbling of milk out of the mouth while breastfeeding
  • White coating on tongue; often misdiagnosed as thrush (the tongue cleans itself on the roof of the mouth and when it tied, it cannot brush up on the hard palate and clean itself)
  • Baby falling asleep at the breast and then waking up hungry (tongue-tie can making it physically tiring for the baby to feed)
  • Baby fail to gain weight
  • Self-deprivation because of hunger
  • Pulling on and off the breast during a feed due to frustration
  • Problems with introducing solids
  • Poor bond between baby and mother
  • Termination of breastfeeding

What to do if you think that your infant is tongue-tied.

If you are experiencing any of these symptoms, you should consult with your pediatrician or a lactation consultant to confirm whether or not your child has a tongue tie.

A tongue-tie release, or frenotomy, is a procedure that is simple, safe and effective immediately. Many pediatricians perform them right in their office with topical anesthetic. Some babies do not even cry after the procedure. Often times the baby breastfeeds right away and there is a significant decrease in symptoms. If you are having any of these symptoms or difficulties breastfeeding – but have been told that your baby is not tongue-tied – get a second opinion.

If your baby is not tongue-tied but you are still having difficulties breastfeeding, it is important to make sure that your infant does not have any other bio-mechanical problems causing these difficulties.

Some of these dysfunctions can include:

  • Temporomadibular Joint Dysfunction (TMJ)
  • Torticollis (the inability to turn the head to one side or a persistent preference for the head to be turned to one side – these infants have a “favourite side” when feeding)
  • Cervical or lumbosacral spine dysfunction
  • Undiagnosed clavicular fracture
  • Tight neck extensor/flexor musculature.

A chiropractor with advanced training in pediatrics or a pediatric physiotherapist can help you rule out these possibilities.


  1. Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA. Newborn tongue-tie: Prevalence and effect on breast-feeding. J Am Board Fam Pract 2005;18(1):1-7.
  2. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002;110(5):e63.
  3. Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: Incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000;126(1):36-9.

For an image and more info on tongue tie please click the link for The Mayo Clinic

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Dr. Kristina Bosnar
Dr. Kristina Bosnar is a chiropractor with a special focus on perinatal and pediatric care. Dr. Bosnar believes in an integrated and holistic approach to the perinatal period and pediatric care. Dr. Bosnar is passionate about supporting women physically and emotionally through the wonderful and unexpected challenges that can occur from the prenatal to the postpartum period.
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