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Informations on ankyloglossia (tongue ties)

Herzl-Breastfeeding Clinic, Jewish General Hospital, Montreal, QC, © 2022
Herzl Family Practice Center, Goldfarb Breastfeeding Clinic
Ankyloglossia: what are restrictive frenulums and
why they can have a negative impact on breastfeeding
Definition:
A lingual (tongue) frenulum or ankyloglossia is a membrane that connects the floor of the mouth to the
underside of the tongue. We are all born with this type of tissue, but in some cases the tissue is thick
and/or not very elastic, preventing the tongue from moving well.
An upper lip frenulum is a short and/or thick membrane that connects the inside of the upper lip to the
upper gum line, preventing the upper lip from moving properly.
Restrictive frenulums can cause breastfeeding problems:
The tongue should be able to move freely, including stretching forward to cover the lower gums, rising
and undulating when sucking. In cases where a restrictive frenulum or tongue-tie is present, one may
observe:
 Nipple pain: baby may find it difficult to get a deep latch and compress the nipple on the palate,
causing friction, pinching, deformation, cracks, or wounds.
 Poor latch, difficulty everting the lips, loss of the seal on the breast, difficulty in creating suction
(negative pressure) to extract the milk, aerophagia (swallowing air)
 Increased discomfort in the baby, possible reflux
 Low milk production and/or slow infant weight gain due to poor latch, poor milk transfer and
poor breast stimulation.
Herzl-Breastfeeding Clinic, Jewish General Hospital, Montreal, QC, © 2022
 A high palate caused by poor tongue movement in-utero (during the pregnancy), which
can worsen latch and milk transfer. The movements of the baby’s tongue during
pregnancy help form the hard palate.
 Muscle tensions due to an inability to move the tongue well and compensation with
other facial muscles. This can create muscle tensions and make sucking more tiring for
baby. Thus, baby can fall asleep on the breasts before finishing the feed, or feed more
frequently.
Signs of restrictive frenulums:
These signs may also be related to other problems and are not just caused by restrictive
frenulums. An evaluation by a health professional who is specialized in breastfeeding is
essential.
In the baby:
 Difficulty maintaining a good latch: letting go often, slipping, or pinching with the
gums or lips
 Clicking sound
 Dripping of milk from the sides of the mouth during sucking.
 Difficulty managing the rapid flow of milk: coughing, unlatching
 Difficulty coordinating the suck-swallow-breath cycle
 Falling asleep on the breast before finishing the feed
 Lip blisters
 Frequent feeds without being satisfied afterwards
 Gas or reflux
 Poor weight gain
In the mother:
 Sore nipples
 Nipple wounds
 Nipple vasospasm
Herzl-Breastfeeding Clinic, Jewish General Hospital, Montreal, QC, © 2022
 Recurrent engorgement, mastitis
 Decreased milk production
To make the diagnosis, the healthcare professional specialized in breastfeeding will not only
base their diagnosis on the anatomy, but also on how breastfeeding is going.
Not all restrictive frenulums require immediate intervention or treatment.
A collaborative interprofessional approach is often necessary, including referral for manual
therapy or bodywork.
Fr enotomy:
This is the procedure by which the restrictive tissue under the tongue or upper lip is cut, in order
to restore its full movement.
Research shows that a “frenotomy” (cutting the frenulum) is a safe and effective procedure.
The frenotomy, like all medical procedures, can present certain risks: bleeding at the site of the
cut, infection, injury to the salivary glands and/or tissue reattachment. It is also possible
that this procedure will not solve all breastfeeding problems.
Current pediatric recommendations are to perform a frenotomy only to facilitate breastfeeding
or feeding in babies.
The possible impacts on the older child are not taken into account in the decision-making
process, because they cannot be predicted in a newborn. A procedure is possible at any age by
other health care professionals, if non-breastfeeding related problems appear in the future.
The information in this document for patients is a suggestion only and does not replace consultation with a healthcare
professional or lactation specialist. This document belongs to the authors and the Goldfarb Breastfeeding Clinic. It is
prohibited to change or modify any part of this document without the permission of the authors and the Goldfarb
Breastfeeding Clinic. This material may be copied and distributed without further permission provided it is used only in a
context that does not violate the International Code of Marketing of Breastmilk Substitutes. For more information, contact the
Goldfarb Breastfeeding Clinic, Herzl Family Practice Center, Jewish General Hospital in Montreal, Quebec, Canada. © 2022.

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Thématiques :
Douleur aux mamelons / seins  Positions et mise au sein Production lactée

Mots-clés :
frenulum of tongue tongue tie ankyloglossia cracked nipple nipple pain frenotomy

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