Ankyloglossia and Breastfeeding

The Impact of Ankyloglossia

Ankyloglossia, or tongue tie as it is more commonly referred to, is a structural abnormality where the tongue is literally tied to the floor of the mouth. While this condition has often been portrayed as "nothing to be concerned about" and a situation that "does not affect breastfeeding", evidence is mounting that it has, in fact, a profound effect upon a nursing infant and his mother.

The impact is often serious and as a result, many women are forced to wean their babies from the breast and bottle feed them much sooner than they would like. Since the characteristics of the mother's breasts have an impact (as in milk transfer), it is hard to determine which types of tongue ties inhibit breastfeeding. What has been determined is that it is not the severity of the tongue tie that is the problem as much as it is the function of the tongue that is produced by the combination of tongue tie, mouth and tongue.

The Science of Milk Production

In the process of breastfeeding, milk develops in the breasts of the mother after she has given birth to her baby. However, the milk supply is replenished and increased in response to the vigorous sucking that empties the breast of milk. If the baby is not able to suck properly or correctly, then the milk supply is not renewed sufficiently which often leads to failed milk supply.

How A Baby Breastfeeds

In order to nurse properly, the baby must open his mouth wide enough to allow the tongue to protrude forward, past the ridge of the gum and then take a big mouthful of the breast. By doing so the milk sinuses are massaged by the movement of the baby's tongue and pressure exerted by the clamping of the gums and lips to cause a release of milk through the nipple. The tongue also acts as a sort of cushion, protecting the nipple from being painfully pinched or even damaged by the upper and lower gums. The movement of the tongue strokes the breast and draws the milk out as well as stimulates the nipple to lengthen, pointing down the baby's throat and toward the esophagus. With efficient suckling, a baby can empty a breast in 10 to 15 minutes.

When a Tongue Tied Baby Tries to Nurse

Often a tongue tied baby cannot open his mouth widely enough making it difficult or impossible for him to latch on correctly. Instead, the baby latches to the nipple and ends up chewing the nipple which is not only extremely painful, it is also very damaging to the nipple itself. Cracking, distortion, and bleeding can be followed by infection and mastitis in such situations. Since the baby is unable to protrude the tongue past the gum ridge or lips because of the tightness of the frenum (cord under the tongue), the mother's nipple is not protected from injury as it would be in normal breastfeeding. All of the functions mentioned above, the elongating of the nipple and the milk being directed to the esophagus for swallowing, malfunction. The baby then ends up choking, gagging, aspirating the milk, coughing and vomiting. Also, the milk sinuses are not properly massaged so release is not stimulated.

Indications of Ankyloglossia

There are several indications that a suckling baby is tongue tied. The tongue tied baby may not be able to seal his lips around the breast adequately and milk will dribble from his mouth while nursing. Noisy sucking or snap-back sucking is common as well as the frenum stretches as far as it can forward to compress the nipple only to snap back like an elastic band. Since latching is so difficult for a tongue tied baby, the mother often suffers intense pain when the baby latches onto the nipple and chews on it or slides off it because his tongue doesn't afford him the power of a good latch. This can make a mother dread breastfeeding. All of this pain can affect the amount of milk produced and a baby leaves the mother with a baby who is hungry.

An infant who is unable to nurse because of tongue tie experiences hunger, malnutrition, sleep disturbances, vomiting and reflux, which causes incessant crying and discomfort for the baby. The mother, unsuccessful at breastfeeding has myriad emotions to deal with, from disappointment and sadness to guilt for not being a good mother. Poor weight gain may force the mother to abandon breastfeeding and go to a bottle, where the infant may still have problems.