All Blogs
What are tongue ties?

Let me be honest straight away, breastfeeding a baby is not easy. As you can imagine the tongue is a vital player in breastfeeding. The tongue aids in pulling the breast into the proper position in the mouth. It also helps collect milk in preparation for swallowing.

In my pediatric chiropractic practice, I have seen 1000's of babies that have been tongue tied that have had a hard time with breastfeeding, bowel movements and even sleeping. The most important information any new parent needs to know is what exactly are tongue ties? What is happening? I will go through these details as well as how to identify a tongue tie so you can better equip yourself for your breastfeeding journey.

I have seen a huge increase in breastfeeding issues in the last 10 to 15 years in my practice. After almost 25 years working with breastfeeding moms, I've noticed that it's becoming more prevalent to have breastfeeding challenges. It's not surprising that a condition that can compromise tongue position and function can also compromise the ability of a newborn to nurse effectively.

Seeing the increased prevalence of tongue ties in my practice over the last 10 to 15 years led me to research indicating that babies born with methylation defects or with MTHFR genetic variations may be at greater risk for tongue ties. This increase may also be due to folic acid supplementation or the synthetic folic acid supplementation we've seen to prevent neural tube defects. Although this has been very important to help prevent neural tube defects, using synthetic folic acid instead of using methyl folate or natural folate has perhaps contributed to the increase of tongue ties in infants.

What is the tongue tie?

The lingual frenulum is a piece of tissue on the undersurface of the tongue and attached to the floor of the mouth. When there is a piece of tissue that's improperly tethered, it doesn't allow the tongue to extend properly out of the mouth or to lift to the roof of the palate. This then interferes with the function of the tongue. This can sometimes be called symptomatic tongue tie or ankyloglossia. When the function of the tongue is compromised, breastfeeding can be difficult. Oftentimes, mothers come to believe that they are not making enough milk. They've gone to a lactation consultant, and have no problem latching but they are not making enough milk.

This can be farther from the truth if the tongue cannot fully extend! When this occurs, the tongue cannot grasp the nipple and extract milk properly. In turn, the milk supply goes down or never builds.

Why do tongue ties get missed?

The obvious tongue tie is called an anterior tongue tie. This is when a thin piece of tissue from the tip of the tongue is tethered to the bottom of the mouth. This type of tongue tie is the easiest to see and is not missed very often by health care professionals. However, it isn't always caught and I have seen quite a few anterior tongue ties that have been missed. Most often, I will see babies with a tongue tie that's in the back. This is called the posterior tongue tie and it may not be obvious, especially to the inexperienced eye. If a baby's having breastfeeding problems and you don't see tissue in the front, you may instead see a thick tissue in the back.

Class 1 Tongue Tie. This is the classic heart-shaped tongue. The tie inserts into the tip of the tongue.
Class 2 Tongue Tie. Considered to be an anterior tie, this tie inserts just behind the tip of the tongue. We don't see a heart-shaped tongue, but the tie is still clearly seen.
Class 3 Tongue Tie. Classified as a posterior TT, the distinction between this and a class 4 TT is that the class 3 still has a thin membrane present.
Class 4 Tongue Tie. No thin membrane is present, so this type of tie is the most commonly missed. The front and sides elevate, but the mid-tongue cannot.

What kinds of problems are caused by tongue ties?

Oftentimes, people think tongue ties can only hinder breastfeeding however it can impair sucking in general. Babies can have minor to severe difficulty coordinating their sucking, swallowing and breathing. Tongue tie babies can get a lot of gas and hiccups as well. Symptoms of tongue ties can run the gamut but often include nipple pain or damage, poor milk transfer, compromised milk supply, and even inadequate weight gain among some babies. Over time, some children who are tongue tied can present with speech articulation problems, swallowing problems, issues with textures and sensitivities with certain types of food, and even sleep apnea. These symptoms are why it's so important to get your baby assessed by an expert who has been working with tongue ties for a long time. When you take your baby to an experienced tongue tie specialist like myself, we see these signs and symptoms all the time. If you're not getting the answers that you need and you're still having a hard time breastfeeding, it's time to get a second opinion.

How is a tongue tie treated?

A tongue tie is treated with a frenectomy. Basically, it consists of a simple incision to the connective tissue called the lingual frenulum. This is a piece of tissue that's tethered from the tongue to the floor of the mouth. Most practitioners will do this in an office setting. I've had 1000s of babies undergo this simple procedure and do very well and in turn, their breastfeeding improves. A baby should see an experienced manual therapist before and after a tongue tie release to make sure that the jaw and the neck are also loosened and that the muscles are working correctly. This will ensure that tongue tie babies can get a better chance of getting a good latch right from the get go.

If you are having trouble breastfeeding, or your baby's having gas or constipation, it's possible that there is an undiagnosed tongue tie. If this is the case, take your baby to see an experienced practitioner like myself or someone who's worked with hundreds if not thousands of babies to make sure that this diagnosis is not missed. This will save you and your baby a lot of heartache and you can approach breastfeeding with the best technique possible. Unfortunately, if your baby's mouth or tongue is not working the way it should, it will be very hard for you and the baby.

In conclusion, getting the right support and advice is the most important part to a successful and beautiful breastfeeding journey.

April 10, 2024
5 min read
Dr. Katrina Bosnar
Certified Functional Medicine Practitioner & Canadian Licensed Chiropractor