ISSN   0974-3618  (Print)          

            0974-360X (Online)





Breast feeding Difficulties in Tongue-Tie


G.S.V. Nivashini1, Thenmozhi M.S2

11st year BDS, Saveetha Dental College and Hospitals, Chennai, India.

2Head of the Department, Anatomy, Saveetha Dental College and Hospitals, Chennai, India.

*Corresponding Author E-mail:



Aim : To identify the Breast feeding difficulties in tongue tie

Objective: To find out the breast feeding difficulties in tongue tie

Background: The tongue is a muscular hydrostatic on the floors of the mouths of most vertebrates which manipulates food for mastication. Ankyloglossia is a congenital disorder in which the tongue is attached to the floor of the mouth called frenulum. This decreases the mobility of the tongue leading to the open deformity and results in mandibular prognathism. The frenulum fails to move back to the tongue during development or heart shaped tongue. The difficulties in Breast feeding will be the baby can open its mouth fully so it can't latch it in correct position which leads to the aspiration of the milk as the baby can't open widely, it will open till the nipple bleeding from the nipple there will be a noisy suck.

Reason: The reason is to find out the problem in the beginning level and can explore the possible ways of treatment and to gain knowledge about it.


KEY WORDS: Tongue-tie, frenulum, breastfeeding, nipples, ankyloglossia, frenectomy




1The medical terminology of tongue tie is ankyloglossia. It is a congenital and hereditary disorder. It is formed when the lingual frenulum is short or thick and attaches to the tongue to the floor of the mouth1. It may also cause speech problems (I.e) they may find difficulty in pronouncing (s, I, th, d, t) and breast feeding difficulty is a common problem which will be helpful in identifying the problem in an earlier stage. In some children the frenulum may recede on its own in the first year of life.2 In order to extract milk from the breast the baby needs to move his/ her tongue to a full extent to cup nipple then it compresses the roof of the mouth. If the child fails to do it, the tongue may lead to the nipple soreness or damage2. It all depends on the degree of tongue tie.3 It is very difficult if it points on the very tip or top ridge of the gum in the floor of the mouth then at the backside.4





Received on 13.05.2015          Modified on 12.07.2015

Accepted on 18.07.2015        © RJPT All right reserved

Research J. Pharm. and Tech. 8(8): August, 2015; Page 1077-1079

DOI: 10.5958/0974-360X.2015.00186.9


The mouth may be affected with simple trauma, mastitis and plugged ducts. If the mother have a small or medium nipples, the child can manage even though with tongue tie than large or flat nipples4.



Scientists like Galen, Hippocrates and others consider tongue as a health barometer and they also stressed on the prognostic and diagnostic importance of the tongue. In medical examinations tongue assessment will5 have a historical importance. The difference in the colour, texture, and oral mucosa6 of the tongue will be used for the diagnosis of several other problems of the body. : the oral mucosa is compared to the skin of the body and certain diseases like cyanosis will be apparent in the mouth often. That's why the tongue is considered to be the " mirror of physical health".


Development of tongue:

The tongue begins to develop at about 4th week of gestation. Local proliferation of the mesenchyme that gives rise to a number of swellings in the floor of the mouth. First swelling is called the tuberculum impar (a large midline swelling of the of mandibular process) which is flanked by two other bulges called lingual swellings. They rapidly enlarge and merge with each other and tuberculum impar to form a large mass from which the mucous membrane of anterior 2/3 rd of tongue so formed. The root of the tongue arises from the hypobranchial eminence (a large midline swelling developed from the mesenchyme of the third arch). It serves as a primordium of the epiglottis7. This will give rise to mucous covering of the root or the posterior 1/3rd of the tongue. The tongue separates from the floor of the tongue by a down growth of the ectoderm around its periphery which subsequently degenerates to form the lingual sulcus and gives the tongue mobility. The muscles of the tongue have different origin. They arise from the occipital Somites, they carry with them their nerve supply the 12 th cranial -the hypoglossal nerve. The mucosa of the anterior two- third of the tongue form the first arch and supplied by the fifth cranial nerve and posterior one third from the third arch and supplied by the ninth cranial nerve.8


Anomaly- tongue- tie:

9Tongue -tie is know as ankyloglossia which is a congenital disorder the May arrest the mobility of the tongue. It is caused by the short and thick lingual frenulum which connects the tongue from the floor of the mouth. Ankyloglossia can affect feeding, speech like letters like (s, I, th, d, t) and pronunciations that needs tip of the tongue movement9.


Normal breastfeedingmethods:

Breast feeding is natural but it won't be efficient for all the mothers it is a acquired skill. There are four simple steps for efficient feeding a10 normal child.



Take a simple and relaxed position while breastfeeding and for comfort you can use pillow and position it whichever side you want. Hold the aerola with your thumb and other fingers.



Position your baby in such a way that his/ her head should be placed in your elbow and back in your palm then tilt your head backwards so that the baby can touch your nipple to his /her mouth wider. Bring your baby close to you so that his/ her belly should touch yours.



Help the baby to scoop your nipple by placing baby's lower jaw below your nipple.



Tilt his/ her head forward and help to place the upper jaw and see to that at least 11/2 inches of the areola should be inside his / her mouth.

Normal movement of the tongue in normal babies:11 As soon as you position your baby the tongue will go to the lowermost position and draws milk from the nipple and the it rises to the roof of the mouth and swallows the milk.12 The principle behind it is when the tongue is in the lowermost position the intra oral vacuum will be increased and milk ejection starts intern rises the tongue and vacuum will be decreased and milk ejection will be ceased.12


Movement of tongue in tongue tied babies:

Here the babies cannot move their tongue so as to compensate that baby will use his /her jaws to increase the pressure excreted on the13 nipple will be beveled. The other most common compensation is that they use their lips to draw milk from the breast. In normal the lips will act act as a seal around the breast and14 so they have to use the lip for both the purpose so baby may fall of during feeding. This leads baby to a fatigue stage, if there is extreme compression it will lead to jaw tremors and interrupts feeding.15


Difficulties of mother in breast feeding tongue tied babies:16

When the baby uses jaw to draw the milk, the nipple will be beveled or damages with the compression in the nipple, this may lead to a blister or burst or a crack in the nipple. 17 The mother will experience maximum pain when there is large tissue damage and vice versa. There will be excessive compression which will be felt more prominent with shallow latch. When a baby has a shallow latch baby's tongue will become less stable. This will lead to extreme pain. The pain will slow down the milk ejection reflex and so the pressure exerted by the baby will still increase and will get milk.18 When the milk flows, the pressure will be reduces and lubricates the nipple and will reduce pain temporarily



Treatment for tongue tie will be prescribed only when the symptoms are seen. If the child is less than twelve months of age surgery can be done with local anaesthesia in physician's office, as the baby will be fully cooperative. If the child is about 1-12 years old general anesthesia will be given19.  Usually surgery will be  done  with clamp and scissor technique and now -a- days they are using laser as well. In some clinics, they are using 1064nm diode laser. This procedure will hardly take a few minutes.20



1.       Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance R F Power, J F Murphy

2.       International Journal of Pediatric Otorhinolaryngology May 2013, Vol.77(5):762–765, doi:10.1016/j.ijporl.2013.02.005 Benefits of frenulotomy in infants with ankyloglossia Neeraj Sethi, Dominique Smith Sahr Kortequee Victoria M.M. WardSusan Clarke

3.       Newborn Tongue-tie and Breast-Feeding Alison K. Hazelbaker, MA, IBCLC

4.       Early Human Development November 2014, Vol.90(11):765–768, doi:10.1016/j.earlhumdev.2014.08.021 Special Issue: Neonatal Update 2014 Tongue tie: The evidence for frenotomy Alastair Brookes Douglas M. Bowley

5.       Treating Tongue-Tie: Assessing the Relationship Between Frenotomy and Breastfeeding Symptoms Author: Ochi, James W. Source: Clinical Lactation, Volume 5, Number 1, 2014, pp. 20-27(8) Publisher: Springer Publishing Company

6.       Review Article You have full text access to this content Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia? Yasuo Ito Article first published online: 24 SEP 2014

7.       Arch Dis Child 2011;96:A62-A63 doi:10.1136/adc.2011.212563.144 British Society of Paediatric Dermatology / British Paediatric Allergy Immunology and Infection Group A systematic review of frenotomy for ankyloglossia (tongue tie) in breast fed infants A H Constantine, C Williams, A G Sutcliffe

8.       Tencates : oral histology : development, structure and function

9.       VOL 19 NO 1 2011 Breastfeeding Review Tongue-tie and breastfeeding: a review of the literature Janet Edmunds RN RM BHSc(Nrg) IBCLC Sandra Miles RN RM BN MN Paul Fulbrook RN PhD MSc BSc(Hons) Revseieawrch

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11.     Fernando, C.: Tongue-Tie, Letter to the Editor, M.J.A. Vol 155, Nov. 18, 724, 1991

12.     Tongue movement and intra oral vacuum in breast feeding infants Donna T. Geedos, Jacqueline C.kent, Leon R. Mitoculad, Peter E. Hartmann.

13.     Fleiss, P.M. et al: Anklyglossia: a Cause of Breastfeeding Problems? Journal of Human Lactation 6:128-129, 19

14.     Marmet, C., Shell E., Marmet R.: Neonatal Frenotomy May be Necessary to Correct Breastfeeding Problems Journal of Human Lactation 6:117-121. 1990

15.     Marmet, C., Shell, E., Training Neonates to Suck Correctly American Journal of Maternal Child Nursing, Vol. 9, #6, 401-407, Nov/Dec 1984

16.     Simpson, E.T., The Management of Tongue-Tie in Infants and Children Modern Medicine of Australia, 50-53, April 1993

17.     Woolridge, M.W., The Anatomy of Infant Sucking Midwifery, 2, 164-171, 1986

18.     Tongue tie: The evidence for frenotomy 2014 Early Human Development Brookes A., Bowley D.M.

19.     Acute feed refusal followed by Staphylococcus aureus wound infection after tongue-tie release 2014Journal of Paediatrics and Child Health Reid N., Rajput N.

20.     Surgical treatment of ankyloglossia 2015Operative Techniques in Otolaryngology - Head and Neck Surgery Baker A.R., Carr M.M.