by Mary Elizabeth Dallas
February 17, 2011

Moments after my son was born and I held him in my arms for the first time, a nurse in the hospital made the offhand comment, “Oh, he’s got a heart-shaped tongue.” My sister, a physician, confirmed that he did in fact have what is known as a tight frenulum. A what? She explained that the piece of skin that was connecting his tongue to the floor of his mouth was short, restricting the movement of his tongue. I was relieved to learn that not only are tight frenulums common, they are easily corrected with a quick snip.

The pediatrician who later examined my son however, didn’t feel it was medically necessary to perform a frenulectomy (also known as a frenuloplasty)—a procedure in which a small incision is made into the frenulum in order to allow the tongue more room to move. In fact, she went as far as to tell me the procedure was not currently “en vogue” and without a diagnosed problem resulting from the condition, a snip was simply out of the question. The pediatrician was siding with the school of thought that tight-frenulums rarely cause problems. I would soon learn otherwise.

When he was just a few hours old, my son proved that he would be a natural when it came to breastfeeding. Before long however, things changed. As my milk supply increased, nursing became much more difficult and I became distressed. I was annoyed and preoccupied when friends and family came to visit, because I knew my son wasn’t getting enough milk. I was worried. He was dehydrated and losing weight.

At first he just seemed sleepy, but after meeting with a lactation consultant I learned that his short frenulum was preventing him from latching on properly. I also learned that being tongue-tied could lead to other problems, including poor speech. A nurse suggesting we seek treatment also mentioned the social aspects of having a tight frenulum: it could affect his ability to kiss or lick an ice cream cone. Sold.

A note from my lactation consultant was all we needed. An otolaryngologist, or ENT, specialist came to my hospital room in short order and the entire procedure took just minutes. I held my son in my lap. He had no medication, and I saw no blood. Immediately after the procedure, he started to nurse. We were lucky. Since then I have met more than one parent in the process of scheduling their 3-year-old for frenulectomies under general anesthesia.

While my story is merely anecdotal evidence, a July 2011 study published in Pediatrics revealed that tongue tie affects up to 4.8 percent of all infants. Furthermore, the study reported that 50 percent of infants with tight frenulums have trouble breastfeeding. Aside from poor latch, the researchers noted the condition is also often associated with maternal nipple pain.

In conducting the study, researchers followed the infants of 58 new mothers who experienced nipple pain and difficulty breastfeeding over the course of one year. All of the infants had significantly tight frenulums, but only 30 of them had a frenulectomy within the first two weeks of life. The remaining 28 infants did not have the procedure.

The study found that among the mothers with infants who had the frenulectomies there was a “a clear and immediate improvement in reported maternal nipple pain and infant breastfeeding scores.” The researchers added the findings suggest the procedure should be performed when infants with tight frenulums have difficulty latching on, resulting in nipple pain for their mothers.

“We addressed previous methodological concerns and believe our study, in addition to the other studies on this topic, should now provide compelling evidence for pediatricians, otolaryngologists, oral surgeons, and lactation consultants to seek frenotomy when indicated.”

Although the frenulectomies are “rapid, simple, and without complications,” the researchers noted that more studies are needed to determine the best ways to screen for tongue tie and the best time to perform the corrective procedure.

There is additional research showing that many cases of tight frenulums are so severe that they interfere with mobility of the tongue tip, pronunciation of words, and breastfeeding.

During breastfeeding, the tongue extends over the gum line and protects the breast against the bony jaw below. If movement of the tongue is restricted, the baby won’t be able to form a tight seal, create positive pressure, and maintain a proper latch.  Without a proper latch, the baby can’t remove milk from the breast, and breastfeeding will be painful for mom. It’s estimated that tongue-tie occurs in 1 in 250 babies. In the majority of cases, no treatment is required, but sometimes babies benefit from having the frenulum cut.

One study conducted by the department of Pediatrics at Cincinnati Children’s Hospital and published in 2002, found that being tongue-tied is not only common, it represents a significant proportion of breastfeeding problems and premature weaning. The study, which examined 3,036 infants with breastfeeding problems, revealed that poor infant latch and maternal nipple pain are frequently associated with tight frenulums. The research concluded that among tongue-tied infants, frenulectomies are a successful strategy for facilitating breastfeeding.

A separate 2005 study conducted by the University of Minnesota Medical School examined the effects of tight frenulums on breastfeeding among infants both 1 week and 1 month old. The study reveals that tongue-tie is a relatively common condition in newborns. Moreover, infants affected by tongue-tie are significantly more likely to be exclusively bottle-fed by 1 week of age.

A 2008 study published in the World Journal of Pediatrics notes the condition is common and often neglected. The study concludes that frenulectomies can be easily performed as an outpatient procedure. According to the results, between 1980 and 2006, 2,620 infants and 158 children with no family history of bleeding disorders were successfully treated for tight frenulums without anesthesia. Moreover, the procedures typically resulted in minor bleeding, which stopped spontaneously within a couple of minutes.

The study also notes that if the condition is not corrected in infancy, it becomes more difficult to treat. As children grow older, their frenulums become thicker and more vascular. Their teeth may interfere with the procedure, and children may also become fearful. The research concluded that early and aggressive treatment of tight frenulums is highly recommended.

Despite existing evidence and years of vigorous debate, there is still no consensus in the medical community over the diagnosis and treatment of ankyloglossia (the medical term for tongue-tied). Since there are no obvious symptoms, and most babies with short frenulums adapt over time, health care providers are often reluctant to intervene. Their reluctance is complicated by the fact that many moms experience nipple pain, and in most cases, the pain resolves after several days or weeks. This makes it even more difficult for mothers of babies with severe tongue-tie, persistent nipple pain, and slow (or no) weight gain to get the care they need.

If you are concerned that your baby may be tongue-tied (persistent nipple pain despite a good latch) talk with your health care provider or lactation consultant—and be sure to get the care your baby needs.

Mary Elizabeth Dallas is a NY–based journalist with more than 15 years of experience, including CNN and ABC News. She is also relishing her newest challenge… motherhood. Today, she is using her experience to help inform parents on the key challenges and issues they face every day.