SKILLS & STRATEGIES

Checking for Lip and Tongue Ties

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Summary:

Frenulums are bands of tissue between the upper lip and gum, and between the tongue and the bottom of the mouth. If one or both are short or tight, a lip or tongue tie may be present.

A lip tie can restrict an infant’s ability to flange out the upper lip during breastfeeding. A tongue tie can prevent babies from maintaining attachment to the breast and/or effectively removing milk from the breast. Either can lead to sore nipples, poor milk transfer, milk supply problems, and slow baby weight gain.

Some lip ties “break” on their own during infancy, but others can persist. Lip and tongue ties are often found together, and both should be assessed by a medical professional.

What does a lip or tongue tie look like?

• A thick band of tissue attaching the upper lip to the upper gum that disallows the upper lip from flanging outwards. In some cases, the labial frenulum may wrap around the gum to the hard palate.
• A visibly thick band of tissue attaching the tongue to the floor of the mouth. It may attach anywhere from the tip to the middle of the tongue. You may notice a heart-shaped tongue tip as well.

What breastfeeding outcomes may be attributed to a lip or tongue tie?

• Nipple pain lasting the entire duration of the feed, despite efforts to correct latch and position by a lactation consultant (IBCLC).
• The feeling of infant gum chomping on the breast during feeding.
• Possible reduction of milk supply over time due to inefficient milk transfer.
• Slow infant weight gain or excessive weight loss.

Equipment Needed:

• Gloved finger
• Calm baby

Steps:

You can assess your baby’s oral anatomy to investigate the presence of restrictive tissues. If you suspect a lip or tongue tie, consult with a lactation professional for a clinical assessment. Using a gloved finger, the provider will assess the following:

  1. Can the lip flange outwards without restriction?
  2. Can the tongue cup the finger while sucking?
  3. Can the tongue extend at least to the lower gum line?
  4. Can the tongue turn to both sides sufficiently?
  5. Can the tongue elevate sufficiently, maintaining suction of the finger?
  6. Does the tongue follow normal peristaltic wave motion?

Regardless of lip or tongue tie, consult an IBCLC for assistance with nipple pain, excessive infant weight loss, or inadequate infant weight gain.

What is the treatment for a lip or tongue tie?
Your IBCLC will partner with your healthcare provider to create a care plan for you and your baby as a feeding pair. If a lip or tongue tie is present, you may be referred to a specialist for formal evaluation, diagnosis, and possible treatment.

Not every lip or tongue tie requires treatment. It depends on the severity of the restriction, the parent’s pain, and the infant’s weight gain.

If the specialist diagnoses your infant with a restricted upper labial frenulum or ankyloglossia, and you both agree to correct it, a frenectomy can be performed. Your provider will cut or remove the frenulum, thus releasing the upper lip or tongue.

This is relatively painless with very little blood, and is generally an outpatient office procedure. Your baby will be able to return to breastfeeding immediately. Your provider may instruct you to perform stretching exercises for a short period of time to prevent reattachment. Many parents notice significant improvement within one day of the procedure.

Follow Up:

Continue to follow up with a qualified lactation professional until any nipple pain, milk supply issues, and infant weight gain are evaluated and resolved.

Resources:

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