Tongue-tie has turned into a bit of controversy in the community of those providing lactation services. I see many nursing mothers who have been told their baby has a tongue-tie and want to get my opinion before doing any sort of procedure.  The fact is that the tongue is integral to infant feeding, regardless of what that baby is eating or what your feeding goals are.  So for a breastfeeding baby, if the tongue isn't working or moving the way it should, it could be a barrier to your breastfeeding goals.

Before you can even begin to understand what "tongue-tie" is, you need to understand what a tongue must do in the setting of breastfeeding. Let's delve into the complex interplay between your baby's tongue and the mechanics of breastfeeding and see how it could affect your breastfeeding journey.  

The Complexity of Tongue Movements

A baby's tongue needs to perform various intricate actions to effectively transfer breast milk. It's not merely about extending the tongue, though. There's much more to it than meets the eye. Let's delve into the nuances of what your baby's tongue needs to do to get that breast milk where it needs to be:

1. Extending the Tongue: One of the primary requirements is the ability to extend the tongue. Ideally, the tongue should extend past the baby's lips.  It needs to do this in order to hold onto the nipple and accomplish the rest of its movements.  In addition, the tongue needs to reach over the gum to prevent biting and chomping, ensuring a comfortable and effective latch.

2. Lifting the Tongue: Arguably the most important skill is lifting the tongue. Not only does a baby need to learn how to lift the tongue, but the tongue needs to have the mobility necessary to do this.  If there is a restriction of some sort, it may prevent your baby from lifting the tongue adequately no matter how hard they try.  This restriction could be from a variation of anatomy (an "oral tie" would fall into this category).  But it also could be a functional inability due to strength, tightness of the neck or jaw, or something else that is keeping that tongue from moving up as needed. 

3. Curling the Tongue Around the Nipple: To facilitate a secure latch, your baby's tongue should be able to curl around the nipple. If the tongue remains straight or gets pulled down into an awkward position, it won't fit the nipple as it should, and you may encounter difficulties with infant feeding.

4. The Milk-Pulling Wave: Perhaps the most crucial movement is the wave-like motion your baby's tongue makes to draw breast milk from the breast towards their mouth. Movements that resemble sandpaper or simply moving up and down can be painful and ineffective. It's essential for your baby to create this wave that pulls the milk in the right direction.

Understanding the Full Picture

It's important to note that a baby may have three out of these four movements and still face breastfeeding challenges. Conversely, some babies may do well at the breast even if some of these movements are limited. To help gauge whether your baby's tongue is functioning optimally, consider the following:

• Observe how your baby moves their tongue when they are at rest or when they are crying - does the tongue move up and reach the roof of the mouth, or do you see the tongue stick out past the lips?

• Do you see a band of tissue under the tongue that seems to be pulling the tongue down in the middle?  You may see a little divot in the middle of the tongue, or the tongue may even be pulled into the shape of a heart.  

• Are you having pain when your baby nurses, or is your baby having trouble gaining weight though you believe you are making enough milk?

These things can be clues to potential tongue restriction, but it takes a skilled and experienced lactation provider to evaluate the whole picture and help determine what interventions might help.  The answer is not always a tongue-tie release.

Seeking Help When Needed

If you suspect that your baby is not using their tongue correctly or you encounter breastfeeding difficulties, please don't hesitate to seek professional guidance. An International Board Certified Lactation Consultant or a physician with expertise in Breastfeeding and Lactation Medicine can provide valuable assistance.  Though a tongue tie release is a relatively simple procedure, it is not without risks.  If you are considering tongue-tie treatment, it's important to find someone knowledgeable to help navigate this issue.

I am one such physician in the Chicagoland area, and I'm available to support mothers and babies throughout Illinois.  Remember that it's okay to reach out for help, and there's no need to navigate this journey alone.

wrapping it up: Patience and Support

Breastfeeding is a beautiful and natural way to nourish your baby that offers many health benefits, but it can come with challenges. The intricacies of your baby's tongue movements are important in ensuring a successful breastfeeding journey. Remember that it's perfectly normal for babies to need time to practice and learn, and sometimes these issues work themselves out over time.  But if you think tongue restriction is contributing to barriers to following your feeding plan, reach out today to get the help you need.