The surprising reason breast-feeding might hurt

Breast-feeding is no easy feat but for some moms, it can be downright miserable.

The culprit? Tongue-tie, an often overlooked condition that affects breast milk supply and baby’s weight gain, and can make breast-feeding not only difficult, but painful.

Here, find out what tongue-tie is, the signs you should look for and what you can do to make sure you and your baby are healthy for a lifetime.

What is tongue-tie?
Ankyloglossia, or tongue-tie, is a condition that restricts the movement of the tongue. We all are born with a frenulum, the membrane that attaches the underside of the tongue to the floor of the mouth. In some babies, the frenulum is too tight or too short.

“If that piece of membrane is placed on an unusual spot on the infant’s tongue, it may restrict the movement of the tongue,” said Irene Zoppi, an internationally board-certified lactation consultant and clinical education specialist for Medela.

Studies show that tongue-tie affects up to 10 percent of babies and it can also be hereditary.

There are two types of tongue-tie and varying degrees of severity.  An anterior tongue-tie is very easy to see and is characterized by a frenulum that’s attached to the front of the tongue. For some babies, they may not be able to stick the tip of their tongue beyond the lower lip. Or when they cry the tongue will look heart-shaped because it’s so restricted.

A posterior tongue-tie happens when the frenulum is attached just to the base of tongue. It’s less obvious, but a practitioner can pick it up by looking closely at the movement of the tongue.

Low milk supply and pain

“When a baby’s having trouble nursing, it’s not unusual that a common reason is anatomical,” said Dr. Julie L. Wei, a pediatric otolaryngologist at Nemours Children’s Hospital in Orlando, Fla.

This is because the way a baby’s tongue moves when he breast-feeds is much different than when he drinks from a bottle.

“It’s the tongue that does most of the work holding onto the nipple and the breast,” Zoppi said.

If the baby cannot latch or maintain the latch, he won’t be able to suck effectively and drain the breasts of milk. He may also gag or pull off the breasts frequently.

He may even try to compensate by sucking very fast but still won’t be able to get enough milk.

As a result, mom’s milk supply can suffer and the baby won’t gain enough weight.

What’s more, it can be very painful for mom each time the baby latches on.

“Instead of grasping the breast and the nipple, the baby could be using a chewing-like motion,” Zoppi said.

As a result, moms may feel discouraged and throw in the towel.

Speech delays and oral hygiene
Left untreated, tongue-tie can also cause speech delays as children get older. Wei sees a handful of children each week who have speech delays, namely problems with articulation and pronunciation. The reason is usually a tongue-tie that went undiagnosed.

“It can be overlooked,” she said.

Even if children receive speech therapy, they won’t reap the most benefit until their frenulum is released.

Tongue-tie can also impact oral hygiene because it can be difficult to clean food from the mouth.

Treatment options
Since research shows that not all babies who are diagnosed with tongue-tie will have problems breast-feeding, it’s important to look at what’s going on with both baby and  mom at the same time, Zoppi said. Of those babies who are identified with tongue-tie, about half will require treatment.

For babies under 3-months-old, the treatment is an in-office procedure that is quick and has minimal risk. Using a pair of scissors and a topical anesthetic, the frenulum is clipped. There is usually minimal bleeding and the baby can breast-feed immediately. For some babies with a posterior tongue-tie, the procedure may have to be repeated.

A pediatrician or pediatric ear, nose and throat doctor usually performs the procedure, although in some parts of the U.S., dentists do as well. Some physicians may use laser which may work better for thicker membranes.

According to a study in the journal Archives of Disease in Childhood, 89 percent of women whose babies had their frenulum released showed improved breast-feeding including a better latch and less nipple pain.

After 3-months-old, physicians may recommend the procedure be done under general anesthesia which is also quick, has minimal risk, and doesn’t require an IV or a breathing tube.

What you should know
Many hospitals in the U.S. are screening for tongue-tie right in the delivery room. Nevertheless, experts agree, “there’s still controversy existing among practitioners about the need for doing this,” Zoppi said. For example, since a posterior tongue-tie is not as obvious as an anterior, some physicians may disregard it.

If you’re having problems breast-feeding or are concerned about your baby’s weight gain, it’s a good idea to speak with his pediatrician, your OB/GYN or midwife, or a lactation consultant.

“If that’s all it is, it’s a simple, quick fix that can make a world of difference,” Wei said.