For normal breastfeeding, the lips need to have flexibility and be able to flange, or flip out, like a fish, to create a seal. The tongue needs to extend past the gums, lateralize (move side to side), and must be able to lift from the back of the mouth. The tongue plays the starring role in breastfeeding. If the infant cannot maintain the tongue over the lower gum during sucking, the “phasic bite reflex” (chewing) is triggered. This action will not remove milk from the breast, causing inefficient milk transfer, low milk supply, and nipple trauma. It must pull the breast into the proper position for breastfeeding, then must cup along its length to keep it in place in the mouth and to capture milk and hold it in place at the back of the tongue in preparation for swallowing.
o Shallow latch
o Dimpling cheeks in while sucking
o Clicking/smacking while nursing as baby resets seal with each suck
o Inability to transfer milk
o Inadequate weight gain or weight loss
o Coughing/gagging/inability to handle flow
o Reflux due to inability to handle flow/suck dysfunction leading to GI upset
o Long, frequent feeds due to difficulties in transferring milk
o Sore, painful nipples
o Cracked, bleeding nipples
o Scabbed nipples
o Creased, blanched nipples
o Reduction in milk supply due to improper drainage
o Repeated plugged ducts/mastitis
o Repeated thrush
o Frustration, disappointment and discouragement with breastfeeding
No matter the appearance of the infant’s tongue or lip, we always look at the function of the tongue and the symptoms of the mother and baby. We encourage you to do further *research on your own if you feel that a tongue and/or lip restriction are causing your breastfeeding difficulties.
National Preferred Providers for Frenotomy
*please note: the listed providers are on a national list of “preferred providers”, meaning they have extensive training in the release of tongue and lip ties, as well as a thorough understanding of normal tongue function in breastfeeding vs restricted tongue function as it relates to breastfeeding.
There are local ENT’s and dentists that also provide the procedure. You are encouraged to read and research on your own and decide what is best for you and your family.
Gary Myers, DMD
3200 Old Jennings Road
Middleburg, FL, 32068
Jennifer Hughes, DMD
114 N 40th Avenue
Hattiesburg, MS 39401
Most providers recommend bodywork (chiropractic or craniosacral therapy) before and /or after revision of any oral restrictions. The following provider is trained and skilled in treating infants (as well as children and adults!)
Kaitlin Ross, DC
o Watson Genna, Catherine. “Tongue-Tie and Breastfeeding.” LLLI. N. p., Apr. 2002. Web. 18 Feb. 2015.
o Watson Genna, Catherine. Supporting Sucking Skills in Breastfeeding Infants. Sudbury, MA: Jones and Bartlett, 2013.
o Hazelbaker, Alison K. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus: Aidan & Eva, 2010.
o Wilson-Clay, Barbara, and Hoover, Kay. The Breastfeeding Atlas. Manchaca, TX: LactNews, 2008.
o Kotlow, L.A. “Diagnosing and Understanding the Maxillary Lip-Tie (Superior Labial, the Maxillary Labial Frenum) as It Relates to Breastfeeding.” Journal of Human Lactation. 29.4 (2013):458-64. Kiddsteeth.com. Web. 18 Feb. 2015.
o Wolf LS, Glass RP. Feeding and Swallowing Disorders in Infancy: Assessment and Management. Tucson, AZ; Academic Press, Inc; 1992
o Coryllos, Elizabeth, Watson Genna, Catherine, Salloum, Alexander. “Congenital Tongue-Tie and its Impatce on Breastfeeding.” American Academy of Pediatrics Section on Breastfeeding. Summer, 2004.
o Geddes, Donna, et al. “Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound.”Pediatrics 2008; 122;e188; originally published online June 23, 2008; DOI: 10.1542/peds.2007-2553. Web. 21 May 2013.