Tongue Tie: To Clip or Not to Clip? |
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Tongue Tie: To Clip or Not to Clip?

liz September 23, 2013

Has your baby had difficulty latching, making breastfeeding incredibly difficult if not impossible? Are your nipples sore and cracked no matter how much coconut oil or nipple cream you slather on them? Is your little one not gaining weight, or even losing? Have you checked his tongue?

I recently had a conversation with a mom about the hard time she had breastfeeding her now teenage daughter. Her newborn baby’s improper latch gave her horrible nipple soreness that never really went away until she weaned. She tried and tried to correct her daughter’s latch, but eventually just gave up and learned to deal with it. What a trooper!

I encouraged her to look at her daughter’s frenulum, and lo and behold, she had a minor case of tongue tie present…16 years after the fact! But wouldn’t it have been better if someone would have recognized that early on so this mama didn’t have to go through all that?

Image by creative commons

What Is Tongue Tie?

Tongue tie, or ankyloglossia, is a relatively common yet often missed birth defect. It occurs when the frenulum (that skinny piece of tissue under your tongue) is too short and connects too close to the tip of the tongue. This makes it really hard for your baby to move his tongue in a way to create a proper latch on to your breast, but he can usually still be fed by a bottle.

While the feeding issue can theoretically be worked around (although breast is still best), tongue tie can also cause other problems later in life. Many tongue-tied children have speech impediments, and some toddlers and preschoolers experiencing discomfort from tongue tie resort to biting peers as a coping mechanism. That certainly isn’t something we want!

tongue tie

What Can I Do About It?

Fortunately, there is a relatively easy cure for a tongue tie. This procedure, called a frenotomy, involves a doctor, dentist or midwife clipping the frenulum to give your baby’s tongue free range of motion.

I’ll admit, when I first heard of this procedure I was a little wigged out, too. But truly, a baby’s frenulum has very few nerve endings, so it’s best to take care of the problem as soon as possible. Here are some benefits to getting the frenotomy performed as soon as tongue tie is detected:

  • Baby will immediately be able to latch properly and nurse normally (in fact, nursing right after the procedure will give him all the comfort he needs).
  • The earlier the procedure is done, the less painful and traumatic it will be.
  • You won’t have to risk biting or speech problems due to his tongue tie later on.
  • Your poor nipples will almost immediately go back to normal with just a little bit of coconut oil to heal them!

Of course, this procedure isn’t right for everyone. Some cases of tongue tie will not cause enough problems for you to deem the clip worthwhile. While there isn’t always a surefire way of knowing this, whoever diagnosed your baby’s tongue tie (your pediatrician, family doctor, dentist, OB or midwife) may be able to tell you whether he or she thinks your baby will grow out of it. (Yes, that can happen!) And if your baby is gaining weight adequately and your nipple discomfort is absent or enough to put up with, or if you would rather bottle feed until determining whether or not your child will need the snip, you may decide to forgo the procedure all together.

The moral of the story? Kind of like what it is with everything. It’s all up to you!

Editor’s note: We recently had our daughter’s lip tie revised. I highly recommend seeing a IBCLC (Internationally Board Certified Lactation Consultant) if you suspect that a tongue or lip tie is a problem for your baby. Also, research the different methods of revision. We chose to see a pediatric dentist who used a water laser to revise our daughter’s tie. I personally would not choose to have a tongue or lip tie revised using the scissor method, but that is a choice that you have to make depending on what is right for your family. 

Have you ever had a baby with tongue tie? What did you decide to do?


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liz
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  1. Thanks for this article. It is a conundrum–the breastfeeding latch is important, as are later speech, etc.

    I would hesitate to say that the earlier it is done the less painful and traumatic it will be, though. Until about 15 years ago, it was commonly thought that babies don’t really feel any pain, and thus why circumcision is best done as a newborn. Now we know that is not true. Not only are they actually *hyper*sensitive to pain as very new babies, but the body remembers everything it experiences–explicit (conscious) memory and implicit (stored in the body in emotions and sensations) are not the same. Not being about to remember a procedure consciously actually makes it more likely to be traumatic.

    My father had tongue-tie as a baby, which was clipped when he was a few days old. As a small child, he was mortally terrified of the dentist. My grandma never understood why he screamed bloody murder whenever anyone tried to go in his mouth. The local dentist actually refused to see him after awhile because he would pass out from fear when he was in the chair even in grade school. After studying trauma in grad school, I would bet money it was related to that experience with having his tongue cut as an infant; that the body remembered even if his mind couldn’t, and the association with pain, fear, and helplessness.

    I’ve also had a friend with a tongue tie baby who was diagnosed and clipped at about 3 days old, but the first 3 days of damage to her nipples didn’t heal till the baby was weaned, because she wouldn’t take a bottle. Every nursing session was painful for her!

    Medical infant “papooses” like in the photo are best avoided–if the child is not calm enough to have a procedure done unrestrained, he/she is likely too worked up to avoid experiencing the procedure as anything but traumatic.

    I wonder if there are any alternative ways to treat this, like gentle stretching or application of ointment to soften the problematic skin string? Thanks for your sensible approach to this dilemma, and granting parents the place of making the best choice in their own judgement.

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  2. I agree with you completely. And as a mom with three kids with tongue ties, and two with severe lip ties as well, I know that it is very unlikely that any clipping needs to take place to ensure a good breastfeeding experience. Sometimes all a mother needs is a little bit of help.
    I had my twins at 30 weeks, and they spent over 2 months in the NICU in a city almost an hour away from my own. I saw them daily, but only enough to try to put them to breast once a day. We failed miserably. I continued to pump and bottle feed them.
    When I brought them home I got my son to BF on my own (with no prior experience!), and he ended up breastfeeding until 22 months. With a severe tongue tie.
    I never managed to BF my daughter. I couldn’t figure out what the problem was. It wasn’t until they were three that I realized my daughter not only had a tongue tie like her brother, she had a lip tie that goes to the bottom of her hard palate. I had not even known that lip ties existed. I felt like I failed her.
    When we had our third child 2.5 years after the twins were born, I had problems nursing her. I couldn’t figure out why. I was an expert, and I had only not been breastfeeding for such a short time. Certainly I could not have forgotten how…right?! My nipples will forever bear the scars of that first week.
    Like her sister, my youngest has a lip tie as well as a tongue tie. This time I was armed with enough knowledge to know such a thing exists, and simply flipped her top lip up when she “latched”, and it created the seal needed to breastfeed successfully. She only just weaned at 33 months old.
    I never had an issue whatsoever with tongue ties. To me, that was normal.
    My twins are now five, and the little one is almost three. All speak clearly, and have beautiful teeth. The ties stretched, as our Dr. assured us they would, and I am thankful that I didn’t put my babies through that trauma for something that would have changed nothing.

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  3. An osteopath can sometimes help with tongue-tie. My first son had to have his clipped, it was a pretty bad one. As a result of this my nipples cracked really bad and breastfeeding was very very painful. Immediately after the procedure there was relief. I continued to breastfeed until he stopped on his own after his 1st birthday. My second son was born in July, they told me he had a minor tongue-tie. Had an appointment with the Pediatrician when he was 3 months old. Was worried about his age if he had to have the surgery done. Luckily the Dr said it looked fine. This is after taking him to an osteopath (for a different reason ). He had told me they could help with this as well. I never had trouble breastfeeding him, but I could see he was tongue tied when he cried. Both my mom and I noticed it looked better after he had seen the osteopath. Worth a try:-)

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  4. My son’s tongue tie was found when the lactation consultant couldn’t figure out why nursing was so painful even though the latch “looked” good. He was still in the hospital when they clipped it, and it saved our nursing relationship. I don’t think I would have been able to nurse through the pain, and I don’t think he would have been able to get enough. His tie was so tight, his tongue couldn’t clear the teeth at all, or really even lift up from the floor of his mouth.

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  5. There are a few points that I wanted to address from your comment, just to clear up what I feel are misunderstandings from the experiences of those that you have known.

    Nipple cracks and trauma should ALWAYS heal! The only reason that they would not, would be because baby still did not have a good latch. A baby does not have to take a bottle for your nipples to heal, and I can tell you that from several of my own experiences (among hundreds of others that I have known with cracked nipples that continued to nurse). They will heal quicker if baby isn’t nursing (though I do not recommend that) but they will still slowly heal while baby continues to nurse.

    With my oldest daughter, her tongue tie revision was done at 3 days old. I did continue to have pain and severely cracked nipples for many weeks. Around 3-4 weeks old, I decided to revisit my lactation consultant, who evaluated her and decided that she was not sucking effectively, despite having her tongue tie revised. We went on to see an occupational therapist who gave us exercises to strengthen her tongue muscles the correct way, and within just a week, my cracks began to finally heal and we were nursing pain free only 2 weeks after we began the therapy. The doctors that did our revision assumed that the procedure itself was enough to fix our nursing issues, but that was not the case with my severely tongue tied baby. I have now met many other moms with similar experiences, so I think it should be noted that the frenotomy may not always be the quick fix, there may be other things that need to be done (stretches and exercises) to help baby regain a proper latch and be able to suck effectively for breastfeeding.

    I have had 2 tongue tied and one child who also had a lip tie, all of which were revised, and neither one is afraid of the dentist (my oldest is actually the opposite, she loves the dentist!) I can’t say that it’s impossible, but it certainly isn’t the case with all children.

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  6. My Mom didn’t speak until 4 or 5. They clipped her tongue & she never quit! I grew up being told that was nonsense, but it worked for her. Just as I was told growing pains didn’t exist until our son spent night after night soaking in the tub to ease his leg pains . Medicine is like all other knowledge. It seems to roll in waves.

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  7. My son was really badly tongue tied at birth and the doc offered to “clip” him the next day. I was completely i unaware just what it entailed. He used sharp scissors to cut two frenulums on either side of my son’s tongue. He jerked and cried loudly with each clip….and each time he tried to nurse for the next few days he would suckle and cry out in pain and stop. He lost a pound and a half that first. Babies are HYPER sensitive to pain and can’t understand what is being done to their body. I would not do that again to another child of mine and would try and tough it out instead.

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  8. I find it hard to believe that the mother of the 16 year old did not know about her daughter’s tongue having a heavy frenum. Did she never take her daughter to a dentist? Or did the mom just not pay attention to the dentist at appointment time? A good dentist would have diagnosed it early and had it taken care of. Also, it does not always have to be treated until later. Not all cases are the same. The day my son was born I noticed his frenum was tied. He fed fine. I didn’t want to clip it if it didn’t need to be done. I waited until he was four to have him looked at by an oral surgeon. He was borderline to needing it done. He did have a slight speech impediment but nothing severe. Again, I know every case is different but there is no harm in waiting to see how things develop. I chose to have the frenum clipped once it was diagnosed that my son needed another procedure done. So while he was out for that the frenum was clipped.

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  9. my son was born tongue tied.. our ped said not to worry unless he develops a speech problem. he is now six..he has no speech problems. I breastfed him for 10 1/2 months.. I did supplement w formula but just because my supply wasnt high and he was my 1st child, so I didnt know much on building milk supply. I think it all comes down to educating yourself before making a decision like surgery..

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  10. My two sons have both had tongue ties my youngest was a 100% tongue tie I had them both clipped when they were a few weeks old, they cried a little but the doctor put them straight on me to breastfeed as soon as it was done. my only wish was that they could have been sorted in the hospital the day they were born. it has been one of the most painful experiences to try and breastfeed them whereas after they were done it was like someone had flipped a switch and it didn’t hurt. I was less concerned about having it done I guess because myself and two sisters have all had tongue ties and my father had a tongue tie which had to be cut at three years old because he actually couldn’t talk (it wasn’t a speech impediment he couldn’t move his tongue to talk). it was far more damaging for him to have it done at three than it has been for my boy’s at a few weeks. one word of warning is that my eldest sister struggled so badly and was very distraught with not only the tie but colic as well that one day she was crying and ripped her tongue tie apart, that is a far scarier and damaging experience for my mother as well as my sister. On a lighter note though the doctor I saw to have my children done gave me lots of advice but she said she likes sort tongue ties out because she believes ever child should be able to lick an ice cream!

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  11. I have had 6 children and all of them have been tongue-tied. I didn’t have any of them clipped and we have had no lasting problems. I breastfed all of them for 12+ months each. None have had a speech problem besides the normal age appropriate impediments. I recommend waiting before clipping your baby’s tongue.

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  12. Every baby is different and not all are hyper sensitive to pain. I chose to have my daughters tongue tie snipped at around 2.5 weeks old because my nipples were cracked/bleeding and I would cry as I breasted her. After the procedure, I latched her on on and it was magic. She was calm and nursing away! But it did take about 4-5 days for her to nurse properly and she would stop in between and cry a little when she got frustrated. You need to remember that the baby is fine tuning their nursing. And with tongue tie snips, they’re learning to have control over their tongue because they now have more movement. I think every case is different. I know I couldn’t have continued the way it was with my daughter and I’m so glad I got the tie snipped.

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  13. I had no idea what a tongue or lip tie was when I had my first son almost 5yrs ago. We had an extremely hard time with breastfeeding. I thought it was my fault and suffered through the bleeding nipples (luckily only lasted about 8 weeks before they toughened up), excruciating nursing sessions, and watched my poor little guy struggle with horrible colic. He’s a happy healthy kiddo that I breastfed for a little over 2yrs but I wish I had known what I know now! I destinctly remember he had a heart shaped tongue…now I find that’s one of the give aways. My youngest (now almost 6 weeks) was diagnosed by the pediatrician on his first post-delivery visit. I had no clue because he latched right away and we haven’t had any problems except for a bit of gas. If I were to get the procedure done (pedi said if he’s eating fine to leave it alone unless he develops speech problems later.) I would only be able to allow it if there were some type of anesthesia or numbing of some sort used. I couldn’t bear the thought of putting my little guy through any kind of pain no matter how fast the procedure is.

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  14. So my 21 month old is having her lip and possible tongue revised in a couple of weeks with NO anesthesia because I don’t want her to have the drugs in her system. However she is always screaming and crying and flailing around every day when I try to brush her teeth. She is the same way at ANY doctors office. However Dr. Kotlow seems to think they can do it because they will swaddle her and have staff steady her head. I’m so scared for her and mostly worried about the recovery and pain and what not especially during the stretches especially since she won’t let me even brush her teeth. I don’t do tylonal or medication because I am quite opposed to those not natural methods unless it’s life or death kind of thing. Any suggestions for pain relief for her? I’m so worried!

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  15. Our baby was always upset during feedings, not gaining enough weight, and hurting my wife tremendously. He was nursing on her by biting her nipple with his gums. A lactation consultant recommended we have his tongue tie taken care of. The baby didn’t react at all when the pediatric dentist cut the tie, and the procedure took literally 10 seconds. Since then, he’s been nursing perfectly, as he is supposed to. He gets more milk, is more full, is happier, and my wife gets more sleep. Of course, don’t do it if you and your baby are doing fine without it. I don’t believe in unnecessary surgery. But the idea that this is definitely going to cause the baby unbearable trauma is just obviously false. It depends on your situation and your baby. For our baby it was absolutely the right decision.

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  16. I had one daughter that was tongue tied. None of the doctors here would even attempt a clipping and told me to just give up breastfeeding. Well, I was not going to give it up because I was a well experienced breastfeeding mom. I found a Lay -midwife who agreed to do it for me. Problem solved!

    Now 14 years later I am still happy I did that. A friend of mine stopped breastfeeding and left the tongue tie and her son had LOTS of speech therapy until finally at age 10 he had to have major surgery to clip it and then more speech therapy to fix his speech.

    I have since learned of an organization that helps children with tongue tie as well as many, many other breastfeeding issues. I would suggest that all of you go to their website http://www.gillespieapproach.com (which I listed as mine but it isn’t I just wanted everyone to beable to go there and read about it.)

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  17. As a professional who works with this issue I feel it important to comment here. I have been a speech language pathologist for over 10 years and have worked with many individuals with speech and feeding issues. I am a huge proponent of doing therapy and doing as little “invasive” treatments as possible, such as surgery. However, I would discourage any parents who choose to do this procedure from feeling any “parent guilt”, or worry that their will be trauma. If anything, the trauma and emotional issues later in life that may result from not addressing the problem may be greater than the things many of the previous posters have described. I have worked with children first hand whose speech is significantly impacted by their tongue tie, despite years of therapy. This can be extremely embarrassing, and it is harder to fix the older the individual, especially if a person’s tongue was restricted during the MOST critical time for them to learn speech-the first several years of life. I could also go on about the potential impacts on feeding-such as difficulty chewing certain foods, halitosis due to decayed food stuck in the mouth because it can’t be cleared, excess drooling, et cetera. I am not saying definitely clip it in ALL cases; as some posters have described above certain situations where there was a minimal effect. What I am recommending is a thorough evaluation by someone who has the expertise to truly determine the impact. A speech language pathologist or an orofacial myologist can conduct detailed assessments to determine how it impacts speech and feeding. Some of these things may not be detected at a young age and may be missed by professionals who don’t have an expertise in speech and feeding. If you determine that it is necessary they I would highly recommend NOT waiting. Find a skilled dentist or oral surgeon who specialized in working with children to do the procedure-if they are good at what they do that should minimize the trauma and it may be worth it in the long run

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  18. I’m on day 6 post surgery. Although my pain during nursing has much improved the trauma of the pain the post surgery exercises are causing me to completely regret the decision to get the surgery to improve his chances in the future.

    He is in SO much pain most of the day and night . Maybe some children experience pain differently and my child is hypersensitive but I feel like I am torturing my child.

    Plus he is only 3 weeks old so there are no approved pain medications that he can rely on until he is 3 months old. Sure there are homeopathic things and Tylenol but Tylenol isn’t really recommended until 3 months of age.

    And I was under the impression that if he happened to experience a lot of pain post surgery it would be minimal and would only last for 3 days post surgery at the most if at all.

    Well here I am to tell you I gave my pain filled crying baby to my husband last night then I cried myself to sleep in the fetal position. The worst thing in the world is to give my son pain like this.

    Honestly. Why do I not see other people online with stories like mine? So I’m giving up on the exercises. I can’t do it anymore. All this pain will be for nothing.

    In hindsight bottle feeding is not the worse thing in the world and if I would’ve known about the limitations in pain management for his under 3 month of age self & how intense his pain would be with the exercises I would have waited.

    AND he was traumatized during the surgery as they only used numbing cream during laser for lip and tongue and the doctor ended up going in deeper for the lip, although the tongue part seems the most painful part for him.

    So all you mothers out there wondering how hard it will be, let me tell you in my case this has turning into the worst week of my life. It could happen to you and your infant so just in case you better have a good proven pain regimen at hand if your going through with it.

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  19. […] problems can sometimes be the result of a tongue tie. If this is the case for your baby, it’s generally easy to fix, and some moms can even […]

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  20. My son is 3 months now with what I would say a small tounge tie. He has had no problem breastfeeding. ( my fourth child,all exclusively breastfed). His story is quite the opposite. He can not take a soother or a bottle as I have tried just to see if he would take one. No such luck. He just swirls them around in his mouth. I’ve tried at least 8 different brands of soothers.( it makes it easier when we’re in a vehicle). So far we are both happy with our progress and he’s gaining weight wonderfully.

    As I see a lot of.mothers saying their nipples are cracked and sore, with my first child, of course they were sore and cracked, your nipples aren’t used to that. Mine were sore to the point where i would almost cry when she would latch. But obviously things get better..my first child also had a good latch and was not tounge tied. I think everyone goes through that the first time they bf, and with little support think they are doing something wrong.

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  21. My first son had his tongue clipped right away as a baby, and then when my second was born, I was told he had tie, but not as severe as the first son, so surgery wasn’t necessary. I monitored it every year of school asking for the speech therapist to review his case (they said he was fine and recommended not clipping), and finally at age 10 when he couldn’t push his tongue up or out and still had a speech impediment, I said enough is enough and got him clipped. I wish I had it done as a baby – he may never completely get rid of the speech impediment. My husband had it done at age 10 and still has speech issues. Don’t always listen to others – trust your gut as a mom.

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  22. It’s interesting to read about babies who have tongue problems. My brother’s first born son had a latch problem, so I decided to do some research. My wife is expecting our first baby, and I don’t want her to have to deal with this. I like how you said it’s up to us, since it really depends on how bad the tongue tie is!

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  23. Both of my boys had lips ties that we had corrected. My doctor used a laser. It was over in seconds and at the end of the procedure nursing was a million times better. The recovery time for the babies was very, very fast. In fact. One of them didn’t even cry!

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Hi, I’m Kate.  I love medical freedom, sharing natural remedies, developing real food recipes, and gentle parenting. My goal is to teach you how to live your life free from Big Pharma, Big Food, and Big Government by learning about herbs, cooking, and sustainable practices.

I’m the author of Natural Remedies for Kids and the owner and lead herbalist at EarthleyI hope you’ll join me on the journey to a free and healthy life!

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