Breastfeeding: is tongue-tie being misdiagnosed?

Breastfeeding expert Clare Byam-Cook helps with our latest nursing issue

In the past, I only saw a few babies a year who had a tongue-tie but now approximately eight out of every 10 mothers who consult me have been told that their baby has a tongue-tie. So what is going on? Are we getting better at diagnosing it, or is it being used as the go-to excuse for all breastfeeding problems?

In my opinion, tongue-tie is frequently misdiagnosed. The NHS claims that only 4-11% of babies are affected by tongue-tie, yet many more are being diagnosed. Many mothers who have been told their baby has a tongue-tie will often consult a doctor who disagrees. It is also common for those who go on to have the tongue-tie cut to see no improvement in their breastfeeding problems. In my experience, I find I can usually demonstrate that a tongue-tie does not need to be cut by showing the mother how to better latch her baby on, which then resolves the problem instantly.

What is tongue-tie?

Tongue-tie (ankyloglossia) is a condition where the baby has a tight piece of skin (frenulum) which tethers the underside of his tongue to the floor of his mouth. This can cause a number of feeding problems, including preventing the baby from opening his mouth wide enough to latch on properly, sore nipples for the mother, difficulty in feeding effectively, long feeds, swallowing air and making a clicking noise when feeding. But it’s important to note that these problems can also be caused by the baby latching on badly.

There are two main types of tongue-tie:

1. Anterior tongue-tie, where the frenulum is too short and tight and/or extends too far towards the tip of the tongue. This is clearly visible and will often be accompanied by a V- shaped notch at the tip of the tongue.

2. Posterior tongue-tie, which is hidden under the lining at the base of the tongue. This is harder to diagnose but can be suspected if the tongue dimples down in the middle, or if the tongue appears to be very short.

What is the treatment?

An anterior tongue-tie is easily treated by dividing it with a pair of sharp, sterile scissors. It’s a very simple procedure which only takes a few seconds and is normally pain-free for baby.

Dividing a posterior tongue-tie is more complex and the specialist may use a laser rather than scissors.

Tongue-tie can be treated privately or on the NHS – you should ask your midwife or GP for details.

Do note that a tongue-tie only needs dividing if it is causing a problem. The difficulty for the mother is knowing whether her breastfeeding problems are caused by a tongue-tie or whether the health professional she is consulting is not giving her the right advice and is blaming everything on a tongue-tie which may or may not exist! For this reason, it’s always best to seek a second opinion, preferably from your GP or paediatrician. You could also look at the section in my book or DVD which explains my method of latching the baby onto the breast, and see whether this helps resolve your feeding problems.

Clare Byam-Cook trained as a nurse and midwife, and has since become the go-to expert for breastfeeding. Clare is the author of What To Expect When You’re Breastfeeding… And What If You Can’t? and also has a DVD, Breastfeeding Without Tears. Check Clare’s YouTube channel for more practical tips.