Lip and Tongue Tie

The rate of breastfeeding in the U.S. has been rising over the past 20 years due to studies showing improved health in breastfed children, as well as improvement in other issues such as gastroesophageal reflux (“spitting up”) and even SIDS (although co-sleeping or sleeping in the same bed is NOT recommended).

With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the tongue to the floor of the mouth. With lip tie the upper lip frenulum (attachment in the middle of the upper lip) limits lip elevation.

The lactation consultant community and The Academy of Breastfeeding Medicine have been attuned to the effects of lip and tongue tie (especially “posterior” tongue tie) on nursing for some time. A recent prospective study by Dr. Bobak Ghaheri in Portland, Oregon, showed significant improvement in breastfeeding outcomes after treatment of tongue and lip tie. Recently Dr. Ghaheri visited Sacramento to give several presentations on this topic that were attended by SacENT doctors, and Dr. David Evans visited Portland to study his techniques.

Sacramento ENT now has facilities for the evaluation and treatment of tongue and lip tie, with laser treatment available at our Exposition office. The most common symptoms include poor latching, falling asleep while nursing, clicking and pain while attempting to latch, reflux symptoms and poor weight gain. As nursing and swallowing are complex tasks, many issues can affect them. Therefore we do strongly recommend evaluation with a lactation consultant before and after any procedure.

Treatment of lip and tongue tie is performed in the office and takes just a few minutes. Only local anesthetic applied to the area is needed. A small amount of bleeding may be seen afterward and your baby is encouraged to feed immediately. Infants may be fussy for a day or two following the treatment and can require Tylenol. It is important to gently stretch the treated areas for several weeks after the treatment to optimize healing. You will be instructed in this simple stretching technique in the office at the time of your procedure.

If you feel your baby may have a lip and/or tongue tie, we recommend you discuss this with your pediatrician and see a lactation consultant. It is important to note that “posterior” tongue tie can only be appreciated by palpating and lifting the tongue, as the appearance of the frenulum is often quite normal. This can sometimes account for disagreement between the physician and the lactation consultant on whether there is tongue tie present. Call us today to schedule a consultation with a SacENT physician.