Some women who are experiencing significant pain with breast feeding in the first four months may have infants who are tongue tied. When an infant has anklyoglossia (tongue tie) the little piece of tissue that connects the tongue to the floor of the mouth called the frenulum may extend too far towards the front of the tongue resulting in some limitation of tongue movement. In order to breast feed without pain, the infant’s tongue needs to be able to extend to beyond the gum line (and preferably to at least the lower lip), be able to round up to cup the nipple and areola and the tip needs to be flexible enough to extend at least halfway to the roof of the mouth. When the frenulum extends too far forward some or all of these manuevers are impaired. As a result the nipple isn’t brought as far back in the infant’s mouth and as such is pressed more against the hard palate rather than the soft palate when nursing. The nipple then gets squeezed in a way that is painful and women get very sore or cracked nipples.
Fixing a tongue-tied infant is pretty straightforward. The frenulum is not filled with blood vessels or many nerves so a trained healthcare provider can use sterile scissors and cut through the area that is extending too far up and free the tongue movement. There’s little bleeding or pain and infants are ready to nurse almost immediately after the procedure.
Clipping tongue-tied infants, as it’s called, fell out of favor for a few decades because of the popularity of formula feeding and because the assumption that tongue-tied children would have speech articulation issues later turned out to be false. Now that more and more women are choosing to breast feed, though, the issues of nursing a tongue-tied infant are more visible. Some women have assumed that nipple pain is a normal part of breast feeding and never mention it to their doctor but in reality, when an infant is latched well breast feeding should be painless.
Now that more providers are familiar with the procedure and aware of its benefits, getting help for you and your infant should be easier. Talk to your healthcare provider if you are experiencing nipple pain with breast feeding and encourage him or her to assess your infant’s tongue to determine if a tight frenulum is part of the problem. Certified lactation consultants are also great resources for figuring out the latch issues leading to nipple pain and the lactation specialist in our office does a bang up job at helping women and babies stick with breast feeding even when the going gets tough.