Ankyloglossia or tongue-tie

Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic Patient handout

A tongue-tie (ankyloglossia) is membrane under the tongue extending further than usual towards the tip of the tongue.

Tongue-ties can cause problems with breastfeeding:

  • Nipple pain
  • Latch problems
  • Poor weight gain.

Research shows that “frenotomy”, or clipping of the tongue-tie, is a safe and effective treatment. Frenotomy, like all procedures, may present some risks. They include bleeding at the incision site, infection, and salivary gland trauma.

Not all tongue-ties need to be clipped, only those that are causing breastfeeding problems. Severe tongue-ties may also lead to speech problems and a higher risk of dental cavities in the future.

Consent form

You will be asked to sign a consent form before the frenotomy is done. The staff at the Breastfeeding Clinic is happy to answer any questions you may have about this condition and procedure.

There are two types of tongue-ties. Both can cause problems with breastfeeding.

Anterior tongue-ties are attached to the tip of the tongue, and are very obvious to see.

The frenotomy takes a few seconds, and is done with the parents present. The baby goes straight to the breast afterwards, as breastmilk helps with healing and soothing. Many mothers feel less nipple pain and a better latch almost immediately.

Posterior tongue-ties are thicker and further back. These tongue-ties are not always seen with the eyes, but felt with the fingers.

For posterior tongue-ties, the frenotomy can sometimes cause a bit more pain and bleeding. We give the infant Tylenol™ before the procedure, and use Orajel™ (topical anaesthetic) to freeze the area. Again, the frenotomy itself only takes a few seconds. Any bleeding is immediately stopped with pressure. The baby goes straight to the breast afterwards, as breastmilk helps with healing and soothing. The mother may not feel a difference right away, and it may take up to 2 weeks to feel a difference in latch or nipple pain.

After the procedure

No special care is needed.

We ensure that the bleeding has completely stopped before you leave the clinic.

We will show you some tongue exercises for your baby that you can try at home 24 hours after the procedure. However, if these exercises make your baby irritable or seem painful, please stop them and call us as needed.

For posterior tongue-ties, you may want to give another dose of Tylenol™ that night if baby is very fussy or irritable.

It is important to breastfeed as often as possible, to help the baby extend the tongue. Usually, a follow-up is booked after 1 to 2 weeks to make sure feeding is going well.

If you have any concerns, or your baby has more bleeding or is irritable:

  • Please feel free to call the Breastfeeding Clinic during the week at 514-340-8222 local 3269.
  • If it is overnight or on a weekend, you may need to go to the emergency room of a hospital that sees babies (such as the Montreal Children’s Hospital or Ste Justine’s hospital).
  • If you do go to an emergency room, please bring this information sheet with you, so that the doctors will know what kind of procedure your baby had.

The Goldfarb Breastfeeding Clinic receives referrals for tongue-ties from all over the Montreal area. About 4 to 6 procedures are performed every week. Each baby is evaluated carefully, and only those tongue-ties that are clearly interfering with breastfeeding will be treated. Sometimes, it takes a few visits to decide whether or not treatment is needed.

The information contained in this patient handout is a suggestion only, and is not a substitute for consultation with a health professional or lactation specialist. This handout is the property of the author(s) and the Goldfarb Breastfeeding Clinic. No part of this handout can be changed or modified without permission from the author and the Goldfarb Breastfeeding Clinic. This handout may be copied and distributed without further permission on the condition that it is not used in any context in which the International Code for the Marketing of Breastmilk Substitutes is violated. For more information, please contact the Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, SMBD Jewish General Hospital, Montreal, Quebec, Canada. © 2009