Now that more mothers are breastfeeding, tongue-tie (ankyloglossia) is on the forefront of medical research again. Some tongue-tied babies breastfeed without difficulty, others cause their mother pain, don't get enough milk, or have difficulty swallowing properly and are very unhappy during and after feeding.
If you are concerned that your baby may be tongue-tied, the following may help you decide if you need more help. An IBCLC (International Board Certified Lactation Consultant) can help with breastfeeding, and many different dentists and doctors can help if your baby needs treatment for tongue-tie. See http://www.lowmilksupply.org/frenotomy.shtml for a list of doctors and dentists who are particularly good at diagnosing and treating tongue-tie.
The first thing to assess is whether your baby can stick out his or her tongue. If you touch your baby's lips, he will probably open his mouth. You can then touch the front of his lower gum with your fingertip. This makes him stick the tongue out. We want to see the tongue come out flat over the lip, without dipping down or pointing down. If your baby can only stick his tongue out when his mouth is closed, that can indicate a posterior (further back) tongue-tie.
Next, we want to see if your baby can lift her tongue way up to the roof of the mouth. All the way up is perfect, half way is enough for most babies to be able to breastfeed. Again, her mouth should be wide open. Most tongue-tied babies can only lift their tongues when their mouths are mostly closed.
Obvious and Sneakier Tongue-ties:
This baby (figure 3) has an obvious tongue-tie. You can see the membrane right at the front of the tongue, and you can see how it makes it hard for him to lift his tongue up.
The baby in figure 4 is also tongue-tied. If you run your finger along the outside of a baby's lower gum, her tongue will try to follow. If the tongue twists like this, it's a sign of tongue-tie.
The baby in figure 5 has a sneaky (posterior) tongue-tie. You can see that it is difficult to get a finger under the tongue. If you press on the front of the little membrane under the tongue (the frenulum), a tied tongue will pull down in the center like this. This shows that the frenulum is tight and does not allow the tongue to move well. This diagnostic trick is called the Murphy Maneuver after Dr. Jim Murphy of California.
Figure 6 shows a very sneaky tongue-tie - a posterior or submucosal one. The frenulum (membrane holding the tongue down) is hiding behind the floor of the mouth (the oral mucosa). You can see that the tongue doesn't lift very well, and that the floor of the mouth is tented out a little.
Notice how when the baby in figure 6 tries to lift her tongue (figure 7), nothing at all is visible except the limited ability to lift the tongue up.
Again, some babies with posterior or submucosal tongue-tie can breastfeed, others have a lot of difficulty. Moms breast and nipple shape and milk supply can make things easier or more difficult for the baby.
The best way to diagnose a posterior tongue-tie is to lift the tongue with a grooved director. Doctors who treat tongue-tie usually have one.
The final thing to do is watch your baby cry. If only the edges of the tongue curl up like in figure 9, that's a sure sign that the frenulum is tight.
Now that you have an idea whether your baby has normal tongue movement ability or not, you can decide what kind of help may be most useful.
You can also take the Tongue-tie symptom questionare at Dr. James Ochi's site http://www.BabyTongueTie.com
Snuggle your baby against your body so he is tummy to tummy (front to front) and lean back comfortably. Most mothers like to hold the baby with the same side arm as they are nursing from, or with both hands. The more you lean back, the more gravity helps hold baby, and the less strain on your arms.
Babies find the breast by feel and smell. Cuddle your baby in a comfortable position so your nipple touches that cute notch right above her upper lip, and her chin snuggles against your breast.
She will then open her mouth wide.
It will look like she won't be able to get her upper lip past the nipple.
She'll tilt her head back a little bit and lunge in for a good mouthful. If her nose is blocked, snuggle her bottom close to your body and slide her a little toward your other breast.
If this doesn't work for you, try leaning even farther back, so your nipple points up in the air. Then turn your baby so he is laying on your chest, with his face aligned to the breast the same way as in the latch photos above.
If you need to shape your breast a little to define a better mouthful, you can do this with one finger above or below the nipple, or a finger above and a finger below.
If these things don't work, express milk very frequently (at least 8 times a day) to feed your baby, and get in-person help!