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Lingual frenulum is one of the obstacles to breastfeeding. This small frenulum causes the baby to have poor sucking ability, so the mother&#8217;s breast is not sufficiently stimulated. When the mother&#8217;s milk flow is inadequate, the milk supply becomes insufficient for the baby, leading to supplementation with formula milk. However, the problem of the baby&#8217;s lingual frenulum can actually be corrected, which will help the baby latch and stimulate the mother&#8217;s breast better. When the baby can suck well again, the mother&#8217;s milk supply will gradually increase until it is sufficient, and formula supplementation will no longer be necessary.
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<h4>Getting to Know the Lingual Frenulum</h4>
The success of breastfeeding depends on three main factors: the infant, the mother, and the environment. The baby&#8217;s breastfeeding starts with gentle sucking, which requires the movement of the tongue tip (let down reflex). The baby&#8217;s tongue must be able to lift, stick out, and pull back to compress the mother&#8217;s nipple areola (latching).
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Normally, every baby has a small membrane at the base of the tongue called the lingual frenulum. However, in babies with an overly tight frenulum, it causes tongue-tie (ankyloglossia), which occurs in up to 16% of all newborns. Mothers need not worry because lingual frenulum is a physical factor that can be easily and quickly corrected. In cases where the mother has flat or inverted nipples, correcting the baby&#8217;s tongue-tie can improve breastfeeding efficiency by 50-60%. For mothers with normal nipples, surgery to release the baby&#8217;s lingual frenulum can immediately increase breastfeeding efficiency by up to 95%.
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<h4>How to Know if Your Baby Has a Lingual Frenulum Problem</h4>
If a mother suspects her baby may have tongue-tie or a lingual frenulum issue, she can seek consultation at a pediatric surgery clinic or observe the following initial symptoms:
<ul>
<li>Low breast milk supply</li>
</ul>
Normally, the amount of breast milk depends on the baby&#8217;s demand. In natural births, if the mother has no postpartum bleeding issues, breast milk should come within the first 24 hours after delivery. In cesarean deliveries, milk should come within 72 hours. However, if the baby has a lingual frenulum, the baby will not suck well, resulting in less milk being expressed from the breast. Consequently, the mother produces less milk over time, which may lead to insufficient milk supply for the baby, potentially causing neonatal jaundice and other complications.
<ul>
<li>Cracked nipples, nipple pain, bruising, or sores</li>
</ul>
Because the baby has to exert great effort to suck, using a lot of force due to inability to stick out the tongue, the baby bites the mother&#8217;s nipple with gums, causing nipple pain. When the baby latches, it feels like something hard is biting. If the mother endures the pain and continues breastfeeding, the nipples may become bruised and cracked, eventually leading to inflammation and infection.
<ul>
<li>Baby refuses to latch, does not latch properly, or sucks slowly (difficult breastfeeding)</li>
</ul>
Tongue-tie causes poor sucking, inability to maintain latch (pop off), long feeding times without satiety, frequent hunger, and frequent crying. At night, the mother must wake frequently to feed the baby every half to one hour (whereas babies without lingual frenulum issues typically feed every 2-3 hours).
<ul>
<li>Baby cannot stick the tongue tip out beyond the lower lip</li>
</ul>
The tongue tip appears heart-shaped or like a spade, sometimes with a groove in the middle due to the lingual frenulum, preventing the baby from lifting the tongue to lick the upper lip or moving the tongue sideways.
<ul>
<li>Baby develops jaundice after birth (breastfeeding jaundice)</li>
</ul>
Most causes of neonatal jaundice are due to ABO incompatibility between mother and baby. However, some babies who suck poorly and insufficiently may have impaired waste transport in the intestines (enterohepatic circulation), leading to jaundice. If excessive weight loss is observed after breastfeeding, medical consultation should be sought promptly for safety.
<ul>
<li>Baby makes noises while breastfeeding (googling or clicky sound)</li>
</ul>
This clicking sound is caused by the baby’s inability to stick out the tongue to compress the nipple areola, resulting in poor breast seal. This condition should be differentiated from lip tie. It can be observed that milk may leak from the baby&#8217;s mouth during feeding, and the baby may experience bloating, frequent spitting up, and choking due to air entering during sucking. Additionally, drooling before 4 months of age may be noticed, possibly due to poor swallowing ability.
<ul>
<li>Poor weight gain or falling below growth standards</li>
</ul>
Hind milk is rich in unsaturated fatty acids Linoleic (Ω6) and Linolenic (Ω3), which are important for myelin sheath formation in brain development. It also contains long-chain polyunsaturated fatty acids such as DHA (Docosahexaenoic acid) (Ω3) and ARA or AA (Arachidonic acid) (Ω6). Insufficient sucking and inability to reach hind milk cause poor weight gain in infants.
<ul>
<li>Speech impediment</li>
</ul>
From age 1 year onwards, children begin to learn to speak. Lingual frenulum causes tongue-tie, limiting tongue movement, which affects pronunciation of consonants that originate from the alveolar ridge and teeth, such as /s/, /d/, /t/, /th/, /n/, /r/, /l/. The /r/ sound is most noticeably affected, as well as English words starting with T, D, Z, S, Th, R, L, such as &#8220;lollipop.&#8221; This may affect the child&#8217;s personality and confidence as they grow.
<ul>
<li>Tooth decay</li>
</ul>
Commonly found in older children, the tight lingual frenulum prevents the child from flicking the tongue to clean food debris from the inner tooth surfaces. Food debris combined with irregular tooth brushing leads to tooth decay.
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<h4>Lingual Frenulum Can Be Treated – Don’t Let It Hinder Breastfeeding</h4>
Tongue tie revision surgery is a minor procedure performed under local anesthesia. It can be done by various methods such as sterile small scissors snip, electrocauterization, laser, or plasma light. If parents suspect their baby has a lingual frenulum problem, they can schedule a consultation with a doctor for examination and treatment.
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Dr. Wasan Nantasanti 
Pediatric and Infant Surgeon 
High Technology Surgery Center 
Phyathai 3 Hospital
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Tongue-tie or sublingual frenulum in infants and children is very important for parents to observe. If there are any concerns, they can consult a pediatric surgeon or a breastfeeding clinic to promptly find a solution to the problem.

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"Tongue-tie" in your little one is not as simple as you think!

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