By Corinne Daut RN,IBCLC, Director of Lactation Services




A tongue-tie (or ankyloglossia) occurs when the lingual frenulum, a piece of tissue that connects the tongue to the floor of the mouth, is either too short, too thick, too inelastic or attached in such a way that it restricts the motion and function of the tongue. Tongue-ties can cause a variety of problems with breastfeeding such as inability to latch, shallow/improper latch, nipple pain or damage, difficulty transferring milk from the breast, slow weight gain, poor breast drainage, plugged ducts/mastitis, reflux, gas/fussiness, and more.  Due to the myriad of breastfeeding issues that can be caused by or related to tongue ties, as IBCLCs it is critical that we assess each baby we see in a lactation appointment. We use a validated tool called the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) to help us measure five different appearance features and seven different functions of each baby’s tongue.  A score below 8 for appearance or 11 for function indicates a tongue-tie. We also look for other signs that relate to a tongue tie such as a high palate, milk tongue, flattened gums, and lip blisters or callouses. 


After assessing each baby with the HATLFF, we complete a feeding evaluation. This means that we watch the positioning and latching technique the mother uses and evaluate how her baby’s mouth, lips, and tongue fit with her breast and nipple shape, size, and elasticity.  We observe how her baby sucks and swallows, specifically looking out for compensations or abnormalities.  We ask each mother many questions while her baby is breastfeeding and ask her to describe any sensations, pain, or discomfort she feels during and after a breastfeeding session. We also evaluate the shape of the mother’s nipple when her baby unlatches and measure the amount of milk that her baby was able to drink during the feeding.  


If after the oral assessment and feeding evaluation we suspect that a tongue-tie is causing a breastfeeding issue, we refer the baby to Dr. Joanna Green at the Pain and Sleep Therapy Center. Dr. Green is an infant tongue-tie specialist who practices right upstairs in the same building as The Birth Center. She is extremely compassionate, kind, thorough, and skilled. She will complete her own evaluation of the baby’s anatomy and oral function, and if appropriate, will officially diagnose a tongue-tie.  After her diagnosis, she will offer to perform a minor procedure called a frenectomy, during which she uses a CO2 laser to release the frenulum tissue allowing for improved function and range of motion of the tongue. 


After a baby is treated by Dr. Green, we continue with follow-up lactation appointments to ensure proper healing, improved tongue function, proper latch, and resolution of associated breastfeeding issues.  Tongue-ties and their effects on breastfeeding can be complex because many other factors come into play; such as the mother’s milk supply/flow, her positioning, her breast and/or nipple anatomy, her pregnancy and birth, and more. The best way to ensure the ideal outcomes for mother and baby is to use a team approach; mom and baby will work with the lactation department at The Birth Center, Dr. Green and her team, and sometimes an infant chiropractor, infant physical therapist, feeding therapist (SLP), or other appropriate specialists.  



For more information about infant tongue ties: