Ask: What is tongue tie?

Joan Comrie is a feeding specialist and founder of Carolina Pediatric Dysphagia in Raleigh.
Joan Comrie is a feeding specialist and founder of Carolina Pediatric Dysphagia in Raleigh.

Q. I am having a lot of pain during breastfeeding and someone suggested that it might because my son has a tongue tie? What is that, and what does it mean for my desire to continue to breastfeed?

A. Ankyloglossia, or tongue tie, is a congenital condition in which the lingual frenulum (the ligament that connects the tongue to the bottom of the mouth) is too thick, too tight or too short and reduces tongue mobility (the ability of the tongue to move correctly). Restricted tongue movements can negatively affect breastfeeding by reducing the infant's ability to suck. In addition to poor milk transfer, incorrect sucking patterns frequently result in sore and painful nipples for mom.

If your baby does indeed have a tongue tie, he will be referred for a simple procedure called a tongue clip (frenulectomy). This very easy office procedure is often done by an ENT (otolaryngologist). The doctor will evaluate the tongue and confirm that the baby has a tongue tie. The physician will make a tiny incision to release the frenulum, giving your baby instant tongue mobility. Often a tongue tie and restricted lingual (lip) frenulum go together, so your doctor will also make sure that the lip frenulum is not also restricted. Because the frenulum is not very vascular, there will be minimal blood. Many physicians will invite the parents to stay and hold your baby during the procedure. You will be encouraged to feed your baby right after the procedure and will be given simple exercises to do for several days to ensure that the incision heals correctly and does not reattach.

If your baby is only a few days old, the procedure should instantly relieve breastfeeding pain as your baby now has the ability to use his tongue correctly. If you do not experience instant relief or if your baby is older, he may need specialized feeding therapy to learn the correct tongue patterns so that feeding difficulties and nipple pain are reduced or alleviated.

The prognosis for successful breastfeeding is very good, especially if the tongue tie is identified and remediated quickly and, if needed, specialized feeding therapy is initiated promptly. If the tongue is released and the tongue does not pattern correctly, your baby is at risk for future feeding and speech difficulties, and it may increase the need for orthodontia work.

If you have a question about your child's health or happiness, ask Joan or any of our experts by sending email to

Joan Dietrich Comrie of Carolina Pediatric Dysphagia
 (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.

Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.