Identifying tongue tie: Does that tell us who will have breastfeeding problems?

If you’ve spent much time discussing tongue ties with other medical professionals, then you probably already know it’s a controversial topic. And if you’ve spent much time around breastfeeding parents (either as a professional or a parent yourself), you probably know that it is sometimes difficult, painful, and emotionally-loaded for the breastfeeder.


So what’s an SLP to do when working on feeding with breastfeeding infants who might have tethered oral tissues??! (Freeze! Step one is to make friends with a lactation consultant.) This study from Schlatter et al., which follows more than 700 breastfeeding dyads might give you a little guidance. Using structured assessment tools, they evaluated every infant’s tongue appearance and function and interviewed each mother to determine if there were any breastfeeding problems. Dyads who demonstrated both impaired infant tongue function and breastfeeding problems were referred for a frenotomy (or, “…if their parents actively opted for the procedure”). Then the interview was repeated two weeks later to see if breastfeeding had improved.

The authors used three assessments that are open access (!!!). Hazelbaker’s Assessment Tool for Lingual Frenulum Function (HATLFF), the LATCH Assessment Tool, and the Bristol Breastfeeding Assessment Tool. The full article has great details on how these assessments were used to determine frenotomy referrals and how maternal interviews were carried out (along with a very readable summary of similar research that has come before this study).

So what did they learn?

  1. Infants with a tongue tie were more likely to have breastfeeding problems, but it’s not quite so cut and dry as that might sound. 55% of the babies with tongue tie had breastfeeding problems, whereas 42% of babies without a tongue tie had breastfeeding problems (significantly less than those with tongue tie).

  2. In infants with tongue tie, the overall tongue function subscore on the ATLFF and the item measuring tongue peristalsis were the best way to predict which dyads would have more frequent breastfeeding problems.

  3. Looking across all dyads, tongue tielow birthweight (under 2500g), birth before 37 weeks gestation, and lack of prior breastfeeding experience increased the odds of breastfeeding problems.

  4. The majority of moms do report an improvement in breastfeeding post-frenotomy.

Here’s what this means for your practice: identifying a tongue tie may increase the odds of breastfeeding problems in some infants, but there's more to investigate. Looking at medical history, discussing breastfeeding history, and comprehensive feeding assessment are essential to decision-making. And when you are checking for tongue tie, tongue function is much more relevant than the appearance of the frenulum. 

Schlatter, S.-M., Schupp, W., Jörg‐Elard, O., Sabine, H., Kunze, M., Stavropoulou, D., Hentschel, R. (2019). The role of tongue‐tie in breastfeeding problems—A prospective observational study. Acta Paediatrica. doi: 10.1111/apa.14924.