Fewer than 3 in 10 babies are exclusively breastfed at six months.

The World Health Organization, La Leche League International, and the American Academy of Pediatrics all recommend exclusive breastfeeding for a baby’s first six months if at all possible, and it seems that most mothers try to follow these guidelines for at least some amount of time. As of 2019, 83.2% of newborns started off breastfeeding. However, the number was cut almost in half at three months and again at six months, when only 24.8% of newborns were exclusively breastfeeding.

Breastfeeding is complicated.

The truth is that breastfeeding isn’t always the rewarding, intuitive experience that moms hope for. It seems like it should be fairly straightforward, but it’s complicated. Infants have to learn to coordinate sucking, swallowing, and breathing. If they pick it up quickly, they’ll nurse frequently and effectively, which, in turn, boosts milk supply. If they run into problems, breastfeeding can quickly become a painful and frustrating experience, which can endanger the mother’s milk supply and the baby’s health.

Tongue-tie and other oral abnormalities have a significant impact on milk supply.

A 2005 study found that tongue-tied infants who started off breastfeeding were three times more likely to be exclusively bottle-fed at one week than infants with no tongue-tie. Since then, several studies have linked tongue-tie, lip-tie, cheek-tie, and other oral abnormalities to early breastfeeding cessation, and for good reason. Tongue-tie and similar conditions make it difficult for infants to latch properly, which can lead to excruciating and persistent pain for mom. Because milk supply is created by supplying milk, tongue-tie creates a cycle of pain and frustration that takes a toll on milk production.

What is tongue-tie?

The tongue is anchored to the floor of the mouth by a little fold of skin called the frenulum. In the case of tongue-tie, or ankyloglossia, the frenulum is shorter or tighter than average, preventing the tongue from moving freely. This makes it more difficult for babies to pull enough of the nipple into the mouth to secure a latch. Often, doctors find and address tongue-tie before a baby is released from the hospital initially, but it’s not always immediately obvious. In many cases, tongue-tie is discovered as a result of breastfeeding challenges.  

How do I know if tongue-tie is causing my nursing problems and low milk supply?

If tongue-tie is the root of your breastfeeding problems, you may notice these signs:

• Sore, damaged nipples
• More frequent feeding paired with insufficient weight gain
• Difficulty latching
• Frantic, fussy behavior during feeding

What should I do if I think my baby is tongue-tied?

First of all, mama, see your doctor at the first sign of pain while nursing. Whatever the issue is, the longer you suffer with it, the less likely you are to continue breastfeeding. On the other hand, if you visit your doctor and/or consult with a lactation expert, you may be able to cut your suffering short and salvage breastfeeding.

In terms of tongue-tie, specifically, studies show that a simple, safe frenulotomy can significantly improve breastfeeding. This outpatient procedure doesn’t require anesthesia, and it frees up baby’s tongue with a single, quick clip of the frenulum. In one study, average breastmilk intake improved 155% after frenulotomy.

If you can’t breastfeed, pumping is the next best thing.

It bears repeating that your breast milk supply is related to how frequently and completely your breasts are emptied. If your baby is having a hard time latching because of tongue-tie (or for any other reason), pumping allows you to maintain your milk supply and still give your newborn the best nutrition available.