Hello, ALCI Ireland | Association of Lactation Consultants in Ireland has detected that you are using an outdated version of Internet Explorer. If possible we strongly urge you to update your browser or switch over to Chrome or Firefox so you can enjoy the full user experience of our website and avail of all the features!
Close This Message'

How can we help when a tongue tie procedure is not possible? By Meg Nagle IBCLC Reviewed by Dr. Vanessa Stitt

GOLD Learning Online Tongue-tie Symposium 2020
Date: September 14, 2020

Meg starts with listing her objectives- to describe the positions that tend to work best for babies who are having trouble latching, to explain how planning with the family helps leads to better outcomes, and to discuss possible challenges that might arise and how to best support families through them.
Factors that may lead to a tongue release not being possible or preferable are geographical, financial, cultural or personal preferences, or availability of services, especially in the light of COVID. Listening to the parent’s individual and personal preferences around feeding is paramount.
Meg describes the different symptoms of ties -the most common being infant’s inability to initiate and maintain a deep latch, to drain the breast efficiently and effectively, and maternal nipple pain. She explains colic appears to be linked to ties because digestion starts in the mouth and so ties can affect that first step in digestion, but that more research is needed.
Meg describes IBCLCs as detectives, not magical! It is up to IBCLCs to figure out what is going on with the breastfeeding dyad, and address these issues by offering different options to mom. She describes how to put the pieces together with four cardinal questions– how does it feel for you? Is your baby settled during feeding? Does your baby effectively and efficiently drain the breast? What are you feeling concerned about?
Meg states that there are many different tongue-tie assessment tool kits, and how this can lead to conflicting advice, but emphasizing the importance of symptoms, not just the oral assessment. She advises against the use of the term “mild” or “severe” tie, and the term”the latch looks fine” as being unhelpful. There is either a restriction causing issues with feeding, or not. How she asks the question of maternal nipple pain is important -is breastfeeding going to be sustainable in the context of this pain, or not?

• Latching and positioning – videos show babies diagnosed with tongue-tie. Video one shows a shallow latch, basically nipple feeding or straw feeding. Video two shows a baby struggling to initially latch, and difficulty maintaining suction. She suggests that we take the least invasive approach first.
• Techniques – Meg reminds us that laid back breastfeeding, self attachment and side lying has an evidence base (Genna 2015). The more hands on flipple technique is a second line option, with more maternal input. She has found that the half-koala/football upright hold, with a pillow providing baby some support at the back, in combination with self attachment or flipple can help. The best positioning is what works for the breastfeed dyad – offer different options. Supply lines like SNS can come in different options including homemade options. A plan should include short term and longterm goals, with reassessment and follow up. This plan must be formed by asking questions – are you feeling that you can continue to breastfeed as things are going now? Is getting a release an option if things don’t improve? Do you feel as though this plan that we’ve made is working for you? Outlining the different possible outcomes are also important – how does mom feels about these outcomes?
• Evidence, research and the internet – Meg makes the point that the internet often acts as a “broker” between parents and healthcare professionals. Linking with local release providers to keep up to date on current research is recommended. Giving parents up-to-date clinical evidence about the procedure is paramount.


Dr Vanessa Stitt September 2020.

Vanessa received a bursary of €50 from ALCI to virtually attend the GOLD Learning Online Tongue-tie Symposium 2020.

Further Reading


Presenting at the ILCA 2023 In-person Conference in Las Vegas:  A Personal Account


ILCA 2023 Conference Presentation: Building Policy Coalitions


WHO/Unicef Congress