For a newborn, breastfeeding is supposed to be instinctive. But for some babies, the first feeds can be unexpectedly difficult. The baby may struggle to latch, make clicking sounds while feeding, take a long time to finish a feed or tire easily. For the mother, breastfeeding may be painful, with sore or damaged nipples and the constant worry that the baby is not getting enough milk.
One possible reason is tongue-tie, medically known as ankyloglossia. It occurs when the thin band of tissue connecting the underside of the tongue to the floor of the mouth, the lingual frenulum, is unusually restrictive, limiting the tongue's movement.
While tongue-tie is relatively common, not every baby with a restrictive frenulum requires a procedure. The decision to intervene depends largely on whether the condition is causing functional problems, particularly persistent difficulties with breastfeeding despite appropriate support.
A recent case at Ankura Hospital in Pune illustrates how laser-assisted treatment can be used in such cases.
The infant, the first child of a couple, was diagnosed with tongue-tie soon after birth. The baby had difficulty achieving an effective latch and produced a clicking sound while feeding. Despite efforts to improve feeding, the mother continued to experience pain, and the infant was not gaining weight adequately.
The baby was assessed by a multidisciplinary team comprising paediatric dentist Dr Abhinav Talekar, senior consultant paediatrician Dr Abhimanyu Sengupta and lactation consultant Amrita Desai. The initial approach was conservative, with feeding support and myofunctional exercises aimed at improving tongue mobility.
What happens during laser-assisted treatment?
When these measures did not sufficiently improve feeding and weight gain, the team opted for a laser-assisted tongue-tie and lip-tie release.
In tongue-tie, the restrictive frenulum can prevent the tongue from moving and extending normally. During a release procedure, a laser is used to precisely divide the restrictive tissue, allowing greater freedom of movement of the tongue. In this case, the procedure was performed under local anaesthesia.
Unlike conventional surgical instruments, a soft-tissue laser can simultaneously cut tissue and coagulate small blood vessels. This can result in a relatively bloodless operative field and allows the clinician to work with considerable precision in the small oral cavity of an infant.
The aim is to cut the tongue tie and restore functional tongue movement so that the baby can achieve a more effective latch and coordinate sucking, swallowing and breathing more efficiently.
Laser treatment is also not applicable in all tongue-tie cases, say doctors. Some babies with a restrictive frenulum breastfeed normally, while others can have significant feeding difficulties.
In the Pune case, the team first exhausted non-surgical options before deciding on the release. Following the procedure, the baby's latch improved during the first feed, according to the treating team. The mother was supported by the lactation consultant in establishing the new feeding technique, and the baby was discharged about an hour later after feeding was established.
Over the subsequent days, the parents reported smoother and more effective feeds, while the baby's weight gain improved.
"Tongue-tie can affect an infant's ability to breastfeed effectively. When a baby is unable to move the tongue freely, it can lead to poor latch, prolonged feeding sessions, maternal discomfort, and inadequate weight gain," says Dr Abhinav Talekar, paediatric dentist, Ankura Hospital.
He adds that a frenulum that appears tight does not necessarily need to be released. "Conversely, when restricted tongue movement is clearly contributing to persistent feeding difficulties and other measures have not worked, a frenulum release may be considered after appropriate evaluation."
A coordinated approach between a paediatrician who can assess the infant's overall health and growth, a lactation consultant who can identify problems with positioning and attachment, and a paediatric dentist who can assess the oral anatomy, helps in addressing the real cause, say doctors, while adding that simply releasing the frenulum does not automatically teach a baby a new feeding pattern.
