by Rita Brhel

Grab a mirror, open your mouth, and point your tongue toward the roof of your mouth. Do you see a stretch of tissue going from the bottom of your mouth to the underside of your tongue? Probably. It’s normal.

This stretch of tissue, technically known as the frenulum, gets a lot of scrutiny in breastfeeding babies. If the frenulum is too short and tight, the baby’s tongue can’t extend past the bottom lip for an effective latch. The result is sore nipples and a frustrated baby. This whole scenario is called “tongue-tie.”

There is another kind of tie that can happen. It’s when the frenulum that connects from the middle of the inside top lip to the top gum, right between where the two big front teeth will go. Find that mirror again, and lift up your top lip with your finger. You should see a stretch of tissue up there, unless yours had been clipped when you were younger, which has been claimed to help with some speech disorders.

Related: Exposing Infants to Music is Critical for Speech Development

Clipping is literally having the frenulum clipped by scissors. Sounds unpleasant, though for babies with very short, tight tongue ties, clipping can be just the ticket to a good latch. Ties should only be assessed by an international board-certified lactation consultant, medical doctor, or pediatric dentist. A pediatric dentist most often performs the treatment.

In some breastfeeding babies, with a history of poor latch, the lip frenulum is too short and tight, keeping the lip rolled under during latch, rather than flanged out, resulting in a poor seal on the breast. This scenario is called lip-tie.

We hear a lot about tongue-tie, and are starting to hear more about lip-tie. Ties are blamed often for a mother’s failed go at breastfeeding, especially when poor latch is involved. Some people claim that there is an epidemic of tongue and lip-tie among babies, perhaps due to nutritional deficits in their mothers during pregnancy.

Is There Really an Epidemic?

The incidence of true tongue or lip-tie is relatively low — between .2% to 2% of newborns are born with tongue-tie. But because having a frenulum is normal, and just how short and tight that frenulum has to be to cause a problem is subjective, and poor latch is a common breastfeeding hurdle with myriad causes, many mothers mistakenly believe that if their baby has a frenulum and they are having trouble with latch, that it must be due to tongue or lip-tie.

With more awareness, due to a higher breastfeeding initiation rate, tongue-tie is identified more nowadays than it was when breastfeeding initiation rates were lower. Basically, there isn’t so much an epidemic of tongue and lip-ties as there is simply more awareness. And because many moms still fly solo in dealing with their breastfeeding challenges, they are unfortunately more likely to attribute their challenges to causes that may not actually be, like tongue or lip-tie.

That said, there is some speculation that severe tongue or lip-ties may have an underlying cause. Most are genetic, meaning the baby’s mom or dad also have a very short, tight frenulum. All of my children, for example, had a naturally short, tight lip tie and one of them had a tongue-tie.

There is also the theory that tongue or lip-ties have their roots in a folic acid deficiency, possibly linked to the MTHFR gene mutation, represented by other midline birth defects like spina bifida and cleft palate.

Related: What is MTHFR and Why Does it Matter for Your Health?

Clipping is Not Always a Silver Bullet

Regardless of its cause, here’s another thing to consider about a tongue or lip-tie and breastfeeding success — not clipping a tie doesn’t necessarily mean baby can’t latch. Many babies, like mine, learn to latch regardless. The more severe cases are usually caught early, while mom and baby are in the hospital shortly after delivery, and the tie is clipped. Sometimes, if a baby’s tie is clipped later, it may still refuse to latch.

My advice would be to have your baby assessed by your local lactation consultant. If a tongue or lip tie is suspected to be contributing to your poor latch, it may definitely warrant consultation with a pediatric dentist for possible treatment. But remember that there a lot of degrees of tongue or lip-tie, and that having a frenulum of some sort is completely normal.

If your lactation consultant doesn’t feel there is enough of a tie to warrant clipping, take her other advice for improving your baby’s latch. Clipping doesn’t always solve a breastfeeding problem, but often patience and problem-solving do.