'The paediatrician saw no sign of it': Mother's experience with son's tongue tie diagnosis

When the band of tissue under the tongue is too short, breastfeeding can be challenging, but getting an accurate diagnosis is often just as difficult, says Helen O’Callaghan

Amy Goodson and Jay Mulvany, with their son Mason, 15 weeks who had a tongue and lip tie sucessfully revised at the National Tongue Tie Centre in Knocklofty Tipperary. Picture: Moya Nolan.

Amy Godson wanted to breastfeed her firstborn, but the Artane mother had gestational diabetes and baby Mason, now 16 weeks, had low blood sugar.

“From day one, I had issues with breastfeeding. He had a very shallow latch — just couldn’t get a good grasp. In the hospital. I was told I’d need to give him formula, otherwise, he’d end up in the ICU. He had trouble with bottle-feeding, too.”

Goodson, supported by her partner and Mason’s dad, Jay Mulvany, continued to triple-feed her baby over the following weeks — “I breastfed, bottle-fed, pumped my own milk to give him a bottle” — but saw no let-up in the feeding problems.

“Jay had to support his head to get him to latch onto the boob; he’d constantly slip off — his lips were turned down and under. With bottle-feeding, he just couldn’t get the suck-swallow-breathe co-ordination right. 

"It was like suck, swallow, try to catch his breath and scream. He’d take an hour to finish his bottles; he’d fall asleep after an ounce, and the cycle continued.”

Via online parenting forums, Goodson heard about tongue tie, a condition in which the band of tissue — the frenulum — underneath the tongue is shorter or tighter than usual, affecting normal function. Before leaving hospital, Goodson asked the paediatrician to check for tongue tie. They saw no sign of it.

“And when the community midwives came on home visit, I was having trouble breastfeeding, but nothing was said about oral ties.”

The couple’s “new normal” was feeding Mason for hours a day. “I had supply issues, which was down to his latch. It was non-stop trying to get milk into him.”

“He had a lot of reflux keeping him awake at night, like he was choking in his sleep,” says Mulvany. 

“He was constantly waking up, gasping for air. So we couldn’t lay him down in his cot. Instead, we took shifts, staying awake, holding him upright.”

Goodson recalls trying to explain their troubles to healthcare professionals. 

“They’d say he’s a great little chap, he’s gaining weight, there’s no issue.” But when both their mothers separately took Mason overnight, the couple were reassured they were not imagining the problem. 

“Both our mums struggled — they said something isn’t right,” says Mulvany.

Consultant paediatrician Dr Justin Roche of the Tipperary-based National Tongue Tie Centre.

They eventually sought help from the Tipperary-based National Tongue Tie Centre, which assesses and treats tongue tie, a condition affecting five percent to 10% of babies. 

Founded by chartered physiotherapist Kate Roche and consultant paediatrician Dr Justin Roche, the centre’s multidisciplinary team specialises in CO2 laser surgery, myofunctional therapy, physiotherapy, feeding support, and lactation consultancy.

During their initial consultation with the paediatrician, Mason was diagnosed with grade-three lip tie and grade-four posterior tongue tie, says Goodson. “Obviously, I was sad, I knew it’d have to be fixed, but it was also refreshing to have an answer.”

A few minutes to fix

Treatment for tongue tie is frenotomy — division of the restrictive frenulum with scissors or laser. It takes just a few minutes. Mason was scheduled for laser treatment early the following week, but first the family saw a lactation consultant. 

“We got feeding support. She showed us different bottles, different-sized teats. We tried different feeding positions. We changed bottles — whenever we tilted these new ones, Mason kept sucking, but he wasn’t sucking in air. These bottles taught him to stop, take a deep breath and start again — to pace himself,” says Goodson.

“So that first night we didn’t have to sleep with him in our arms — he lay down and he slept without reflux. Over the three days before the procedure, the new bottles trained him to use different muscles in his mouth.”

Just 12 minutes after Mason was taken off to have the procedure, “he was back in our arms and taking a bottle”, says Mulvany. While his milk intake was down and he was on pain meds for a few days, he coped well.

“He’s a different baby. He’s on five-ounce bottles now. We feed him every three hours. Before, it’d have taken him 12 minutes to take an ounce of milk, now it takes him seven,” says Goodson.

Before arriving at the National Tongue Tie Centre, healthcare professionals had said Mason was thriving and didn’t have tongue tie. To find out definitively that he did came as “big-time relief”, says Mulvany. “With so many telling us otherwise, you’d doubt yourself.”

Dr Alan O’Reilly, GP, lactation consultant, and tongue-tie specialist, based at Dublin’s Camden Medical, says parents often arrive confused and frustrated, due to conflicting advice from health professionals. “Between GP, paediatrician, and public health nurse, it can be completely conflicting as to whether the child has tongue tie.”

O’Reilly says there is a lot of discussion about tongue tie on social media and on parent-to-parent forums. “Some conversations may not be evidence-based clinical discussions. That ‘my child had tongue tie released and it made all the difference’ doesn’t mean it will for every child, because there are so many different types of tongue tie.”

Dr Alan O’Reilly, GP, lactation consultant, and tongue-tie specialist, based at Dublin’s Camden Medical.

There is tongue-tie awareness among healthcare professionals in Ireland, but “poor understanding of how to examine for and diagnose” the condition. “There’s no formal training and there should be — for GPs, public health nurses, paediatricians, lactation consultants. Without it, parents are getting conflicting advice.”

The degree of discomfort with frenotomy depends on the type of frenulum, O’Reilly explains. “If very thin and fibrous, there’s minimal discomfort and rapid recovery. If it’s thicker, more vascular, there’s more discomfort, longer recovery time. I’ve had babies sleep through it, while others cry for five or 10 minutes.”

At the National Tongue Tie Centre, Roche says increased breastfeeding rates have put tongue tie on the map. A dad-of-six — five had tongue tie — he says this personal experience got him interested in the field. He sees about 1,000 patients annually, mostly infants and children. “At least half the babies we see are bottle-fed, or a combination of bottle and breastfeeding.”

In the case of breastfeeding babies, Roche sees tongue tie causing maternal pain, very frequent feeding, unsettled babies, and occasional poor weight gain. He says mums bottle-feeding babies with tongue tie may typically experience very slow feeding, short, frequent feeds, their baby may have colic, reflux, or trapped-wind symptoms.

“Some of these babies may be struggling with the flow. If baby is taking 10 minutes to take an ounce of feed, the mum is often advised to go for a faster-flow teat. The babies then struggle [more] with that flow rate; it’s almost like they’re being water-boarded.

I’m increasingly seeing babies with bottle-aversion, because their feeding experience is unpleasant. Some parents try to catch their baby when they’re waking up and drowsy — or do a lot of work to settle the baby, so they’re almost falling asleep when they’re feeding.

Roche has met families who have been told tongue tie “doesn’t matter” for bottle-feeding. “How you feed your baby shouldn’t determine whether a structural deficiency is addressed.”

Roche describes typical feedback from breastfeeding mums post-frenotomy: “They can’t get over how much more comfortable it feels. They feel the baby drawing the milk, rather than mum having to do lots of compression.”

And mums of bottle-fed babies say the “whole experience is so much calmer — they can’t believe how relaxed their baby is after feeding”.

• April 16, 2025: This article has been edited to remove references to a document concerning tongue tie and frenotomy procedures. This document is still in draft form and was inadvertently included here.