舌系带过紧 Tongue Tie – 国际母乳会

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你是否在母乳喂养时感到疼痛，可能还伴随着宝宝体重增长缓慢？虽然绝大多数这种哺乳问题可以通过调整哺乳和含乳姿势，再加上良好的母乳喂养管理来解决，但有时候舌系带过紧可能也会造成哺乳问题。

舌系带过紧(即舌系带过短)是由较紧或较短的舌系带(将舌头固定在口腔底部的膜)引起的。

舌系带通常在出生前变薄并向后缩。否则，舌系带可能会限制舌头的活动。舌系带过紧往往有家族遗传倾向，一般认为男孩比女孩更常见。高腭弓或上腭异常与舌系带过紧之间存在联系，因为舌头活动受限会影响上腭的形状。

母乳喂养的挑战也可能因其它原因产生。先识别原因再确定适合的解决方案很重要，因此要向有经验的人寻求帮助。

识别舌系带过紧

当宝宝试着抬起舌头或往前伸舌头时，舌头可能会变形、缩短或呈心形，舌系带明显往下拽住舌中央并限制舌的活动。或者你能看到或感觉到舌头和口腔底部之间的坚韧组织。

舌系带过紧的程度因人而异，可能难以准确诊断。又短又紧的后舌系带过紧比较罕见，但可能尤其难以诊断出。

母乳喂养会受到怎样的影响

舌系带过紧不同程度地影响到舌头的活动。舌系带越短越紧，就越可能影响母乳喂养。一些舌系带过紧的宝宝从一开始母乳喂养得就很好，另一些宝宝则在哺乳和含乳姿势改善后才能很好地哺乳。但是任何限制正常舌头活动的舌系带过紧都会导致母乳喂养困难。宝宝要能够自由活动舌头，并把舌头伸到下牙龈外，同时嘴巴张得大大的，才能很好地哺乳。下面的症状都与含乳欠佳有关，可能是由舌系带过紧造成的。

宝宝可能：

根本无法含住乳房
不能较深地含乳，导致乳头疼痛和损伤
难以持续含住乳房，发出“咔哒”声像是吸不住乳房
应对快速流动的乳汁时，会噗噗地呼气和呛奶
需要频繁哺乳才能吃到足够的奶量
体重增长不佳，或需要补充奶来保持足够的体重增加
出现需要治疗的黄疸
当乳汁流速减慢时，在乳房上很烦躁
出现肠绞痛

妈妈可能会经历：

哺乳时疼痛，伴有乳头损伤。刚喂完奶乳头可能被压扁或变形成楔形，就像新口红的形状一样，往往乳头尖上有一条横纹。
由于无效的乳汁移出而导致乳房肿胀、乳管堵塞和乳腺炎。
由于无效的乳汁移出而导致产奶量低
奶量过多——如果宝宝通过频繁吃奶来弥补哺乳不足的话
感到疲劳、沮丧和挫败
过早停止母乳喂养

母乳喂养对每个宝宝都很重要

虽然有时你会因为母乳量不足而临时补充配方奶，但这只是治标不治本。配方奶对你和宝宝都有短期和长期的健康风险。

舌系带过紧的宝宝也可能有奶瓶喂养的困难。乳汁可能会在喂奶时从他嘴里漏出来，他也可能患肠绞痛。

治疗

当舌系带过短引起母乳喂养问题时，可采取有效的治疗方案——特别是如果能及时治疗的话。虽然关注哺乳和含乳姿势有助于维持母乳喂养并在一定程度上提高舒适度，但有证据表明，通过舌系带松解术(见下文)治疗舌系带过紧会有效解决母乳喂养的困难。体重增长可以显著改善。舌系带松解术后继续母乳喂养，除了持续享受母乳喂养的好处外，还最大限度地提高了宝宝口腔(上腭)、语言和牙齿正常发育的机会。这包括提高了舌头的活动能力去舔食和移动口腔周围的食物颗粒，有助于预防蛀牙。

继续母乳喂养

如果你已经很痛苦，再掌握母乳喂养的艺术有时会更有挑战。你往往需要下定决心才能坚持下去。这里的信息可以帮助你在治疗前后持续地母乳喂养。

软化乳房

如果你的乳房很柔软，那么舌系带过紧的宝宝会更容易含上，所以要频繁地哺乳来避免乳房肿胀。宝宝摇晃着头去舔乳头时，他们会很自然地轻松含上乳。或者你也可以用反向压力软化法将体液从乳头区域推开，这样宝宝可以很好地含上乳。将一只手的五个指尖围着按在乳头根部。轻柔而稳定地按压约一分钟，在乳晕上留下一圈小窝。你也可以用手指侧面按压，把拇指放在乳头的一边，食指中指放在另一边，也就是放到宝宝含乳时嘴唇所在的位置。需要的话可以轻轻用手挤出来一点儿母乳。

生物养育法™

如果宝宝能够长时间依偎在妈妈胸前，他们往往会本能地含乳含得很深、很舒服。试着在半躺时让宝宝趴在你身上，这样他的胸部和肚子都会贴着你。这种“后躺”的哺乳姿势被称为“生物养育法™”，可以边做肌肤接触边哺乳，或者你和宝宝也可以穿点儿衣服这样地哺乳——只要能让你俩更舒适、更方便，怎么样都行。由于重力作用帮助宝宝保持舌头向前伸，这会极大地改善宝宝的吃奶效率和你的产奶量。

半躺式喂养姿势（生物养育法™）

图片来源：英国母乳会

较深地含乳

帮助宝宝尽可能较深地含乳。这会增加他们吃到的奶量，并减少妈妈乳头疼痛的几率。

图片来源：英国母乳会

如果宝宝张开嘴时舌头缩回去了，就试着把他的下巴移得离乳头稍远一点，这样就能用舌头感受到乳房“更肥软”的部分。用手指在乳晕边缘按出凹痕，把宝宝的下巴放在此凹陷处也很有用。

图片来源：英国母乳会

你也可以试着把拇指或食指放在宝宝上唇要接触的乳头根部附近。按下去乳头就会翘起来偏离宝宝，他看到的是你的乳房，而不是乳头。随着宝宝嘴巴张开，搂紧他，用你的拇指或食指把乳房送入他嘴里。乳头是被最后吸入的，然后在他嘴里伸展开。需要的话，你可以把手指抽出来。

国际母乳会的哺乳辅导可以给你进一步的建议来帮助你改善宝宝的哺乳和含乳姿势。

鼓励舌头的活动

为了鼓励宝宝把舌头往前伸，你也可以尝试：

你半躺着，让宝宝趴在你身上。你试着往前和往后调整自己身体的角度，来感受重力作用是如何影响舌头位置的。
鼓励宝宝在喂奶前后舔自己嘴唇或你的乳头上的乳汁。
你向宝宝伸出自己的舌头，来鼓励他模仿你。

维持住奶量

假如宝宝嗜睡或有黄疸，或者假如你乳房肿胀或乳头凹陷，那么舌系带过紧会雪上加霜。如果宝宝不能直接从乳房上吃到足够的母乳，你就需要挤奶喂给宝宝，直到他能有效地吃奶为止。如果宝宝不能彻底吸软乳房，就要一天至少8次用手挤奶或者用吸奶器吸奶。这样可以维持住你的奶量，还能确保他吃到足够的母乳。

你俩学习如何母乳喂养的同时，可以用勺子、杯子或注射器喂少量挤出的母乳。奶瓶或奶嘴会混淆宝宝的吸吮技巧，所以可以向国际母乳会的哺乳辅导咨询有利于母乳喂养的瓶喂或用哺乳辅助器的方法。这种装置在宝宝哺乳时，通过一根贴在乳房上的管子提供给他额外的乳汁，避免了用奶瓶吃奶。

上腭异常

由舌系带过紧引起的舌头活动受限，可能会影响宝宝上腭的形状，导致高腭弓或较深的泡状上腭。这可能是哺乳时吸吮中断、有“咔哒”声和乳头疼痛的一个原因。上腭异常的宝宝也可能因为干呕而抗拒较深地含乳。

以下方法会有所帮助:

先把指甲修剪整齐，并洗干净手指
触摸宝宝的嘴唇，等到他们张开嘴
轻轻滑入你的手指，指腹朝上沿着他的硬腭伸入，触发呕吐反射前停下。

把这变成一个愉快的游戏，过几天，慢慢把你的手指伸得更深一些来克服宝宝的敏感。在舌系带松解开后，宝宝舌头运动的增加有助于让上腭形状变得更正常。

治疗舌系带过紧

能做什么？

舌系带松解术 ——把舌系带松解开——可以极大地提高妈妈和宝宝母乳喂养的舒适度和效率。松解开舌系带是一个又快又简单的手术。六个月以下的宝宝不需要麻醉。

有一些医疗专业人员接受过松解舌系带的专门培训。对舌系带过紧以及它如何影响母乳喂养的认知各不相同，所以值得坚持并寻求其他医生的意见。

等待是一种选择吗？

有时候很薄的舌系带会自然断开，或者可以通过轻柔按摩舌系带被拉伸开。舌系带越早松解开，母乳喂养的困难就越容易解决。为六个月以上的宝宝松解舌系带是一个比较复杂的手术，通常需要全身麻醉。

舌系带松解术 ——会怎么做？

在医生初步评估后，宝宝会被包裹起来抱着(通常由助手抱着) ，所以在手术中他会保持不动，只需要一两分钟即可。医疗人员抬起宝宝的舌头，用一把圆头的无菌剪刀或高温烧灼消毒的剪刀，把舌系带松解开。

这个手术疼吗？

非常年幼的宝宝是不需要麻醉的，因为松解舌系带即使疼，也只会有点儿疼。一些宝宝对被包裹着的反抗多于对治疗本身。其他的孩子在整个手术中都在睡觉！一旦手术结束，就会让你马上给孩子哺乳，来慰籍他、清洁伤口、并让舌头尽快活动。宝宝口腔里面的伤口愈合得很快。一般术后唯一需要做的护理就是哺乳，以保持伤口清洁、让舌头活动。宝宝的舌头下方可能会有一块白斑，不过会在24到48小时内愈合。

如果问题没有解决？

通常妈妈注意到哺乳时她的舒适感会立刻改善。有时宝宝需要一到两周来适应舌头变得更灵活了。大一点的宝宝会发现较难适应舌头增加的灵活性，就会建议给他们进行舌头锻炼。偶尔宝宝的舌系带需要第二次松解，通常是因为第一次松解得不够彻底。如果你怀疑最初的手术没有解决宝宝的母乳喂养问题，就要另行咨询。要坚持去寻找解决方案。如果涉及好几个因素，解决问题就需要时间和专业知识。国际母乳会的哺乳辅导可以建议更多的探索方式，并提供持续的支持。

乳头疼痛

如果哺乳时很疼，使用不同的哺乳姿势可能有用。或者用你觉得最舒服的姿势，直到乳头愈合了。检查宝宝的含乳——如果宝宝从较深的含乳开始，但在哺乳的过程中不知不觉嘴会滑脱到乳头上，可能会让你疼痛。半躺的哺乳姿势或者在胳膊下多垫点儿可能会有帮助。

可以向国际母乳会的哺乳辅导询问乳房按压的相关信息，它有助于宝宝更快吃到更多的母乳。乳汁流速的增加也帮助他更有效地哺乳。

在哺乳前用手挤奶来刺激乳汁流动。或者从不太疼的那侧乳房开始哺乳，一旦来了奶阵就换一边。疼痛会减少乳汁流量，导致乳房肿胀和乳腺炎。请询问你的医生、助产士或家访护士如何使用合适的止痛药。在哺乳前温敷并做轻柔的按摩和放松动作有助于乳汁流动。

湿敷伤口愈合法

潜在的问题被纠正后，湿敷伤口愈合法可以帮助乳头愈合而不会形成结痂。每次哺乳后，轻轻拍干乳头去除表面的水分。在每个乳头上涂薄薄一层超纯羊脂膏，要轻轻涂抹而不是摩擦。也可使用没有衬垫的水凝胶垫。

乳头皲裂处的血

乳头皲裂处的血对宝宝无害。你可以在继续哺乳的同时努力改善哺乳和含乳姿势。

如果愈合缓慢

一旦宝宝开始很好地含乳了，你应该觉得更舒服，并在几天内注意到伤口愈合的迹象。否则就要去看家庭医生——有时细菌感染或真菌感染会妨碍愈合。持续的疼痛可能表明宝宝的舌系带过紧需要治疗(或更进一步的治疗)

寻求帮助

这个时候在你当地的国际母乳会小组中得到其他妈妈的支持就是无价之宝了。

国际母乳会哺乳辅导联系方式

2022-09-03

你可以在此找到离你最近的哺乳辅导。

Tongue Tie

Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.

Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn’t happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.

Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled.

Identifying tongue tie

When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its centre down and restricting its movement. Or you may be able to see or feel firm tissue where their tongue meets the floor of his mouth. Degrees of tongue tie vary and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot.

How breastfeeding may be affected

Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with their mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.

A baby may:

Be unable to latch on to the breast at all.
Be unable to latch on deeply, causing nipple pain and damage.
Have difficulties staying on the breast, making a clicking sound as he loses suction.
Splutter and choke when coping with fast flowing milk.
Breastfeed constantly to get enough milk.
Have poor weight gain or need supplementation to maintain adequate weight gain.
Develop jaundice that needs treating.
Be fussy at the breast when the milk flow slows.
Develop colic.

A mother may experience:

Pain during feeds, with damaged nipples. Her nipple may be compressed or distorted into a wedge shape like that of a new lipstick immediately after feeding, often with a stripe at its tip.
Engorgement, blocked ducts and mastitis because of ineffective milk removal.
Low milk production because of ineffective milk removal.
Oversupply—if her baby compensates for not being able to breastfeed well by nursing very frequently.
Tiredness, frustration and discouragement.
A premature end to breastfeeding.

Breastfeeding is important for every baby

Though sometimes needed as a temporary supplement if your milk production is very low, introducing infant formula is not the answer. It has short-term and long-term health risks for both your baby and you. A baby with tongue tie can also have difficulties with bottle feeding. Milk may leak from his mouth during feeds and he may suffer from colic.

Treatment

Where a tongue tie is causing breastfeeding problems, treatment options are available and effective— especially if the treatment is prompt. Although attention to positioning and attachment can help maintain breastfeeding and improve comfort to a certain extent, there is evidence that treating tongue tie by frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the continued breastfeeding benefits, continuing to breastfeed after frenotomy maximizes a baby’s chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth, helping prevent tooth decay.

Keeping breastfeeding going

Mastering the art of breastfeeding can sometimes be a challenge and it takes determination to keep going if you are in pain. The information here can help you keep breastfeeding, both before and after treatment.

Soften your breast

A baby with tongue tie may find it easier to latch on if your breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, they naturally makes it easier to latch on. Or you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be. Gently hand express a little milk if needed.

Biological nurturing™
A baby often instinctively attaches more deeply and comfortably if they can snuggle up close to their mother’s chest for periods of time. Try letting your baby lie on your body as you recline so both their chest and tummy are against you. This kind of ‘laid-back’ breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed—whatever is more comfortable and convenient for you both. Because gravity helps a baby keep their tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make.

Biological Nurturing

A deeper latch
Help your baby get as deep a latch as possible at the breast. This will maximize the amount of milk they get and minimize nipple pain.

If your baby retracts (pulls back) their tongue when they open their mouth, try sliding their chin a little further from the nipple so he can feel the ‘fatter’ part of the breast with his tongue. Denting the breast at the edge of the areola with a finger and placing your baby’s chin in the dent may also help.

You could also try placing your thumb or finger near the base of the nipple where your baby’s upper lip will be. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. If needed, you can then slip your finger out. An LLL Leader can give you further suggestions to help you improve your baby’s positioning and attachment

Encourage tongue mobility

To encourage your baby to move their tongue forward, you can also try:
• Reclining with your baby on top of you. Try leaning forward and back yourself to understand how gravity affects tongue position.
• Encouraging them to lick milk from their lips or from your nipple before and after feeds.1-9
• Sticking your tongue out at your baby to encourage them to copy you.

Maintain milk production

If your baby is sleepy or has jaundice, or if you have engorgement or inverted nipples, then a tongue tie can make things worse. If they are not able to take enough milk directly at the breast then you will need to express it and give it to your baby until they are able to breastfeed effectively. Express by hand and/or with a pump at least 8 times a day if your baby is not draining the breast well. This will maintain your milk production and ensure they get enough milk.

Small amounts of expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Bottles or dummies can confuse your baby’s sucking technique so consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

An unusual palate

Restricted tongue movement caused by tongue tie may affect the shape of a baby’s palate, leading to a high palate or a bubble palate with a high spot. These may be a factor in broken suction, a clicking sound and pain during breastfeeding. A baby with an unusual palate may also resist a deeper latch due to gagging.

The following may help.

• Start with a clean finger with closely trimmed nail.
• Touch your baby’s lips and wait until they open their mouth.
• Gently slide in your finger, pad side up along his hard palate, stopping just before the gag reflex is triggered.

Make this a pleasant game and, over a few days, gradually move your finger back to overcome sensitivity. After a tongue tie is divided, a baby’s increased tongue movement helps the palate shape become more normal

Treating Tongue Tie

What can be done?
Frenotomy—dividing the tongue tie—can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is a quick and simple procedure. No anaesthetic is needed for a baby under six months of age.

There are health professionals who have been specifically trained to divide tongue ties. Knowledge about tongue ties and how they affect breastfeeding varies, so it is worth persisting and seeking a second opinion.

Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a baby over six months old is also a more complicated procedure and usually requires a general anaesthetic.

Frenotomy—what will happen?
After the health professional’s initial assessment, your baby will be swaddled and held (often by an assistant) so they stay still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of round-ended sterile scissors or by cauterising it.

Does it hurt?
No anaesthetic is needed for a very young baby as having a tongue tie divided only hurts a little, if at all. Some babies protest more at being swaddled than about the treatment. Others sleep right through the procedure! You will be asked to breastfeed your baby as soon as the procedure is over, to offer comfort, clean the wound and get their tongue moving as soon as possible. The inside of a baby’s mouth heals very quickly. The only treatment usually needed is to breastfeed to keep the wound clean and keep his tongue mobile. There may be a white patch under your baby’s tongue, but this heals within 24 to 48 hours.

If things don’t resolve
Usually a mother notices an instant improvement in her comfort during breastfeeds. Sometimes it takes a week or two for a baby to adjust to their tongue’s greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally a baby’s frenulum needs dividing a second time, usually because the division was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby’s breastfeeding problems arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can suggest further paths to explore and provide ongoing support.

Painful nipples

Using different feeding positions can help if breastfeeding is painful. Or use the position you find most comfortable until your nipples heal. Check your baby’s attachment later in the feed—if they slip down your nipple, this may cause you pain. Reclining breastfeeding positions or extra support under your arms may help.

Ask your LLL Leader about breast compression, which can help your baby get more milk quicker. An increase in milk flow may also help them breastfeed more effectively.

Hand express to stimulate milk flow before feeding.Or start on the least painful side, switching sides once your milk lets down. Pain can reduce milk flow, leading to engorgement and mastitis. Ask your doctor, midwife or health visitor about using a suitable painkiller. Applying warmth and using gentle massage and relaxation exercises just before feeds can help milk to flow.

Moist wound healing

When the underlying problem is corrected, moist wound healing can help your nipples heal without scab formation. After each feed gently pat your nipples dry to remove surface wetness. Apply a tiny smear of ultra pure modified lanolin to each nipple, dabbing it on rather than rubbing. Hydrogel pads without a cloth backing can also be used.

Blood from cracked nipples

Blood from cracked nipples is not harmful to your baby. You can continue to breastfeed whilst working to improve positioning and attachment.

If healing is slow

Once your baby starts latching on well you should feel more comfortable and notice signs of healing within a few days. If not, visit your GP—sometimes a bacterial or fungal infection can prevent healing. Continued pain may be a sign that treatment (or further treatment) of your baby’s tongue tie is needed.

Seek support

This is a time when the support of other mothers in your local LLL group can be invaluable.

You can find your nearest Leader.

2022-09-03

参考文献 References

Hazelbaker, AK. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press, 2010.

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo Tx: Hale Publishing, 2010.

Watson Genna, C. Supporting Sucking Skills in Breastfeeding Infants. Burlington, MA. Jones & Bartlett, 2012.

Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188–94.

Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246–50.

Hong, P. et al. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Ped Otorhinolaryngology 2010; 74:1003–6.

Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010.

Miranda, BH. and Milroy, CJ. A quick snip—a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. JPRAS 2010; 63:e683–5.

NICE Guidelines

Watson Genna, C. And Coryllos, EV. Breastfeeding and tongue-tie. J Hum Lact 2009; 25(1):111–2.

资料来源：https://www.laleche.org.uk/tongue-tie/