Clinical pearl: The Murphy Maneuver for diagnosing tongue tie

If baby is having trouble breastfeeding and you are not sure if he is tongue-tied, San-Diego pediatrician Dr. James Murphy suggests pushing your little finger to the base of the tongue on one side and sweeping it across the other side to see what you can feel. If you feel little or no resistance more than a small “speed bump,” then most likely there is no problem.

Should you feel a large speed bump that you can get past with a little more effort, it is most likely a “tree trunk” frenulum, a short, wide band of tissue buried in the floor of the mouth and attached to the base of the tongue. It usually, though not always, restricts tongue movements and causes latch problems even though it looks like there isn’t enough there to be a problem.

When you can’t sweep your finger across without pulling it back to “jump over a fence,” the frenulum is a fibrous band attached closer to the front of the tongue. It may be buried underneath the floor of the mouth or visible as an external web. If you see a narrow white streak running down the middle of the floor of the mouth that feels like a wire, it usually extends to the front of the tongue like a string. Pushing your finger into this “piano wire” frenulum will often cause the tip of the tongue to tilt downward and the center if the tongue to pull down and crease along the middle. “Tree trunk, “fence,” and “piano wire” frenulums are red flags for significant tongue function impairment.

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols, including our protocol for managing Neonatal Ankyloglossia.