Breastfeeding Medicine

Physicians blogging about breastfeeding

Clinical pearl: The Murphy Maneuver for diagnosing tongue tie

with 10 comments

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.

Written by bfmed

November 4, 2010 at 4:20 pm

Posted in Mythbusters, Protocols

10 Responses

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  1. […] This post was mentioned on Twitter by Tameryn , Monique Jones and BF Medicine, BF Medicine. BF Medicine said: Clinical pearl: The Murphy Maneuver for diagnosing tongue tie: […]

  2. […] Länk till tips om man funderar på i fall barnets tungband är kort. […]

    Kort tungband « Sagogrynet

    November 4, 2010 at 6:34 pm

  3. […] Just wandering in here. Katt, has your LO been checked for posterior tongue tie? PTT can be associated with persistent thrush. Unfortunately you need a real expert to diagnose it, an IBCLC or ENT specialist (ear nose throat).…ng-tongue-tie/ […]

  4. […] latch, breastfeeding can be painful and milk transfer might not be very efficient. I came across this great article in the Breastfeeding Medicine Journal recently that shows how infant tongue ties are diagnosed. One […]

  5. I got to attend a lecture by Dr Murphy on Tongue-tie and this technique has helped me immensely in identifying the implication of one TT to another in terms of how likely intervention is needed and how soon. I keep telling myself I should be keeping a record about the success of the technique and find myself explaining it to Pediatricians who are unaware of it. many don’t even assess by feel- rather just by sight. Often the harder to see one the more likely it is causing mother/baby problems which are consistent with “reasons to treat”. A great tool! TT is not well-defined by literature yet and many mothers-babies have ongoing problems as a result.


    September 2, 2012 at 8:10 pm

  6. PLEASE edit the typos!

    Katherine Wilson-Thompson, IBCLC

    April 19, 2013 at 10:41 am

  7. […] also found the following articles helpful as I was researching this issue for Dash and myself: Using the Murphy Maneuver to diagnose a tongue tie and Dr. Ghaheri’s information about the different lip tie classes/meanings (with pictures.) Dr. […]

  8. […] de herramientas que permiten evaluar la conveniencia de una intervención (Test de Hazelbacker, maniobra de Murphy), ya que no todos los frenillos suponen dificultades ni la cirugía es siempre la opción más […]

  9. […] Länk till tips om man funderar på om barnets tungband är kort. […]

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