Tongue-tie

Tongue-tie

Symptoms that may suggest your baby has a tongue-tie:

For baby:

• Difficulty attaching and staying on the breast or bottle

• Small gape / shallow latch

• Very long and/or frequent feeds

• Clicking sounds when feeding

• Dribbling whilst feeding

• Grinding, gumming or chewing on the nipple or teat

• Falling asleep before the end of the feed

• Restless and/or unsettled during/between feeds

• Colic, wind, hiccups 

• Symptoms of reflux

• Excessive early weight loss / slow weight gain / initial good weight gain slowing as the weeks progress

For breastfeeding mum:

• Sore, damaged, misshapen nipples

• Painful breastfeeding

• Reduced milk production

• Poor milk drainage leading to repeated engorgement, blocked ducts or mastitis

• Emotional and physical exhaustion

Because there can be other causes for the symptoms described above it is essential that a full feeding assessment is made by a skilled practitioner before considering tongue-tie division.

Research suggests that tongue-tie occurs in about 10% of the population, affects more boys than girls and appears to run in families. It is caused by a short or tight lingual frenulum (the membrane that attaches the underside of the tongue to the floor of the mouth) and this can restrict movement of the tongue. This in turn can lead to challenges breastfeeding which can also be painful for mum, or difficulties feeding from a bottle. The medical name for tongue-tie is ankyloglossia. 

Not all babies with tongue-tie will experience feeding difficulties; sometimes support to maximise positioning and attachment can enable baby to feed effectively and without pain for mum.

A full feeding history with assessment, and an assessment of baby’s tongue function and appearance will help us to create a feeding plan unique to you and your baby.

For babies unable to breastfeed or bottle-feed effectively even with support, or whose mums experience ongoing pain whilst breastfeeding the tongue-tie can be divided using a simple and quick procedure called a frenulotomy. No anaesthetic is needed for young babies, and the procedure often leads to improved feeding and tongue mobility for baby, and reduced pain for the breastfeeding mum. For some mums and babies dividing the tongue-tie is only part of the solution to feeding challenges, and ongoing support may be needed.

I am not currently working as a tongue-tie practitioner

Following assessment and discussion we may decide that tongue-tie division is appropriate. We will discuss the intended benefits and also risks of the procedure, and check that there are no adverse reasons for doing the division. With your consent your baby will be gently swaddled and their head and shoulders held by a parent or companion. Wearing sterile gloves I will open your baby’s mouth with finger and thumb so that I can clearly see the frenulum, then using sterile single use curved scissors I will carefully snip the tongue-tie, checking that the division is complete. Sometimes a second snip is needed to complete the division, then I will hold a piece of sterile gauze over the wound, un-swaddle your baby and pass them back to you to feed, removing the gauze swab first. There is usually minimal bleeding following the procedure, and most babies will cry out when the tongue-tie is snipped but stop quickly when they are cuddled and fed by you.

Your post-procedure feed will be observed and support provided. We will also talk about wound care and discuss some simple tongue exercises to do at home to reduce the risk of re-attachment and increase mobility of your baby’s tongue. 

I am able to perform tongue-tie division at your home on babies under 6 months old where feeding challenges are experienced by the baby and/or the breastfeeding mum. 

Please note I am unable to perform a tongue-tie division if your baby has not had vitamin K and is under 12 weeks of age –  this is due to the rare but serious risk of Vitamin K Deficiency Bleeding (VKDB) in newborn babies.