What is tongue-tie?
Tongue-tie (Ankyloglossia or Lingual Frenulum) is a condition where the membrane underneath the tongue is too tight or short.
There are two distinctive ways to describe tongue-tie.
Some practitioners use a percentage to evaluate the severity of the tongue-tie, which has little significance during clinical assessment. We tend to refer to tongue-tie as anterior (visible) and posterior (not visible).
Anterior tongue-tie appears as a string of tissue that attaches the tongue to the floor of the mouth and can be clearly seen.
Posterior tongue-tie is when the lingual frenulum is further back and hidden but can be felt during the assessment.
If the tongue-tie is too short or tight, the tongue-tip could appear heart-shaped, forked or blunt. Therefore, may cause a restriction of the tongue mobility.
The statistics shows that about 8-15% of infants are born with a tongue-tie or partial ankyloglossia, where nearly half of them would need to go through the procedure.
Does tongue-tie cause problems?
Not always. However, attachment to the breast involves the infant moving the tongue forward to the lower gum to grasp and draw the nipple. From this the surrounding breast tissue wells into the mouth to form a teat.
This action is important for effective attachment at the breast and maintenance of sucking for the entire duration of feeding.
Some infants with tongue-tie are unable to grasp the nipple/breast, while others attach poorly causing nipple damage. That may lead to insufficient milk supply, engorgement and mastitis.
Babies may be feeding for longer periods but are slow to gain weight. Others may have short and frequent feeds and gain weight perfectly well.
Excessive dribbling or gagging during feeds could be related to tongue-tie and some babies may seem unsettled and colicky following. This may cause a distress to the parents and the infant.
Difficulty with elevation, protrusion and lateralisation of the tongue may cause longer-term issues. For example oral hygiene; licking between lower teeth and lip, licking the upper lip and cleaning food from the roof of the mouth. Also, managing solids (chewing or swallowing) and speech development in older children.
Signs and symptoms which may be related to tongue-tie
- Difficulty to latch: slips off, clamps and bites
- Clicking sound during feeding
- Small mouth gape
- Shakes head without attaching
- Irregular feeds (lasting more than an hour with less than two hours gap in between)
- Coughing and spluttering (an impression of oversupply)
- On/off the breast, pulling away, losing interest easily and falling asleep during feed.
- Swallows air and appears windy with hiccoughs and trapped wind
- Colic symptoms
- Grunting and straining to pass stools
- Restless and irritable most of the day
- Weight loss, static growth or slow to gain
- Painful, stinging or burning nipples
- White or blue nipple after feeds (Raynaud's type of symptoms)
- Nipple trauma such as cracked, bleeding nipple
- Throbbing breast pain in - between feeds (thrush type of symptoms)
- Breast is full after feeds.
- Engorgement/blocked ducts/ mastitis
How can a tongue-tie be managed or treated?
The treatment for tongue-tie is a procedure called a frenulotomy.
It is still controversial whether babies with tongue-tie need treatment. NHS NICE guidelines say frenulotomy is usually safe for young babies and could help with breastfeeding difficulties when all the other measures have failed.
Parental consent is required for baby's tongue-tie to be treated.
If the decision is made not to have the procedure then there are options. Depending on the severity of the condition, assistance with positions and attachment at the breast may improve the situation.
What is frenulotomy (tongue-tie division)?
The tongue-tie procedure should be undertaken by a trained medical professional, experienced in infant feeding. Professional Indemnity Insurance will also need to in place.
To release the tightness under the tongue is generally a simple and safe procedure that does not need a general anaesthetic.
The tongue-tie is released within seconds using sterile, sharp, round-ended scissors. Babies usually sleep through the procedure but some may cry for a short time.
Older babies do not like being wrapped up so they are the ones who will cry out even before the actual procedure. Therefore, it is difficult to know if treating their tongue-tie is actually uncomfortable.
We recommend a small dose of Calpol to be given to the older babies prior to the procedure to minimize discomfort.
A small amount of bleeding is occasionally present. This stops when pressure is applied using sterile gauze.
Most mothers report that feeding improves immediately but if it does not we will be there to assist you with feeding techniques.
The white patch that you may see under your baby's tongue following frenulotomy will heal in week or two and doesn't require any special attention.
In some cases where tongue-tie has been recognised at a later stage it can take up to a week for the baby to start using the released tongue to the full potential.
If this is the case, we recommend a series of exercises that will help to speed up the process.
The follow-up assessment is essential to make sure that the tongue-tie area has healed and feeding has improved.
The younger your baby is the better the results!
MumMeBaby Clinic by appointment
- Infant feeding assessment
- Infant feeding
- Tongue assessment
- Tongue tie treatment
- Tongue tie follow up
Appointment for Frenulotomy, please bring with you
- Red book
- GP name and address including postcode.
- Babies over 4.0 kg or 8 weeks I would recommend Paracetamol / Calpol to be given prior procedure.
- If your baby is not breastfeeding, please bring expressed milk or formula.
- Large towel to wrap your baby in.
- You must be prepared to support your baby or bring someone with you. It is easy to do.
- Appointment time from 30 minutes but may last up to an hour.