A Tongue Tie is when a thin membrane of skin (lingual frenulum) attaches the tongue to the floor of the mouth or the lower gum ridge, which restricts the tongue's movement. It can be attached at the very back of the tongue (posterior) in the middle or at the very front tip of the tongue (anterior). The procedure to divide a babyβs tongue tie is called Frenulotomy. The membrane under the tongue is divided to enable optimum tongue movement and function to help babies feed more effectively.
Some Tongue-Ties may be noted at the new born examination undertaken usually by a Pediatrician or a Midwife with additional competency; others may be diagnosed whilst the mother and baby are still receiving post-natal care or when baby is older, by a Health Visitor, Breastfeeding Specialist or GP. The following clues may be present;
The tip of the tongue may be, βflattenedβ, βheart βshapedβ or βnotchedβ at the tip.
The tongue doesnβt lift up fully to the roof of the mouth, particularly noticeable when baby is crying. It may also be βsquared-offβ when lifting or sticking out rather than pointed.
The centre of the tongue may be βhumpedβ or have a hollow shaped depression in it when lifting it.
The tongue may not be able to protrude beyond the lower gum, therefore not cushioning the ni**le from pressure during breast feeding causing damage, compression or distortion of the ni**le.
Poor attachment the baby can βslip off the ni**le
Reasons for Treating Tongue-Tie
The treatment for tongue-Tie is a simple procedure called a frenulotomy (sometimes called frenotomy or frenulectomy). Not all babies and children with Tongue-Tie need treatment, some may be fine without it. National guidance from the National Institute of Clinical Excellence (NICE guidelines) suggests that frenulotomy is usually safe for young babies and could help with feeding problems. Frenulotomy may be recommended in babies up to 6 months of age if there are;
Difficulties with feeding for baby which may/may not include the following;
Poor weight gain
Prolonged jaundice
Fractured frequent feeds
Baby feeding βall the timeβ
Baby appearing unsatisfied after a feed
Agitation and frustration whilst feeding
Head-rocking or waving on approaching the breast for a feed
Clickingβ, βslurping noisesβ may be present.
Dribbling of milk during a feed
Falling asleep prematurely during a feed
Multiple attempts at latching or maintaining latch βSlips of the ni**leβ
Use of expressed breast milk or artificial milk supplements
Excessive coughing, choking, vomiting, colic and reflux
Restricted tongue movement
Difficulties with Breastfeeding for Mother may include;
Distortion and or compression of the ni**les resulting in pain, damage, loss of tissue
Incomplete milk transfer by baby resulting in engorgement and/or mastitis
Poor initiation and maintenance of maternal milk supply
The presence alone of a visible or anterior sub-mucosal (hidden/posterior Tongue-Tie) is not an indicator for treatment with frenulotomy. Tongue mobility is the critical factor that affects breast feeding.
In the UK, the National Institute for Clinical Excellence (NICE) operational guidance regulates our practice in the treatment of Tongue-Tie. NICE states that the procedure to divide a Tongue-Tie should be carried out only to assist mother and baby to feed more effectively. Frenulotomy should not be undertaken as a procedure for concerns that parents may have about their babyβs future ability to speak, eat or for cosmetic reasons.
What Should Parents Look For When Choosing A Tongue-tie Practitioner?
Clinical expertise, extended competency in treating all variants of Tongue-Tie, and treatment of recurrent Tongue-Tie
Thorough explanation of the benefits, risks, and alternatives to Frenulotomy.
Thorough informed consent process which includes information on how to deal with post-surgical complications.
Ready availability of practitioner for post-surgical follow-up and to offer telephone advice and support.
What to Expect after Frenulotomy
Following the procedure some mothers and their babies find an immediate improvement in feeding. For others it will take longer, sometimes weeks or more for feeding to improve as the baby acquires new skills to feed. Whilst having a Tongue-Tie both mother and baby have acquired adaptations to their feeding to work around their difficulties.
After the procedure, it can take some time for some mothers to gradually transition from the use of
for example, ni**le shields, finger or syringe feeding expressed breast milk or artificial milk, whilst their Breastfeeding gradually improves.
It is important that you view Frenulotomy as part of a plan to improve your feeding; it is not always an instant fix.
