What is tongue-tie:

  • Tongue-tie (Ankyloglossia) is defined as, restricted tongue movements caused by the ‘frenulum’ a piece of skin attaching the tongue to the base of the mouth, being short and tight.
  • Tongue-tie affects up to 2% of the nation, is more prevalent in boys and is often hereditary. 
  • Tongue-tie may affect a baby’s feeding and in rare/severe cases can cause a lisp or speech impediment.
  • Many parents become anxious at the mention of tongue tie, but it’s not always an issue. I’ve created a guide to help you identify problems and give options of what to do next.

What’s the difference between anterior and posterior tongue tie?

  • An anterior tongue tie, is when the frenulum attaches to the tip of the tongue. Movement of the tongue beyond the lip is restricted and the tongue forms a heart shape at the end. This type of tongue tie is easy to spot and might be picked up by a Midwife or Doctor shortly after birth.
  • A posterior tongue tie is more difficult to diagnose. The frenulum is situated at the base of the tongue, under a thin layer of mucous membrane. The tongue appears short and the sides curl up when the tongue is lifted.

Also note:

  • There are varying degrees of tongue tie, which may or may not affect breastfeeding.
  • The tongue is a muscle which stretches, strengthens and adapts over time. Early problems may rectify with appropriate support.
  • The anatomy of a baby’s mouth changes around 4 – 6 months. Babies often become more efficient at breastfeeding by this stage.
  • Every mother’s anatomy and physiology is different, the size of breasts, nipples, sensitivity, milk flow. 
  • Every baby’s anatomy is different, mouth shape, palate, chin, lips, strength of suck. Varying combinations of mother’s and baby’s anatomy can impact breastfeeding to different degrees when a tongue-tie is present.
  • A low birth weight or premature baby will not have the same sucking strength and rhythm as a term baby. Tongue-tie in these babies may cause more problems, although releasing the tie is not always a cure.

How can tongue tie affect breastfeeding?

Nipples:

  • Cracked, bleeding, blistered or damaged.
  • White line down the centre after feeding
  • Lipstick shape or squashed appearance.
  • Pain – feels like biting, pinching, gumming or scraping.

Latch:

  • Baby slips off the breast during feeds or struggles to latch on.
  • Baby makes a clicking sound during feeds.
  • Baby’s cheeks are sucked in
  • Baby’s mouth looks small at the breast.
  • Baby can’t latch onto the breast at all.

Breasts:

  • Breasts are lumpy and engorged.
  • Breasts get mastitis, thrush or a bacterial infection.

Baby:

  • Insufficient weight gain.
  • Prolonged feeding times of one hour+ and baby not satisfied.
  • Feeding frequently, every one to two hours with cluster feeds.
  • Windy.
  • Green poo.
  • Thrush in your baby’s mouth.
  • Unsettled and fractious. (You may have a combination of these symptoms)

How to identify if your baby has a tongue-tie?

  • Have you noticed your baby’s tongue does not reach out beyond its lip? TIP: Whilst baby’s awake, using a finger, stroke down your baby’s nose, lips and chin or stoke baby’s cheek from the mouth outward. Your baby should react by sticking their tongue out.
  • Does your baby’s tongue form a heart shape at the end?
  • Can you see an obvious piece of skin attached to the tip of baby’s tongue, restricting upward and outward movement?
  • Does your baby’s tongue look short and curl up at the sides when they crying?

What to do if you suspect a tongue-tie?

Seek professional advice to clarify your suspicions and get support.

  • Find a professional trained in breastfeeding and tongue-tie diagnosis, preferably a Lactation Consultant, Midwife or Neonatal Doctor. Some Midwives, Health Visitors or G.P’s may not be able to help you.
  • You specialist will ask lots of questions, such as relevant medical history, birth, how your baby’s feeding is going. They will fully examine your baby’s mouth and tongue as well as your breasts and nipples. If possible, a full breastfeed will be observed to rule out other potential problems. In some circumstances two appointments are necessary to identify if a procedure is required.
  • If a procedure is deemed necessary, the specialist will discuss this with you.

What would the procedure involve – ‘Frenulotomy’ 

A frenulotomy involves a small, painless procedure, whereby the frenulum is cut with scissors. This releases the tongue, giving more freedom of movement. A new baby has not developed nerves or vessels in this area, so it should not cause too much distress.

  • Most practitioners will request you restrain from feeding baby for two hours beforehand, as it helps if your baby is awake for the procedure to be able to feed straight after.
  • You might want to take a relative or friend for support.
  • Your baby is swaddled and head held gently in place. A professional uses an instrument to lift the tongue and then snips the frenulum with sterile scissors.
  • Babies under 3 months have few vessels in this area so bleeding is minimal and generally stops once your baby is feeding.
  • Anaesthesia is not required as your baby’s nerves haven’t developed in this area.
  • For older babies a general anaesthetic may be required.

What are the options?

Private:

  • Check reviews or go with a recommendation.
  • Check the ‘Association of Tongue-tie Practitioners’ website
  • Ensure your practitioner is qualified and experienced.
  • Ensure practice is safe and sterile.
  • Pay from £100-350 (higher price for a surgeon).

NHS:

  • Go to your local breastfeeding support group – details should be provided by your hospital on discharge.
  • Book a consultation.
  • Get a referral to your loca tongue-tie clinic.
  • Waiting time can vary from one week to one month. This will depend on your referrer, hospital and availability.

After procedure:

  • Support should be given helping your baby to breastfeed post procedure. Breastfeeding helps the tongue to heal, calms your baby and helps stop bleeding.
  • Some practitioners suggest massaging the wound for a number of days after the procedure, to prevent re-adherence of frenulum. Parents and babies report not liking this and there are alternative tongue exercises that are less invasive.

Risks:

  • Infection, as with any surgical procedure although this is rare, especially if your baby is breastfed immediately after. Breastmilk is a natural antiseptic, as is saliva.
  • If your baby is fractious, spikes a temperature or becomes unwell, has green poo, excessive saliva, bleeding or under the tongue looks green or swollen, seek medical assistance straight away.

The wound will look white under the tongue whilst it’s healing.

  • Reoccurrence – the tongue-tie grows back and the procedure may need repeating. There is less risk of this if your baby is solely breastfeeding.

Follow up:

  • Professional guidance from a breastfeeding specialist / Lactation Consultant within the first week is helpful. Often women and babies need to re-learn technique.

Can tongue tie cause speech impediments?

Only in rare and severe cases. Many people with tongue-tie do not realise they have it!