Tongue-tie can affect infant feeding

The tongue has a fold of tissue in the middle underneath called a frenulum. If the frenulum restricts tongue movement so that feeding is (is difficult?) affected, then a tongue-tie is diagnosed. The majority of frenula are not tongue-ties. Only if the frenulum restricts tongue movement so that feeding is affected, is a tongue-tie is diagnosed.

Making a diagnosis

We use a number of diagnostic tools to help establish if baby has an organised suck and swallow pattern, and whether they’re using their lips and tongue to form an effective seal on the breast or bottle.

Sometimes baby may be a little disorganised for another reason, so we find that alongside taking a full history, observing your baby taking some of their feed can be a really helpful part of the picture.

Before making this diagnosis other causes of infant feeding problems must be excluded. These include poor position and attachment and biomechanical factors (tensions in muscles or connective tissues that restrict or affect tongue movements or function). Other less common causes, such as poor tongue function and sucking problems include medical causes like neurological and developmental conditions which must also be excluded.

What is important is not just the appearance of the frenulum but how the tongue is working - how it functions and moves.

Some examples of feeding issues that require feeding and tongue-tie assessment:

Mother

  • Nipple damage

  • Misshapen nipples after feeds

  • Low supply

  • Blocked ducts or mastitis

  • Blanched nipples after feeds

  • Sore nipples

  • Breast pain – shooting, burning, stabbing, deep

    Baby

  • Difficulty attaching to breast

  • Long feeds

  • Unsettled

  • Poor weight gain

  • Unsatisfied after feeds

  • Clicking sound when feeding

  • Tiring easily and falling asleep early in feed

Types of tongue-tie

There are many ‘types’ of tongue-tie. Some are easily visualised on lifting the tongue or even just when baby cries. Others can’t be easily seen as they are deep in the mouth. The appearance doesn’t in itself define a tongue-tie. This can be confusing for parents researching the condition. A wide array of medical opinions, conflicting information on the internet and differing local policies can add to confusion for parents.

The procedure

Frenulotomy or tongue-tie division is a very simple procedure that doesn’t take long and can often be carried out in the home. No anaesthetic is needed. The procedure involves cutting into the frenulum. There are small associated risks that will be discussed with you fully before signing our consent form for the procedure. Risks include bleeding, infection (very rare) and regrowth of the frenulum

Surgery can be performed by us on infants from 24 hours of age (Day 1). Older babies are also treated if there is difficulty with weaning or good clinical reason to carry out the procedure when they are older.

Aftercare

The mouth heals quickly but there may be increased crying during the first 48 hours. Day 3 and day 6 after the procedure may be fussy days. Changes and improvements may continue for several weeks after treatment. We’ll give you bespoke detailed information and guidance to guide you through every aspect.

We suggest a follow-up appointment in a week but a telephone follow-up may suffice if all goes well and there are significant improvements in the feeding.