What is a tongue-tie?

A tongue-tie is when the membrane (lingual frenulum) connecting the tongue to the underside of the mouth is shortened or tight leading to restricted tongue mobility. It is called an anterior tongue-tie when it attaches nearer to the tip of the tongue and a posterior tongue-tie when it attaches further back towards the floor of the mouth. Some tongue-ties are more obvious and may be detected soon after birth. The tongue may appear heart shaped and obviously restricted. Some, however, are less obvious and are identified through feeding difficulties and detailed assessment of tongue function. A tongue-tie may affect the ability of the tongue to lift, move laterally and protrude, this can contribute to feeding difficulties. The general incidences of tongue-tie are unknown, however a study conducted in Southampton found 10% of babies were tongue-tied, with half having associated feeding difficulties. There was also a family history of tongue-tie in half of the babies seen.

What problems can it cause?

To breastfeed effectively, a baby needs to be able to open their mouth wide, extend their tongue and draw in an adequate amount of breast tissue. A good seal needs to be made around the breast and the tongue needs to move effectively to remove the milk. These movements can also be important for bottle feeding. If a baby has a tongue-tie that restricts this ability to feed effectively then the following problems may be evident: For the mother – painful feeding, damaged nipples, poor drainage of the breast leading to engorgement or mastitis, difficulty establishing and maintaining an adequate milk supply, resulting exhaustion, and early cessation of breastfeeding. For the baby – difficulty getting and sustaining a deep attachment to the breast or bottle, frequent or very long feeds, weight gain concerns, difficulty controlling the flow of the milk leading to dribbling and choking easily, reflux, noisy feeding and wind problems. Long term problems may result in tooth decay as there can be difficulty in removing food debris from the back teeth. There may also be an increased risk of speech problems but this is controversial and the evidence is not clear. Please note that there may be other causes of these problems aside from tongue-tie, so skilled assessment and breastfeeding support is important. Ineffective positioning and attachment to the breast or other bio mechanical issues such as jaw or neck problems may also contribute to feeding issues. Sometimes osteopathic assessment and treatment is helpful.

How can tongue-tie be treated / managed?

Some babies can feed perfectly well despite having a tongue-tie. Therefore, adjustments to positioning and attachment may be all that is needed to resolve problems with feeding. It is advisable to seek specialist breastfeeding support.

If problems continue despite specialist support, then tongue-tie division or frenulotomy is an option. You may be able to get an NHS referral from your local breastfeeding clinic or GP. See the link to The Association of Tongue-tie Practitioners website for a list of some of the hospitals that provide the procedure and a list of private practitioners.

We can provide specialist feeding support and tongue-tie division in our private clinic or in the comfort of your home.

What does the procedure involve?

If your baby has a tongue-tie the procedure and risks will be thoroughly explained to you, so you can make an informed decision. If you agree to the procedure you will then be asked to sign a consent form. The procedure is very simple and quick. Your baby is swaddled and you will be shown how to hold your baby’s head gently. Sterile gloves are worn and the tongue is elevated with a finger and the lower lip held down to expose and stretch the frenulum. The tongue-tie is then divided using sterile, sharp, round ended scissors without the need for an anaesthetic. Babies may feel a small amount of pain, if any, and usually settle quickly and are able to feed straight away. There is usually very little bleeding and any oozing is controlled by applying pressure to the area with sterile gauze and encouraging feeding as soon as possible. You will be given support afterwards and an agreed plan will be discussed with you to help you with your ongoing feeding experience. Aftercare information will be given to you including exercises to help reinforce your baby’s increased tongue mobility. Ongoing support is available within our free follow up clinic or within our private clinics.

Where can I find more information?

If you would like more information please contact us or have a look at the following links,

The Association of Tongue-tie Practitioners

NICE guidelines on Tongue-tie division Midirs article on Tongue-tie.

What does a tongue-tie look like before and after the procedure?

' This was an excellent treatment for my son, effective with instant results. In combination with a private consultation regarding lactation, this was probably what enabled us to return to purely breast milk feeding.'

Harvey’s Mum

' Very satisfied, extremely professional and reassuring.

Worth the very long journey from Cirencester to be seen!'