Tongue-tie is a condition which affects up to 1 in 10 babies and is more common in boys than girls. It can run in families. Tongue-tie occurs when the frenulum (the membrane which stretches from under the tongue to the floor of the mouth) is short, restricting the movement of the tongue. There are varying degrees of tongue tie.
Normally the tongue looks rounded or square at the tip, will extend well beyond the bottom lip and when the baby cries the tip of the tongue will elevate towards the roof of the mouth. With a tongue-tie the baby may not be able to stick his tongue out over his bottom lip, his tongue may remain in the bottom of his mouth when he cries or form a ‘v’shape, and his tongue may have the characteristic heart shape. These types of tongue-tie can be quite easy to spot. However, some tongue-ties are much more subtle.
With posterior tongue-tie the baby may be able to briefly extend his tongue over the bottom gum or lip. However, he may not be able to keep it there. When he cries just the edges of the tongue may curl up, rather than the whole tongue tip lifting. He may have difficulty with the lateral movement and the wave like motion of the tongue needed to breastfeed may be disrupted. The baby may also find it difficult to cup and hold the breast with his tongue. Posterior tongue-ties are much harder to spot and only become apparent when the baby is examined by specialists in breastfeeding or tongue-tie.
The majority of Paediatricians, GPs, Health Visitors and Midwives are not trained in assessing babies for tongue-tie and it is not a routine part of the neonatal check done after the baby is born. There is generally a very poor understanding of tongue-tie and the impact it can have on feeding amongst healthcare professionals, despite the growing body of evidence from around the world. Hence it is not unusual for lactation consultants to come across babies who are several months old, whose mothers have been struggling to breastfeed, who have an undiagnosed tongue-tie. The majority of women who give up breastfeeding do so in the first couple of weeks, usually because the baby has problems latching or refuses to latch, or because of nipple soreness. I suspect that some of these women have babies with undiagnosed tongue-tie.
The degree to which tongue-tie affects feeding is not dependent on the appearance of the tongue-tie. Some babies with very obvious tongue-ties attached at the tongue tip breastfeed very successfully. Whereas others, sometimes with tongue-ties which are hidden under the lining of the mouth, really struggle. Tongue-tie can, in some cases, affect bottle feeding causing gulping, choking, dribbling milk during feeds, wind and reflux. It can also have implications for managing solid foods, dental health and speech later on.
Tongue-tie is not a new condition. However, its significance has been overlooked by the medical world over the last 50 years or so. This is partly because of the use of bottle feeding during that time, a reluctance to accept that breastfeeding has a substantial impact on the health of mothers and babies and the failure to acknowledge the growing body of evidence that tongue-tie causes feeding issues. In 2005 NICE issued guidance stating that division of tongue-tie is a safe procedure with proven efficacy in helping women to continue to breastfeed.
Breastfeeding difficulties associated with tongue-tie include difficulty latching, sore nipples and poor weight gain. Other issues associated with tongue-tie include low milk supply, poor weight gain, gulping and choking on the flow, wind, hiccoughs and reflux, fussing or falling asleep after just a few minutes on the breast, very frequent or prolonged feeds, clicking during feeding, nipple trauma (mothers describe the sensations as like putting your nipple into a cheese grater), bruising of the areola, baby clamping onto the nipple, slipping off the breast, mastitis, pinched and white nipples, and difficulty getting baby to open mouth wide.
Some of these symptoms can be associated with poor positioning and attachment and can be resolved with skilled breastfeeding help. However, if you have had help with improving the way your baby latches to the breast and still have sore nipples, or your baby has the symptoms mentioned above and you suspect a tongue-tie then it is essential that you seek help from someone experienced in tongue-tie assessment.
Tongue-tie is treated by simply snipping the membrane under the tongue with sterile blunt ended scissors. This procedure is called frenulotomy. It is not believed to be a very painful procedure (some babies sleep through it and most cry for just a few seconds after) and it can be done without anesthetic in young babies. Any bleeding is usually minimal and babies can feed straight after the procedure. The procedure is available locally on the NHS. However, it is not available at every hospital and waiting times can run in to several weeks. Local NHS tongue-tie services are run by surgeons and do not include a thorough feeding assessment and there is no support provided afterwards with getting the baby to successfully breastfeed. Some babies will feed after the procedure with no problems at all. But, some do take time to adjust to using their new fully mobile tongue and there can be other issues impacting on the feeding, so support from someone skilled in breastfeeding in the first few days and early weeks post procedure is crucial. Tongue-tie division should not be seen as a quick fix.
For more information take a look at my Guide for Parents by clicking here
I offer frenulotomy privately to parents of babies with tongue-tie after completing training in Southampton in 2011. See the tongue-tie assessment and division services page for more information.
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