Sarah Oakley BA (Hons), RGN, RHV, IBCLC, Cert HP (Open)

Nursing Nurture

Tongue tie

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 beyond the bottom lip and when the baby cries will elevate to the middle 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 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. The edges of his tongue only may elevate when crying. He may have difficulty with the lateral movement of his tongue 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 GPs, health visitor and midwives are not trained in assessing babies for tongue tie and it is not routinely part of the neonatal check done after the baby is born. Hence it is not unusual for lactation consultants to come across babies as old as 2 or 3 months, 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 severity of the condition. Some babies with very obvious tongue ties breastfeed very successfully. Whereas others, sometimes with less severe tongue ties, really struggle. Tongue tie can, in some cases affect bottle feeding (babies leak milk from the side of their mouth, take a long time to feed, get lots of wind and make smacking and clicking noises during feeds). It can also have implications, in some cases, 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 because of the use of bottle feeding during that time. In 2006 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 wind, hiccoughs and reflux, fussing or falling asleep after just a few minutes on the breast, 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 experience in tongue tie assessment.

Tongue tie is treated by simply by snipping the membrane under the tongue with sterile blunt ended scissors. This procedure is called frenulotomy. It is not painful and can be done without anaesthetic in young babies. Any bleeding will be 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 and NHS treatment does not include a thorough feeding assessment and there is no support provided afterwards with getting the baby to successfully latch on. 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 so support from someone skilled in breastfeeding, post procedure, is crucial.

I can now offer frenulotomy privately to parents of babies with tongue tie after completing training with Carolyn Westcott, who is part of Mr Mervin Griffith’s team in Southampton. Carolyn and Mervin have carried out thousands of frenulotomies on babies with feeding issues over the last 15 years and have done lots of research into the issue. Some of this research was used to inform NICE.

Cost £150.00 for frenulotomy in the home with the option of a follow up visit at the reduced price of £30.00.

Cost £100.00 for frenulotomy in my Cambridge clinic which is held fortnightly on Monday mornings. Follow up in clinic £20.00.

For frenulotomy visits up to 30 miles from Ely there is no mileage charge.