A tongue-tie is the restricted movement of the tongue caused by a short and tight lingual frenulum (the ‘stringy’ membrane most of us have underneath our tongue). These restricted movements can result in issues with breastfeeding.

A tongue-tie may make it difficult for babies to breastfeed. To feed properly, your baby needs to be able to lift their tongue up and over their lower gum, in order to cushion your nipple during the latch and prevent damage.

Your baby’s tongue also needs to come out of its mouth with a thin and wide tip.

Tongue-tie can stop your baby’s tongue coming out far enough, or prevent them from opening their mouth wide or moving their tongue correctly, so they cannot latch onto your nipples properly. Your baby may experience:

• inability to open their mouth wide for latching

• biting or chomping on the breast

• unsettled behaviour during feeds

• slipping off the breast

• frequent or very long feeds

• excessive early weight loss, poor weight gain or faltering growth

• clicking noises and/or dribbling during feeds

• colic or excessive wind

• reflux (vomiting after feeds)

  The nursing parent may complain of:

• sore or damaged nipples

• nipples that look misshapen (‘lipstick’ shape, flat) or blanched after feeds (vasospasm)

• mastitis

• low milk supply or oversupply

• exhaustion from frequent or constant feeding

• distress due to breastfeeding not established

A simple procedure known as frenulotomy or tongue-tie division is used to cut the tongue-tie. I will divide the tissue under your baby’s tongue so they can hopefully use it more fully.

Most babies do not need a tongue-tie released. The majority of breastfeeding issues are normally solved with support with positioning and attachment. It is important that you and your baby have a thorough feeding assessment and time to ensure that there are no other issues before considering division. I will always carry out a thorough assessment before considering this procedure.

This procedure has the potential to improve your baby’s tongue mobility. This could also allow a gradual improvement of your breastfeeding experience with reduced symptoms for you and your baby, including reflux and wind.

Pain

We cannot ask babies how much it hurts but in my experience babies tend to settle quickly, very similar to the newborn heel prick test on Day 5. By offering a feed straight after the procedure you can help soothe your baby.

Bleeding

A small blood loss from the surgical site is expected and bleeding will normally stop within 2 to 10 minutes.

Tongue-tie recurrence

The national rate for frenulotomy wound reattachment is 3 to 4%. The main causes of this can be the baby not moving their tongue often, extensive use of bottles and dummies, the moist area where the wound is sited and the fact that babies heal quickly.