Tongue-Tie & Breastfeeding Support from a lactation consultant (IBCLC)

What is a tongue-tie?

Tongue-tie itself can be hereditary and research suggests that it may occur during embryonic development.


A tongue-tie or ankyloglossia is defined as a tongue mobility restriction caused by a tight or short lingual frenulum. If the frenulum is attached at, or close to, the tip of the tongue may look blunt, forked, or have a heart-shaped appearance. Some babies may be born with an obvious visible frenulum under the tongue, but others are more difficult to visualise without specialist help. If the frenulum is attached further back, the tongue may look normal. With specialist professional assessment of your baby’s tongue function and feeding history, you can get expert support in visualising any potential tongue-tie.


In terms of treatment, some babies may benefit from a procedure known as a frenulotomy which releases the restriction of the tongue tie and enables baby to feed more effectively. If you’re concerned about such a treatment, please find more information below or just get in touch.

Key terms

Tongue Tie

Also known as Ankyloglossia.

A tongue mobility restriction due to a tight and/or short lingual frenulum.

Lingual Frenulum

A short or tight piece of skin joining a baby’s tongue to the bottom of their mouth.

Frenulotomy

A treatment to release the restriction of the tongue tie through division. 

Signs and symptoms of a tongue tie

  • For Mum

    • Sore/damaged/bruised nipples
    • Painful feeds 
    • Nipples which look misshapen or blanched after feeds
    • Discoloured nipples post-feed
    • Engorgement 
    • Mastitis
    • Low milk supply
    • Exhaustion from frequent/constant feeding
    • Distress from being unable to establish breastfeeding

  • For Breastfeeding Baby

    • Unable to maintain latch 
    • Slow weight gain 
    • Static weight 
    • Slow / prolonged feeds 
    • Reflux / colic wind symptoms 
    • Unsettled post feeds 
    • Restricted tongue movement
    • Small gape resulting in biting/grinding behaviour
    • Unsettled behaviour during feeds
    • Difficulty staying attached to the breast or bottle
    • Frequent or exceptionally long feeds
    • Clicking noises and/or dribbling during feeds
    • Hiccoughs
    • Reflux (vomiting after feeds)

  • For Bottle Feeding Baby

    • Inability to make a seal around the bottle
    • Holding the teat shallow in front of the mouth 
    • Dribbling from their side of their mouths whilst feeding 
    • Choking
    • Poor sucking rhythm
    • Unsettled post-feed
    • Wind
    • Slow or excessively slow feeds 

Your baby may not display all these signs and there can be other causes for these symptoms so thorough assessment by a practitioner skilled in breastfeeding is essential.

Tongue Tie Division (Frenulotomy)

Not all babies that have feeding issues will require a tongue tie division/frenulotomy but we will discuss if this is a procedure that suits your baby. Following this full discussion and with your consent, I will complete the procedure.


Firstly, your baby will be swaddled in a towel or blanket, which I ask you to bring as added comfort for baby, and their head held gently to avoid movement. The division is performed using sterile, individual use, curved blunt ended scissors and gloves under direct light. It takes seconds and causes little discomfort for your baby. Babies usually cry for a truly short period which settles very quickly with a feed. Anaesthetic is not used, and bleeding is usually minimal.

Can tongue division help with feeding?

The short answer is yes.


However, part of our service is to develop an individualised feeding plan together, one which works for you and your family. It is important that you are aware that the tongue tie procedure can be part of this plan to improve your feeding and that feeding support is essential in improving infant feeding.


Following the division, some mothers and babies will experience an improvement straight away with feeding, whilst others can take a little longer (3-4 weeks).


For more detail, please see the ATP leaflet  WHAT IS A TONGUE-TIE?

 

The infant feeding specialist midwife will talk you through everything thoroughly, so you are fully informed, and any further question will be answered within the clinic appointment or feel free to email through specific questions.

Email me

Frequently Asked Questions

Please read this valuable information before your baby’s appointment.

  • What happens in clinic?

    Once a full feeding history has been discussed, the infant feeding specialist midwife will assess your baby’s tongue function and appearance and discuss the examination findings with you. If your baby is found to have a tongue tie, then you will be offered a division procedure (Frenulotomy).

  • When will the procedure take place?

    The procedure will be completed within your clinic visit by the infant feeding specialist midwife.

  • How old does my baby need to be?

    Your baby should be no less than 5 days old and no older than 16 weeks. 

  • What are the risks to having the procedure done?

    Bleeding - A small amount of blood loss is expected, however heavy bleeding following the procedure is rare. You will feed your baby straight away which minimises bleeding further.


    Pain - Some babies sleep through the procedure. However, most babies cry, but no more than during a nappy change. Babies often cry because they do not like being held still and, in this case, because someone is holding their mouth open - they often cry even before the tongue-tie is divided. Babies over 8 weeks can have Calpol. For babies under 8 weeks, the GP will prescribe Calpol, but most settle with just a feed.


    Infection - Research shows that the risk of infection is small. A survey of 36 Association of Tongue-Tie  Practitioners (ATP) of 9,365 babies who had Tongue Tie division found there were no infections (0%). Sterile scissors, gloves, and swabs are always used during the procedure. The mouth is not a sterile area, but it is clean and quick to heal. Also, breastmilk has been found to naturally contain antibodies to fight infection. 


    Unsettled baby - Some babies take time to relearn how to feed with more tongue movement; they may be unsettled and fussy with feeding for a day or two. You may also find that you need to adjust positioning and attachment which you will be supported with by your infant feeding specialist midwife as part of the clinic appointment. 


    Reformation - It is rare, but scar tissue can form in about 4 out of every 100 babies which may restrict your baby’s feeding. It can take around 4 weeks for feeding to improve, sometimes longer, and babies often need to re-adapt to their new range of tongue movement and relearn a different sucking technique. There may also be a period of relearning a different technique for position and attachment for the mother too. 


    However, there are no guarantees that this procedure will be a “Quick Fix”, and any procedure must be accompanied by skilled feeding support. The infant feeding specialist midwife will talk you through everything thoroughly, so you are fully informed.

  • What do I you need to bring to the clinic?

    1. Your Baby’s Child Health Record (The Red Book) - this is important for identification and communication to other professionals.
    2. Suitable adult helper to hold the baby’s head (usually baby’s mum or dad).
    3. A large towel/blanket to swaddle baby in.
    4. If the baby isn’t currently feeding at the breast, please bring a bottle with expressed or formula milk.
    5. If you are using nipple shields, please bring the shields with you.

  • Can you help with Lip-Tie?

    Currently (in 2023), there is no published evidence supporting a link between breastfeeding issues and lip-tie.


    The National Institute for Health and Care Excellence (NICE) have not issued any guidance on this subject, and therefore, training is not available in lip-tie division for practitioners in the UK. This is out of my scope of practice. 

  • What is an IBCLC

    International Board Certified Lactation Consultants(IBCLCs) are trained to international standards in supporting mothers and babies in their breastfeeding journey. They have extensive knowledge of all areas related to lactation and are highly qualified to help with both simple and more challenging breastfeeding issues.


    All IBCLCs are initially certified by examination by the International Board of Lactation Consultant Examiners and are required to recertify every 5 years either by exam or accredited continuing education programs. IBCLCs are required to abide by a code of professional conduct and ethics.  All IBCLCs are listed on the international register:  www.iblce.org


    Certification as an IBCLC protects the public by identifying qualified lactation consultants, increasing patient confidence, and helping to sustain a maternal-child health team that delivers evidence-based care for new families.


     


     

Breastfeeding Support

Breastfeeding may be the most natural way to feed your baby, but it is not always easy. Breastfeeding is a skill that needs to be learnt by both mother and baby. Like learning any new skill, it takes a good teacher and lots of patience to get right.


I have supported many families who have continued breastfeeding despite previous stressful experiences, providing friendly and professional help and support.


If you are having issues, please get in touch for a full assessment and one-to-one support.