Valerie Gommon Midwife’s Blog

Tongue tie

Posted on: December 2, 2010

I have recently had a client whose baby had ankyloglossia and needed a tongue-tie division (or frenulotomy), the baby was having some difficulty with breastfeeding, and the mother was experiencing nipple soreness despite good positioning.

Tongue-tie may be hereditary and is a condition where there is a short or tight membrane underneath the tongue; it can be hard to diagnose and is easily missed. The skin “tie” can be attached at the tongue tip or further back and as a result the tongue-tip can appear heart-shaped; the tongue movements to lift, move from side to side and protrusion can be restricted and this may affect the way the baby feeds.  A recent study found that of babies having feeding difficulties up to 10% had a tongue-tie.

What should you look for?

You may experience pain on breastfeeding your baby, your nipples may become damaged and you may develop mastitis or find it difficult to establish an adequate milk supply (although all these symptoms can relate to positioning issues too).

The baby may have difficulty feeding and may need to feed frequently and for prolonged periods of time to be satisfied. There may also be weight problems, noisy feeding, dribbling and increased windy behaviour (although again your baby could have these symptoms without tongue tie).

Some babies can feed perfectly well despite having a tongue-tie and adjustments to positioning and attachment may be all that is needed if there are problems with feeding.  It is definitely advisable to seek specialist breastfeeding support such as La Leche League, National Childbirth Trust, Association for Breastfeeding Mothers or Lactation Consultants GB and if the problem continues despite this 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; hospitals providing this treatment are listed on the Baby Friendly website, however there are also private practitioners who will perform this for you and some of them are listed at the end of this article.

Should it be decided that a frenulotomy is necessary, the procedure is very simple and takes a few seconds.  Your baby is swaddled and held gently to keep the head still. The tongue-tie is snipped using sterile, sharp, round ended scissors without the need for an anaesthetic; your baby may feel a small amount of pain but will usually settle quickly and will be able to feed, indeed some babies actually sleep through the procedure!  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.

Good information on tongue tie can be found here on the Lactation Consultants GB website.


2 Responses to "Tongue tie"

Very useful info. I was born tongue-tied and had an operation to correct it when I was 3 years old as I was having difficulty speaking and had chapped lips due to saliva control issues. My mum had a real struggle to get the operation done on the NHS back then as it was considered cosmetic surgery! I had a full anesthetic and 3 stitches and was in hospital for a few days – how much easier it could have been now! Fortunately, neither of my girls inherited the condition but I didn’t realise that it could be spotted (and solved) so early and could affect breastfeeding.

My little boy was born with a tongue tie and by the time he was 3 days old I couldn’t carry on feeding him myself because it was just too painful. We decided that persevering with the breastfeeding was more important to us than waiting for an NHS referral, so we got a letter outlining the problem from the midwife and details of a consultant at a local hospital, and paid to have the little snip done. It didn’t seem to bother him in the slightest (a drop or two of blood; I was definitely more upset about it than he was). Straight afterwards he fed properly for the first time for about an hour and it was bliss, in comparison!

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