Tongue Tie
What is Tongue Tie?
Tongue tie is the name given to a fairly common condition when the frenulum,which is a fold in the membrane that usually runs from the base of the tongueto the floor of the mouth, extends along the underside of the tongue instead.Sometimes the membrane is very thin and stretchy and sometimes it is quitethick. It may finish anywhere from near the base of the tongue to the very tip.It is often seen in several members of the same family.
Identifying Tongue Tie
Tongue tie is often first noticed when a baby is crying and the tongue curls upand back in the mouth. The tongue tie can be seen as a membrane whichgoes from under the tongue to the bottom of the mouth. It may cause adimple in the middle of the tongue or make the tongue look heart-shapedwhen the baby tries to poke its tongue out toward the bottom lip.
Does if cause any problems?
In many cases, no problems are caused at all, babies can breastfeedperfectly and nothing needs to be done. In some babies, the tongue tie mayrestrict the normal movement of the tongue as the baby breastfeeds and maycause breastfeeding difficulties such as:
- Inability to attach on to the breast
- Painful or damaged nipples
- Inability to maintain attachment of suckle efficiently
- Very long feeds
- Slow weight gain or failure to thrive
However, all of these problems may be solely due to the mother having notbeen shown how to correctly position and attach her baby and this shouldalways be checked first. It is extremely important that this is done by anexperienced professional prior to referral as not all tongue ties need to beseparated.
In cases where babies are bottle feeding, although the tongue is not neededin the same way to obtain the milk, there are occasionally difficulties such as:
- Excessive dribbling of milk
- Persistent wind
Some tongue ties may also cause problems with oral hygiene where the tongue movement is so restricted that a child or adult cannot use the tongueto clear bits of food debris from between the teeth or other areas of the mouth.Speech and language difficulties are only rarely associated with tongue tieand early separation does not guarantee such problems won’t occur later inthe child’s life.
What can be done about it?
In some cases, very thin tongue ties may break spontaneously or can be stretched by gentle massage of the frenulum. If tongue tie is causingbreastfeeding problems which cannot be resolved by correct positioning foroptimum attachment, the baby may need to have the tongue tie divided.
How are tongue ties divided?
This is a quick and simple procedure which is usually done as an outpatient and does not require a general anaesthetic if the baby is under about 6-months of age. It will be done by a trained professional who has beenspecifically trained to carry out the procedure. The baby will be wrapped upand the tongue tie divided with a pair of round-ended, sterile scissors or bycauterization. It takes only a minute or two. If the baby wants to feed it canbe breastfed straight away. Occasionally, a baby will sleep through theprocedure!
How to arrange division of Tongue Tie
The midwife, health visitor or GP will arrange for the baby to be reviewed by the infant feeding specialist midwife at Homerton University hospital. This will be to confirm the tongue tie and to identify that the procedure can be undertaken by one of our midwives. Some babies may be referred to the oral facial maxilla surgeons at Homerton university hospital this may be because of the baby’s age or severity of the tongue tie.
After the tongue tie has been divided, parents have access to local breastfeeding clinics to discuss any ongoing feeding problems.
If a tongue tie has been diagnosed and no feeding problems exist but the parents still wish the procedure to be carried out, this should be arrangedthrough their GP.
Further information about tongue tie can be found at thefollowing websites:
For referral, please contact one of the following:
Jocelyn Walder
Infant feeding specialist midwife
Tel. 020 8510 7672
Or pager via switchboard – 020 8510 5555
Alternatively via the maternity helpline: 020 8510 5955 – 10.00am to 6pm everyday