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Tongue tie is when the small piece of skin that holds the tongue to the bottom of the mouth is very tight. It can cause less movement of the tongue. You may hear it called a ‘restricted lingual frenulum’.

During the early weeks of pregnancy, a baby has a small piece of skin in place to guide the development of the mouth. As pregnancy progresses the membrane becomes thinner and remains loosely attached to the tongue and the bottom of the mouth. In some babies this membrane has remained unusually short and tight. Tongue tie is more common in:

  • babies who are born prematurely
  • where there are other family members with tongue-tie
  • more boys than girls

Tongue tie can be diagnosed during a baby check after birth but can often be difficult to spot.

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How Will Tongue Tie Affect My Baby?

For some babies tongue tie causes no problems and does not require treatment. However, for a small number of babies the tongue tie may be more restrictive which could interfere with feeding. If this happens you will be offered extra feeding support.
If your baby has a tongue tie that is causing a feeding problem, your health professional will refer you to a tongue-tie practitioner at your nearest hospital. This will usually be a specialist midwife who has had training in tongue-tie assessment and separation.

Tongue Tie and Breastfeeding

For some babies, having a tongue tie means they cannot open their mouths widely enough to attach to the breast and suck properly. For this reason, they tend to slide off the breast and this can result in a poor attachment at the breast causing pain.

It is more likely that the nipples may become damaged and sore and may bleed. Some babies will be unable to feed well and can get tired, but they soon become hungry and want to feed again. Often, these feeding difficulties mean the baby fails to gain much weight.

 If your baby is breastfeeding, they may:

  • have difficulty latching on to your breast
  • have difficulty staying on your breast
  • cause painful feeds
  • be feeding for a long time
  • fall asleep during feeds
  • be unsettled and seem hungry
  • not gain weight as expected
  • make clicking noises
  • suffer with colic, wind, hiccups
  • have reflux (vomiting after feeds)

If the tongue tie is affecting breastfeeding, you may have:

  • sore nipples
  • lumps in your breast (blocked ducts)
  • pain, swelling and/or redness of the breast and possibly flu-like symptoms (mastitis)
  • a low or decreasing supply of milk
  • breasts that do not feel softer after feeding

Your midwife or support worker will give you support and advise you on breastfeeding and the best position to hold your baby during feeds.

Tongue Tie and Bottle Feeding

Tongue tie may also affect your baby’s feeding if they are bottle-fed. They may:

  • find it difficult to bottle feed
  • take a long time to feed
  • drink only small amounts
  • dribble a lot of milk during feeds
  • make clicking noises
  • have colic, wind, hiccups
  • have reflux (vomiting after feeds)

Top tip: Try using a bottle with a longer teat and a thinner base to enable your baby to latch onto it  better.

What Are The Treatment Options for Tongue Tie?

If your baby has been diagnosed with tongue tie that is affecting their feeding, you will need to decide how it should be treated.

Your options are:

  • do nothing and continue with feeding support to see if the problem improves (effective for most babies)
  • be referred to an assessment clinic for further discussion with a tongue-tie practitioner
  • frenulotomy, where the skin that is causing the tongue tie is cut to allow the tongue more movement

What Happens During a Frenulotomy?

A frenulotomy is a simple and quick procedure. It can be performed either while you and your baby are on the maternity ward or as an outpatient at the tongue-tie clinic. Your baby will be wrapped in a towel to keep them still. They will then be placed on a bed and a light will be used to look into your baby’s mouth. Blunt-ended, curved scissors are used to cut the frenulum. You will always be with your baby for the procedure.

Your baby may cry during the procedure and afterwards for a short time and there will be a small amount of bleeding when the tongue-tie is cut. In babies who are only a few months old, it is usually done without any pain relief. A general anaesthetic is usually needed for older babies with teeth, which means they’ll be unconscious throughout the procedure

The procedure does not seem to hurt babies. This is because there are very few nerve endings in the area around the bottom of the mouth. Some babies sleep through the procedure, while others may cry a bit.

What Happens After The Procedure?

When the tongue-tie has been cut, it opens into a diamond shape at the base of the tongue. This seals over quickly and then becomes a white patch which looks a bit like an ulcer. This gradually gets smaller and heals over a period of 1–2 weeks. If your baby is jaundiced, it can appear yellow. After the frenulotomy you will be expected to feed your baby; this helps control any bleeding. For most babies, there is an immediate improvement in feeding although it may take longer in some babies and take up to two weeks.

There is usually only a little bleeding after the procedure. Sometimes the wound can bleed slightly for up to 24 hours after the frenulotomy. The bleeding normally settles on its own with no further treatment or long-term effects on your baby. Before you leave the clinic, the wound will be checked to ensure there is no bleeding and you will be given information on caring for your baby.

What Happens If My Baby Does Not Have Their Tongue Tie Treated?

You can decide not to have your baby’s tongue tie separated if you do not want to. As your baby grows, so do the mouth and the tongue. As the tongue moves it is possible for the frenulum to separate spontaneously. This may occur during childhood or even when an adult.

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