Tongue Tie

 
 

What is a tongue tie?

Tongue tie.png

What is a tongue tie?

Some babies are born with the condition tongue tie, which has the medical name ankyloglossia. Everyone has a fold of skin under the tongue (called the lingual frenulum), but in tongue tie, it is shorter or thicker than usual, and this restricts the movement of the tongue. The condition may be mild, or it can be severe, with the tongue joined to the bottom of the mouth.

How common is tongue tie

It happens in 1 to 10% of babies but in most cases it does not cause any problems.

What problems may a tongue tie cause?

  • Tongue tie often does not cause any problems, in which case it does not need treatment.

  • It may cause feeding difficulties, such as:

    • poor latch

    • clicking

    • dribbling

    • sore nipples or mastitis (inflammation/infection of the breast).

  • If the baby isn’t feeding efficiently, he or she may not gain weight at the normal rate (failure to thrive). Theer are, however, lots of other reasons this could happen that are not related to tongue tie, so you should see your GP first if this is a concern.

Will an untreated tongue tie cause speech problems?

It is common for parents to be concerned about the effects of tongue tie on their child’s speech, but in fact it is very rare that tongue tie causes speech problems. Tongue ties are not divided as a precaution against speech difficulties, only in an older child who has been assessed by a Speech and Language Therapist.

 

What assessment and treatment is needed?

Breast feeding is sometimes difficult for lots of reasons, especially for first-time mothers and very young babies, and feeding difficulty is not necessarily caused by a tongue tie. Breast feeding may take some time to establish. Many babies with tongue tie do not need them to be divided and can manage with support from a lactation consultant. (See Plymouth Latch-On website for details) 

Babies who have problems with breastfeeding or bottle feeding require assessment and support by specialist midwives. They give advice and support to refine feeding techniques.

 

Who needs tongue tie release?

Babies that experience feeding difficulties who have a tongue tie may benefit from having it divided. 

Babies and children with a tongue tie that feed adequately and gain weight at the expected rate do not require any treatment.  

 

What does a tongue tie release involve?

Tongue tie release, also known as ‘frenotomy’ is the most commonly used treatment for tongue tie around the world. It involves cutting through the fold of skin using scissors. For babies less than 3 months old, this is usually done in the outpatient clinic and it doesn’t require an anaesthetic or pain relief as it is a relatively minor procedure.  

Although parents’ biggest concern about the procedure is usually the fear that the baby will be in pain, the procedure is generally well tolerated by most babies and they are able to feed straight after having it.  

Babies are wrapped tightly in a towel to stop them wriggling, and most will begin to cry a little because they do not like this. As soon as the procedure is finished - this takes a few seconds - the towel is unwrapped and most babies stop crying straight away. The baby is taken back to its parents and fed immediately, by either breast or bottle. Newborn babies often sleep through the whole treatment. Usually, there are only a few drops of blood.  

A general anaesthetic (being put to sleep) is usually used for babies older than three months old. This is very safe for otherwise healthy babies, but parents often wish to consider alternatives to tongue tie release if this is required.

 

Risks of tongue tie release

  • Bleeding.

  • Infection.

  • Recurrence/scarring.

  • Damage to glands that produce saliva or the salivary ducts.

  • No improvement of symptoms.

Aftercare

If your baby has a tongue tie release in the outpatient clinic we usually need you to stay for 10-15 min to make sure that they are feeding well and there is no bleeding. If your baby requires a general anaesthetic to have a tongue tie release, they can be discharged home after recovering from the anaesthetic. In most cases pain relief following the procedure is not required.

What are the alternatives to tongue tie release?

  • If not causing any problems, tongue ties do not need to be divided at all.

  • Nipple shields can be used when nipple soreness becomes a problem.

  • Switch to bottle feeding, either with expressed breat milk or formula. Some babies find different teats easier.

  • Mothers of older babies (4 months plus) may consider early weaning, although you should take advice from your Health Visitor about how to do this. Although 6 months is the recommended weaning age, if there is a tongue tie causing feeding difficulty in a baby older than 3 months, they would need to be put to sleep to cut it, so many parents feel that early weaning is preferable.

I think my baby has a tongue tie that is causing feeding difficulty. What should I do?

The ENT Department at Derriford Hospital, Plymouth runs a specialist NHS tongue tie service. If you think your baby has a tongue tie that may need to be cut, ask you GP, Health Visitor or Midwife for a referral to ENT at Derriford Hospital.

Remember:

  • Breast feeding may take time to establish, so referral is not usually accepted before the baby is 2 weeks old.

  • Babies older than 3 months usually need to be put to sleep if tongue tie division is needed.

  • Older babies approaching 3 months will be prioritised for appointment. Derriford ENT will do their best to see all babies with suspected tongue tie before 3 months, but this does rely on receiving the referral in time.

  • The best age for a baby to be referred is at around 1 month old.

  • A tongue tie that is not causing feeding problems does not need to be cut.