Tongue Tie and Upper Lip Tie


What is a tongue tie?

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Some babies are born with the condition tongue tie, which has the medical name ankyloglossia. The fold of skin under the tongue that connects to the tongue to the bottom of the mouth 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.

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

What is an upper lip tie?

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Almost everyone has an upper labial frenulum, which is the piece of skin that attaches the inside of the top lip to the gum. If this is shorter than usual and restricts the baby’s ability to turn their top lip out onto the breast or bottle teat when feeding, it can interfere with the latch and cause feeding difficulties. It is estimated that around a third of babies with a tongue tie may also have an upper lip tie (ULT), and if this is the case then dividing the tongue tie alone will not fix the problem.

What problems may a tongue tie/ULT cause?

Tongue tie/ULT may cause problems with breastfeeding, such as difficulties attaching or staying attached to the breast, clicking, dribbling, colic, and the mother suffering sore nipples. If the baby isn’t feeding efficiently, he or she may not gain weight at the normal rate. 

It is common for parents to be concerned about the effects of tongue tie on their child’s speech and teeth development, but in fact there is no evidence in the medical literature to suggest that tongue tie causes dental or speech problems.  

ULT may sometimes cause a gap (diastema) between the top front teeth and there is some evidence that this may increase the chances of tooth decay here. Not all children with ULT develop a gap, though.


What assessment and treatment is needed?

Many babies with tongue tie/ULT 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. Nipple shields can be used when nipple soreness becomes a problem.


Who needs tongue tie/upper lip tie release?

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

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


Why may an operation help?

‘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 and a clamp. 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.  

ULT release is also done in outpatient clinic. Because the upper lip tie is thicker than a tongue tie, it can be a bit more painful. 

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 is usually used for babies older than three months old.


Risks of tongue tie/ULT release

Tongue tie/ULT release is a straight-forward procedure. The risks include bleeding, infection, recurrence, damage to glands that produce saliva or the salivary ducts (tongue tie release only), and no improvement of symptoms. All these risks are rare. 


If your baby has a tongue tie/ULT 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/ULT release, they can be discharged home after recovering from the anaesthetic. In most cases pain relief following the procedure is not required.