Too tied to feed? - Information for parents
Congratulations on your new baby!
As new parents we appreciate that you want to do the very best for your baby and this sheet aims to provide information to help you understand the possible implications for your baby having a tongue tie, and what courses of action are open to you, if required, to overcome any difficulties that may arise.
If you have any further questions or concerns please do not hesitate to ask your Midwife, Breast Feeding Coordinator.
What is a tongue tie?
Each person has a piece of tissue that attaches the underside of the tongue to the floor of the mouth – this tissue is called the frenulum. Sometimes the frenulum may be exceptionally ‘tight’ or extends unusually further forward, occasionally reaching to the tip of the tongue, which may prevent full movement of the tongue. This may then mean that the baby may not be able to ‘stick his /her tongue out’ as if to lick an ice cream.
How does a tongue tie affect breast feeding?
The tongue plays a very important part in enabling a baby to latch properly at the breast. By extending the tongue out over the lower gum and lip, the mother’s breast tissue is cushioned from the movement of the lower gum compressing her milk ducts during the action of suckling. In addition the tongue performs a ‘wave like’ milking of the breast to help the baby extract the milk from the breast.
If the baby is unable to fully extend the tongue because of the tongue tie, the baby may have difficulty in latching or maintaining the latch, and the mother may experience pain or un-resolving nipple soreness during feeding, as the tongue will not be able to cushion the breast from the lower gum, and will cause friction from disordered movement during suckling. Further patterns may then develop because the limited tongue movement may mean inefficient transfer of milk from mother to baby, resulting in a hungry baby who feeds frequently.
Does tongue tie always cause feeding problems?
The honest answer is NO!
Some babies with tongue tie are able to breast feed well without any difficulties at all, others do experience problems, and occasionally some babies will have difficulty with bottle feeding.
Sometimes with time and movement of the tongue, the frenulum may loosen a little, and difficulties resolve spontaneously.Your Midwife or Breast Feeding Coordinator, will be able to show you how to position your baby correctly at the breast, in order that your baby can extend his/her neck adequately, to ensure use of the tongue is maximised during feeding, which may be enough to breast feed successfully.
However, sometimes it may be necessary to cut the tongue tie in order to allow baby full and sufficient tongue movement to feed effectively.
How is the tongue tie cut?
Division of a baby’s tongue tie is a quick simple procedure. A small amount of local anaesthetic gel may be applied to the frenulum on a small cotton wool roll, the tongue is then gently lifted by the surgeon to enable good vision of the frenulum, and then using a sterile pair of scissors the tie is then cut.
There may be a few drops of blood, which usually stop very quickly. The wound heals rapidly and some babies may be left with a small white patch under the tongue, which may take 24-48hours to resolve.
Some babies sleep through the procedure, some cry a little, more from being held still than the actual procedure - average crying time is around 15 seconds. You may hold your baby throughout, or if you wish the Breast Feeding Coordinator will be present and can hold your baby for you, whilst you wait outside the room.
You will be able to breast feed your baby within minutes of the procedure, and may notice a difference in feeding straightaway, as your baby learns to make full use of the tongue.
Are there any other factors to consider when deciding whether to opt for surgical treatment of tongue tie?
There has been extensive audit and follow up of babies whose tongue tie has been divided, in particular by Mr. Mervyn Griffiths, Consultant at Southampton General Hospital, and a similar audit by Mr Graham Smith, at Kingston Hospital, confirmed that there have been no difficulties reported in connection with the procedure.
Most babies with tongue tie will learn to speak without any problems, but occasionally limited tongue movement may cause some difficulties with some speech sounds. These difficulties are not predictable, but by the time they are noticeable at the age of about 1-3 years, it would become necessary to cut the tongue tie under a general rather than a local anaesthetic.
How do I arrange to have my baby's tongue tie divided?
Following discussion with a breast feeding advisor you may choose to have your baby's tongue tie cut. This can be done at Parkside Hospital, in Mr. Graham Smith's clinic, usually on a Friday morning. Mr. Smith is Consultant Oral Maxillo/facial Surgeon at Parkside. It is possible that a Breast Feeding Coordinator will also be present, not just to give support through the procedure, but to also arrange and advise on follow up care.
At present, referral of your baby to Mr Smith can either be arranged by:
- Your G.P. - NHS G.P. referrals now take about 2 to 6 weeks.
- Yourself - this will be as for private treatment via Mr Smith's secretary :-
Mrs Angela Eburne
Mobile 07709 617 100
Mon - Fri
Self funding cost is £170, however this procedure is covered by medical insurance companies
It is intended that babies are treated as soon as possible after referral, hopefully no longer than one week's wait.