Tongue tie (or Ankyloglossia to give it its proper name) is a condition where the piece of skin (frenulum) under the baby’s tongue is short, and can stop the tongue from moving properly. Although it does not always cause a problem, some babies can have difficulty with breastfeeding, as the baby cannot take enough of the breast into his/her mouth.
PROBLEMS WITH BREASTFEEDING MAY INCLUDE
- Not latching on properly
- Falling off the breast easily
- Sore nipples for mum
- Baby does not gain much weight
- Seems to want to feed constantly
Poor drainage of milk can lead to MASTITIS (click here for information on Mastitis)
WHAT CAN BE DONE TO CHANGE THIS?
If you are having the above problems, and think your baby has a tongue tie it will need to be reported to your GP, midwife, health visitor or peer supporter. They can then refer your baby to a specialist infant feeding clinic for it to be looked at. Royal Preston hospital offers a tongue-tie clinic where they are seen by the Infant Feeding Specialists and a Paediatrician (children’s doctor). Young babies can actually have the tie snipped by a doctor if they feel it is necessary and in most cases it helps the baby to feed better.
HOW IS IT DONE?
Once the baby has been seen by the Paediatrician they then return to a special ENT (ear nose and throat) session and a Surgeon snips the tongue tie with sterilised scissors. The procedure actually lasts only a minute, and research shows that some babies have actually stayed asleep whilst having it done, so there is no proof that it actually hurts them! As soon as the operation is over, your baby is returned to you for feeding, as this is the best way to comfort him/her. A few drops of blood may be seen and this is normal, but the inside of the mouth heals quicker than any other part of the body, so all baby needs is to be fed and cuddled. You may see a small white patch under the tongue where the tie was snipped but it does not seem to cause any discomfort.
THE FUTURE
In a recent study of babies who had been given the tie snip, it was found that 80% of mothers reported better breastfeeding within 24 hours. Not all babies who have a tongue tie will need surgery to correct it, it will be based on how bad it is, but it may help your baby to breastfeed more easily.
Written with guidance from “division of Ankyloglossia (tongue-tie) for breastfeeding” (NICE 2005) and Lancashire Teaching Hospital’s Trust “infant tongue frenulotomy service care pathway” (2007)
7 responses so far ↓
kristy // Apr 25, 2008 at 8:46 pm
both my children are tongue tied. with my son he couldn’t suck at all and i wasn’t able to breast feed him, i expressed and used to seringe the milk in to his mouth until he learnt to suck on a bottle, adapted. his tongue tie was never noticed until i had my 2nd baby, he was two years at the time. when i had problems again feeding my 2nd baby we noticed she was tongued tied, this was the 1st i ever herd about it, checked my son and everything fitted in to place! when they stick out there tongues there heart shaped. i fed my daughter til her 1st birthday, but not the easyest of ways and i did have alot of trouble in the start with latch, as she couldn’t latch on very well really.
my mum said i had it to! never knew that til i had problems with my daughter.
my next babys due in 12 weeks time, so guess we’ll see if this baby is also tongue tied. but i now know i can feed a tongue tied baby so i feel ready for the battle.
my son was quick to start talking btw but he slowed down and stopped at around 2, when he was 3 he picked up again. my dauhgters only 15mths so can’t comment on her speach yet.
Brian Palmer, DDS // Apr 12, 2008 at 4:06 pm
[Following is a letter Dr. Palmer received from a mother describing the life changing experience her son had because he had a frenectomy. This is a true, but a very frightening story, because it illustrates what little healthcare providers know about frenulums/frenums.]
January 24, 2008
Dear Dr. Palmer,
I wanted to thank you and tell you my son’s story. My son was born in Feb. 2001, and by 22 months was only saying one word: go.
It was clear to my husband and I that he was very intelligent, but we worried. His doctor recommended that we have him evaluated by Early Intervention. When the speech evaluator visited, I brought up the subject of Connor’s tongue. I had noticed that, when he stuck his tongue out, it never really extended out of his mouth, and I wanted to know if that could be causing the speech problem. She said that it would have no effect. I was a bit confused by that, but deferred to her “expertise.”
He was assigned a speech therapist who came twice a week. After three months with no progress, she said to me “Have you thought about getting his tongue checked by an ENT doctor?” I was furious that she had waited three months to mention it, and mad that the evaluator had dismissed my concerns.
At this point, he was 26 months old. I took him to an ENT doctor to be checked. She told me that, yes, he had a tight frenum, but that there was “no established literature” about the effect on speech, and that it would have no effect. She suggested that I might want to get it fixed before his teen years “so that he would be able to kiss properly,” and even suggested that I have it done by a dentist in the dentist’s office! It was clear to me that she wanted no part of giving me a diagnosis of any kind or providing any treatment to my son.
I immediately started talking to everyone that might know something about it, and searching the internet. My Early Intervention coordinator gave me a phone number of a couple who had been told to wait a year to perform the operation, and regretted it. I also found and downloaded your frenum document (2003).
Between those two inputs, I was given the courage to stand up to the doctor. I went into her office and said “I want this surgery done, and I want you to do it as soon as possible.” She did not argue, and scheduled the surgery for the following month. It was performed without a hitch. For six weeks, he didn’t utter a single sound. He was constantly moving his tongue and mouth around with a fascinated look on his face - exploring his new possibilities.
Meanwhile, my son was up to his neck in therapy of all kinds. His new speech therapist was telling me that my son was severely autistic and would never function in a normal classroom. The therapist advised me to take him to a neurologist. Fearing that I would be accused of negligence if I didn’t, I took him to the neurologist. The appointment occurred during my son’s six weeks of silence following the operation. The neurologist immediately discounted the speech therapist’s opinion because “it’s clear to me after two minutes with him that he understands every word I’m saying.” He was very alarmed at my son’s lack of speech. When I explained everything about the tongue and the recent surgery, the neurologist said “That’s irrelevant.” He wanted to hospitalize my son overnight for heavy testing. I refused, and he was not happy about it.
In the meantime, after the six-week silence, my son started using every word in the book. He’s now turning seven, and you can’t keep him quiet for five seconds. I have received comments from teachers that his vocabulary and diction are excellent. It took us two more years to completely escape the well-meaning machine of special education, thankfully just before he started kindergarten. He is currently ahead by two years in reading and math skills, has many friends and is a joy to us.
I cry whenever I tell this story, from great relief. If I had not seen your presentation, talked to the right people and stood up to all the various doctors and therapists, I am terrified to think what might have happened to my son, and what might be happening to countless other kids. Please continue to do whatever you can to spread the word about these issues. If you reach even one other parent like me, it’s worth it.
Thank you, thank you, thank you. I can never thank you enough.
MR in NY
Brian Palmer, DDS // Apr 12, 2008 at 4:04 pm
April 12, 2008
I have 2 presentations on tongue-tie on my website that might be of interest to some. I just presented in Leeds at the LCGB conference on March 28. Links are:
http://brianpalmerdds.com/frenum.htm
http://brianpalmerdds.com/bfeed_frenulums.htm
Brian Palmer, DDS
Kansas City, USA
dena smiles // Apr 6, 2008 at 9:46 pm
Regarding Sharon Breward’s response (above) about the NICE guidelines stating” a suitably qualified health professional” being able to perform the TT snip; is it correct that Midwifes used to routinely perform this in hospital? since the onslaught of bottle feeding whereby the Infant can be less active in the use of it’s tongue- we don’t check anymore.
This meant many sad and frustrating nights for me, I still look at my wee girl (30 months now) and wish my start with her hadn’t been so distanced. I struggled feeding her and knew something was wrong, I had already fed, in varying conditions and circumstances,
my 4 other children.
I knew she wasn’t getting my milk, it was there alright, I had to pump it out of me around the clock- she just couldn’t access it.
The breastfeeding support Midwife told me there was nothing wrong with her feeding technique, or my positioning etc. but She didn’t checked for TT.
I remembered a time when some friends had their first child, the difficulties Jeanie faced in feeding her daughter seemed to be the same as what was going on with me and Suki, my little hungry bird.
Jeanies daughter was TT.
I checked Suki’s tongue and yes it was a short little heart. I went to the GP and got an appointment with the Paediatrician who is in great demand as he only does 1/6wk visits.
My Midwife could have easily performed this job, the little snip that released us both together into nurturing harmony.
Instead I had to wait 5 weeks of pumping out, sat with gritted teeth only wanting to feed my baby.
If breastfeeding is to be supported then we have to look at all and everything surrounding it. That’s very big, so lets start with the tongue! It’s the way we speak, what we say comes from who we are, the way we were nurtured.
Thanks for the site! I’m a new student midwife
Sudha Chandrasekhar MD FAAP IBCLC // Mar 26, 2008 at 1:25 am
Im a pediatrician and IBCLC in the US. I do frenotomy for partial ankyloglossia (tongue tie) as an easy outpatient procedure in my office in the newborn period. They need to be referred to the ENT only if they are older and the tongue clipping is being done to correct a speech impediment. My LC uses the Hazelbaker scoring tool to assess the baby’s need for frenotomy prior to the procedure. We have had tremendous success and no complications so far. Dr Sudha
sharon breward // Mar 16, 2008 at 1:07 pm
great website ladies!
however could i ask you to consider amending your info re tongue tie a wee bit?
the info gives the impression that it has to be a dr or surgeon that releases a TT.
NICE stated “a suitably qualified health professional” could do it & there are a number of Infant Feeding Specialists/mw’s/even the odd HV that have trained to do this procedure.
It would be good if the website info could reflect this so as not to give the impression that it is solely a job for a doctor.
e.g In our area the TT babies do not need to see a paed - if a TT is picked up & is thought to be causing problems then the babies are referred to me at the bf clinic
again thanks for a lovely website
best wishes
sharon breward
IBCLC
Ruth LLL Leader // Mar 15, 2008 at 4:26 am
One easy way to see if your baby has tongue tie is that the tip of the tongue looks like the top of a heart…the way a heart dips in…and baby has trouble extending the tongue.
Do get your baby checked as soon as you can. It’s much easier when baby is new!
Good luck and congrats on a terrific site!
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