Tongue-tie occurs when tongue movement is restricted by the presence of a short, tight membrane (known as the lingual frenulum) which stretches from the underside of the tongue to the floor of the mouth. This strand of tissue is visible when the tongue is lifted and is a normal part of anatomy. However, when it is short, tight, and inelastic, extends along the underside of the tongue or is attached close to the lower gum it will interfere with the normal movement and function of the tongue and is a tongue-tie. It is more common in boys (2:1) and 1 in 7 babies will be born with a tongue tie.
There are a few ways of classifying tongue ties, the most obvious is dividing them into "anterior" and "posterior" ties. Anterior ties are easily visible, often they cause the tongue to have a typical heart shape. Posterior ties are not as simple to spot as they are often embedded and need to be diagnosed by a professional trained in diagnosing and treating Tongue Ties, such as a lactation consultants, some ENT doctors, some specialised dentists.
Some signs of Tongue Tie are: cracked nipples, misshapen, white nipples, painful latch and engorged breasts. Baby's symptoms can be: white membrane visible under tongue when crying, heartshaped tongue, inability to open their mouths wide, tongue mobility is restricted (baby can't stick his tongue out), slow weight gain, clicking sound during feeds, sucking cheeks in, gulping and spluttering, very windy and colicky, screaming after a feed, fussy on the breast, sliding off during a feed, needs repositioning, dribbling down the side of the mouth and others.
Some Tongue Ties are, even when very visible, asymptomatic and require no treatment. Some mild cases might resolve when baby grows and can feed more efficiently.
The criteria for treatment are feeding difficulties. If the mother has received breastfeeding support and correcting latch and positioning don't have enough effect then surgical treatment as soon as possible is advisable. This will help mothers to continue breastfeeding instead of switching to formula.
When performed on a newborn up to 5 months the surgical treatment is usually performed without anaesthetic and is usually very well tolerated. The baby is swaddled and head and shoulders need to be held to minimise movement. The frenulum is cut with single use sterile surgical scissors. There should be minimal bleeding and it is encouraged to breastfeed (or bottlefeed) baby straight after that for comfort but also so that the tongue can press down on the wound. Complications such as prolonged bleeding or infections are very rare and most babies tolerate it very well. If baby is older than 2 months it is permissible to give paracetamol before and after the procedure, it may not be necessary.
Aftercare includes keeping the site very clean, do not let baby suck fingers that haven't been washed thoroughly with soap, if baby uses a dummy or bottle, make sure it is sterilised. There are gentle exercises the parents should do with the baby to encourage tongue movement after the procedure. Making sure a deep latch is practised after the procedure is a good way to keep the tongue moving. Unfortunately between 2-4% of the cases will reattach and will have to be revised if the symptoms return.
Divison of a Tongue Tie is not a magic fix and practicing a good latch and attachment has to be practised at the same time. It can take a few weeks to see the full results while baby is learning to use the tonge correctly.
I will not perform a Tongue Tie divison unless the baby has had either the Vitamin K injection or at least 2 doses of Vitamin K orally if the baby is under 6 weeks old.