My baby has a tongue-tie
What is a tongue-tie?
A tongue-tie or ‘ankyloglossia’ is present at birth and occurs when the frenulum (which is a thin piece of skin beginning midway along the underneath of the tongue attaching it to the floor of the mouth) is misplaced and begins at the tip of the tongue instead, or is thicker or shorter than usual. It occurs in four to five per cent of babies. It is often seen during the first check by the midwife following birth, or if the baby is having difficulties attaching to the breast during feeding. In severe cases the tongue is often pulled into a square shape or is found to be forked at the tip (a shape rather like the top of a heart). You may also notice that your baby is unable to protrude their tongue beyond their lips.
Tongue-tie often does not cause the baby any problems, but if it is severe can affect breast feeding as the baby is unable to extend the tongue forwards enough to be able to cup the breast and suck rhythmically. As they grow up, an affected child may have problems with speech impediments and/or dental problems due to the inability to move the tongue around the mouth and lick their teeth. Even licking an ice-lolly can be problematic.
The condition is found more commonly in boys than girls and has a tendency to run in families, so you may find that your baby has relatives who were also born with a tongue-tie.
Is tongue-tie a problem?
This will very much depend on the extent of the tongue-tie. If the tongue tie does not interfere with breast feeding there is a school of thought who believe it is best not to divide the tongue tie as the tip of the tongue will grow as the baby gets older and will not cause any problems.
Can tongue-tie be treated?
If the tongue tie interferes with breastfeeding a paediatrician or specialist midwife with training can perform a simple procedure of cutting the tie – called a frenulotomy. Research studies have shown that frenulotomy is a safe procedure for babies and is beneficial to successful breastfeeding. It is a minor surgical procedure which literally takes only seconds to perform.
What does a frenulotomy involve?
- Your baby’s tongue-tie will be assessed to see whether it is appropriate to perform a frenulotomy. The paediatrician or specialist midwife will explain what is involved and will gain your informed consent before dividing the tongue-tie
- You will need to cuddle your baby firmly to stop them wriggling around and the specialist midwife/paediatrician will show you the best way of doing this. Alternatively, you may prefer that someone else holds your baby still for you
- The paediatrician or specialist midwife will wear sterile gloves and use sterile scissors and swabs (small pieces of sterile gauze). The tongue-tie is divided using a special pair of scissors which have blunt ends and a curved blade. It is easy to divide the tongue-tie because your baby does not have any teeth
- The baby’s tongue is held upwards and the tie divided with one snip with the sterile scissors. The procedure takes just a few seconds and the baby is quickly encouraged to latch at the breast following the division. This will comfort them and also prevents the edges of the cut from knitting together and healing over again
NB. Your baby’s tongue does not need to be numbed with local anaesthetic because the frenulum has a poor nerve and blood supply. Also, giving your baby an injection of local anaesthetic is likely to be more uncomfortable for them and prolongs the whole procedure. If your baby’s tongue was numbed the effects would probably last for awhile and there is the concern that they may not want to breastfeed afterwards
In the majority of cases there is no bleeding when the tongue-tie is divided. Very occasionally, there is some bleeding but the paediatrician or specialist midwife will press against the cut with a small gauze swab. The wound heals very quickly following this procedure
Will my baby be distressed?
It is important to remember that crying is the only means of communication for your young baby. Some babies do cry during the procedure because they dislike being held still, or having their mouth held open. A number of babies also cry even before the tie has been snipped, but this is no more than the crying often heard during a nappy change. Some babies also sleep through the entire procedure from start to finish!
What will the cut look like afterwards?
The day following the frenulotomy, or a couple of days afterwards, the cut is likely to look rather like a white ulcer or blister on the underside of your baby’s tongue. Studies seem to indicate that this ulcer/blister is painless and should not stop your baby from breastfeeding. However, your baby’s mouth is not sterile, so it is best to avoid introducing potential infection from dummies, nipple shields or teats until the frenulotomy site has healed – this usually takes only a few days. If the white blistered/ulcerated area starts to develop a greenish tinge, or if your baby seems ‘out of sorts’ or not interested in breastfeeding, you should always contact your midwife, Health Visitor or GP immediately for their advice.
Most maternity units will provide follow-up after the frenulotomy, unless parents request otherwise. This is usually in the form of a telephone call one month following the frenulotomy, to check that all is well and to see whether there has been an improvement in your baby’s feeding.