Short on time? Then the key things to know are:
- A tongue tie is when the piece of skin that attaches your tongue to the floor of your mouth is shorter or tighter than usual.
- Having a tongue tie cut is not always a golden ticket to easy feeding. Getting support to rectify the concerns before and after surgery is essential.
- Not all tongue ties need surgery, some can be sorted with non-surgical methods and support with your latch and breastfeeding.
Tongue tie is an oral condition that can affect babies from birth. Some babies aren’t bothered by it however it can sometimes impact their ability to feed from the breast or bottle.
Here we share the signs of tongue tie as well as treatment options and what to do next.
What is tongue tie?
Most of us have a piece of skin that attaches our tongue to the floor of our mouth. This is called a lingual frenulum.
A tongue tie (ankyloglossia) is when this piece of skin is short, tight, attached right at the tip of the tongue and / or the gum line, and causes a restriction in movement and function.
What are the symptoms and signs of tongue tie?
Here are some of the signs of tongue tie. It is important to note there may be other causes of these symptoms and therefore it’s best to get skilled breastfeeding support (whether that’s through the NHS, a breastfeeding support group, the national breastfeeding helpline or a Lactation Consultant) to complete a thorough assessment of feeding with you and your baby.
- Concerns and issues with latching your baby on
- Sore nipples and/or damaged nipples
- Pain when feeding
- Nipples which look like a lipstick shape after a feed / mis-shaped nipples
- Nipples which are white or compressed after a feed, and pain after feeds
- Low milk supply/ reducing milk supply
- Recurrent blocked ducts/mastitis due to poor milk removal
- Constant, frequent feeding (feeds can be excessively long, or very short)
- You may hear a clicking noise
- Your baby may dribble lots during a feed
- Your baby may have a ‘chompy’ or ‘bitey’ sucking technique
- Your baby may find it difficult to stay latched onto the breast or the bottle. You may find your baby is coming on and off the breast regularly throughout a feed.
- Feeds may be frequent and very long as babies are not able to remove all the milk they need. These babies can also be sleepy on the breast as they are working very hard to extract milk and this can also affect milk supply in the long term.
- Your baby may experience colic type symptoms
- Your baby may be very windy and have frequent hiccups
- Your baby may have difficulty sticking out or lifting their tongue.
- Your baby’s tongue may look heart-shaped when they stick it out.
How does tongue tie impact breastfeeding?
Having one or more of these signs and symptoms, and even having a tongue tie diagnosed by a professional, does not necessarily mean that the tongue tie is negatively impacting breastfeeding.
It is very distressing when breastfeeding is not going well and can feel overwhelming trying to work out the cause. An experienced practitioner can assess a breastfeed alongside examining the baby's mouth in order to make a judgement about whether there is a tongue tie which is restricting tongue movement and negatively impacting feeding.
They will then be able to work with you to make a plan, provide you with information, support you and make any referrals that might be needed.
What are your options?
Depending on the severity of the symptoms and the findings from the assessment of the tongue tie, you may be given some non-surgical strategies to help manage and improve breastfeeding, or you may be advised that a surgical procedure is the best option.
It can be a good idea to start with the less invasive management strategies to see if things improve, and if they don't then proceed to a referral for surgery. Your breastfeeding professional will discuss all this with you.
How to manage tongue-tie
- Support with positioning and attachment: exploring positions that encourage a deeper latch, laid back positions, exaggerated latch, and compressions can help with some of the signs and symptoms of tongue-tie.
- Cranial osteopathy can help release any tightness in the jaw which can have a positive impact on tongue movement. It can also help relieve symptoms of colic and reflux.
- Tongue exercises to help your baby experience and explore a greater range of movement. This can also be useful post-surgery.
- For those who may be feeding from the bottle as well as the breast: mimic breastfeeding by ensuring a wide mouth on the bottle, pacing the feed and feeding responsively.
Surgical treatment for tongue-tie
Surgery can sometimes be the best option for tongue-tie. There are a variety of terms used for this surgery including tongue tie division, frenotomy, frenulotomy.
The surgery involves cutting the short, tight frenulum with sharp, sterile scissors with blunt ends. It is usually done without anaesthetic when done in the first six months.
You can be referred through the NHS and it will be done in your local hospital by a surgeon, midwife or Lactation Consultant. There is often a private option through the NHS.
Alternatively you can see a Lactation Consultant who is also a Tongue Tie Practitioner privately. They will either see you in their clinic or come to your house.
Tips for tongue tie surgery:
- If your baby is having a frenotomy you will be asked not to breastfeed for 2 hours before the procedure.
- The practitioner will talk you through everything before they proceed and you may be able to stay in the room whilst the procedure is undertaken, or be asked to wait in a room nearby.
- Your baby will be swaddled and their head held still while the procedure is performed.
- Your baby will then be given straight to you for a breastfeed which will help calm your baby and compress the wound. Breast milk has pain relieving components too.
- There may be some bleeding initially.
- As the wound heals it appears like a white diamond shaped ulcer.
- You may be given tongue exercises to do post surgery.
For further information on research and risks associated with this procedure take a look at the NHS or NICE website. It is always important to be fully informed before consenting to any surgical procedure.
When choosing someone to perform the frenotomy it is important to make sure they are well qualified and fully insured. You could look at the Association of Tongue Tie Practitioners (ATP) website for more information.
What is a lip tie?
A lip tie is the membrane that connects the inside of the upper lip to the gum.
A lip tie is a normal part of anatomy for all babies. Lip ties are there to provide stability and a gap for adult teeth.
Does a lip tie impact breastfeeding?
At present there isn’t any published research supporting the idea that lip ties are associated with feeding issues.
The general consensus of breastfeeding specialists and tongue tie specialists is that lip ties are a dental concern and not a feeding concern.
However it may be helpful to know that when breastfeeding is going smoothly, we would not expect to see the upper lip flanged.
Flanging of the upper lip could be your baby compensating for a poor latch, due to positioning and attachment or possibly due to tongue tie. Therefore if you see flanging of your baby’s upper lip, you may wish to seek skilled breastfeeding support to help you to improve or adjust feeding to be more comfortable and effective for both you and baby.
Got any questions about tongue tie? Book an appointment online with our lactation consultants who can provide specialist advice and help with any concerns you have about breastfeeding.
Lizzie, Naytal Lactation Consultant
Lizzie is an experienced IBCLC and qualified Midwife. She provides holistic and in-depth breastfeeding support for women and their families.