Tongue tie is not the modern day infant feeding ‘fad’ that some believe. It is mentioned in ancient texts such as the Bible and an obstetric text book from the 1600’s, as well as in documentation about the French King Louis in 1610 having his tongue tie divided shortly after birth. Some consider that it is one of a handful of historical procedures that is still carried out in the modern day.
With the invention of formula milk, any issues with breast feeding and latch were easily solved by recommending bottle feeding; a bottle teat can’t feel the pain of a poor latch! There was also a social lean for decades towards bottle feeding in Britain. More recently the issues surrounding a tongue tie & their impact on feeding have been brought to the attention of parents, whether breast or bottle feeding, by stronger modern-day communications & health promotion. There is social media, parenting groups and a higher rate of new mother’s choosing to breastfeed due to the health benefits of breast milk being more widely known. Parents can be at home and yet have a wealth of knowledge & support for their infant feeding journey at their fingertips via the internet. In the UK as practitioners we do try non surgical solutions before recommending a tongue tie division such as positioning and attachment advice. A division should only be indicated after a thorough feeding history and oral assessment by a person trained to assess for tongue ties. Only registered health care professionals (Nurses, Midwives, Dentists, Doctors etc) should be performing the procedure as they would then be registered with the Care Quality Commission (CQC). Parents should ensure their provider is CQC registered for safe, effective and high-quality care.
A tongue tie is basically when the lingual frenulum joining the underside of a tongue to the floor of the mouth is too short, too tight and over developed to allow normal movement of the tongue. We all have a frenulum, but they should not restrict our tongue movement. The tongue requires good elevation and extension to allow the tongue movement needed to breastfeed. When the jaw drops (needed for a deep latch) a tongue that is tied will not lift high. That baby will then struggle as a wide deep latch doesn’t mean milk, they will adapt to a shallower latch that allows their tongue to move. This shallow latch causes nipple trauma, milk transfer issues and is inefficient. This impaired tongue function also causes issues for bottle fed babies with sealing the teat and controlling milk flow.
Symptoms for a breastfeeding mother may include:
- Sore damaged and misshapen nipples
- Pain during feeds that does not improve with positioning and attachment
- Re-occurring engorgement, mastitis, blocked ducts and blebs
- Low milk production or what appears to be an abundant milk production/engorgement due to ineffective milk transfer by baby
- Exhaustion and anxiety from frequent and prolonged feeding
- Clamping or grazing sensation during feeds
Symptoms for baby may include:
- Difficulty or inability to attach to the breast
- Frustration at the breast or ‘bobbing’
- Frequent slipping off the breast
- Excessive weight loss or slow gain
- Static weight gain at around 3 months old
- Falling asleep from exhaustion during a feed rather than fullness
- Prolonged, frequent or fussy feeding
- Unsettled between feeds
- Clicking noises / grinding / gumming / chewing of the nipple whilst feeding
- Symptoms of wind / colic / reflux
- Coughing or choking whilst feeding
Babies who bottle feed may experience:
- Long feeds
- Inability to create a seal around the teat leading to excessive dribbling of milk
- Noisy, clicking, lip-smacking during each bottle feed
- Slow or no weight gain & weight loss
- Symptoms of colic and /or reflux
- Early breastfeeding difficulties
Tongue tie division (frenulotomy) can be performed in a home or clinic setting and is considered safe and low risk by the National Institute of Clinical Excellence. The procedure itself is very quick. The baby is wrapped securely with their head and shoulders held still. If parents are present, they can speak to the baby to soothe them (if they are not then the practitioner and their assistant would do this). The tongue is lifted to expose the tie and a pair of sterile scissors is used to divide the tie. Numbing of the area is not required. Sterile gauze will be used to press on the site and your baby will then be given to you to cuddle and feed. There is a small amount of bleeding, but this is usually minimal, lasting 2-5 minutes. Babies can be unsettled in the initial 24-48 hours but are soothed with frequent feeds and cuddles. Liquid paracetamol can be given in babies over 8 weeks old but is generally not decided as necessary by parents. Should a baby need the procedure the practitioner will explain their assessment and the procedure in full detail. Speaking to parents who have had their baby’s tongue tie divided to improve infant feeding is a good idea as it can lessen anxiety surrounding the procedure.