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Tongue Tie Assessment & Division (Frenulotomy)

What is tongue tie (ankyloglossia)?

Tongue tie is defined as ‘ a congenital anomaly characterised by an abnormally short lingual frenulum, which restricts the mobility of the tongue’ (NICE 2005)

This means that some babies are born with a tighter than usual piece of skin between the underside of their tongue and the bottom of their mouth. As the lingual frenulum is shorter than usual, the tongue movement is restricted. it can run in families, occurs more in boys than in girls and when babies are born prematurely.

How do I know if my baby has it?

Sometimes it is possible to see that the lingual frenulum is tight and appears to restrict the baby’s tongue movement. Other times it is not visually obvious and the mother may be experiencing difficulties and/or pain with feeding the baby.

Occasionally soon after birth, a midwife or doctor examining your baby may have suggested to you that your baby has tongue tie. However until you baby has been feeding for a few days, it is not possible to know if it is significant or not.

How can my baby’s feeding be affected?

Tongue tie can affect both breast and bottle feeding. The effects are often more obvious with breastfeeding. Due to the tongue movement being restricted, often the baby finds it difficult to ‘latch’ onto the breast and/or cannot maintain the ‘latch’ on the breast – the baby slips off frequently causing nipple pain/damage, breastfeeding takes a long time and occurs frequently. Baby may appear restless, unsettled and hungry. Eventually weight gain could be affected.

If bottle feeding the baby also may take a long period to time to feed or drink only small amounts or dribble lots of milk when feeding.
(It is important to note however that these issues may NOT be caused by tongue tie and therefore full consultation needs to be undertaken. It is also possible that performing frenulotomy affords no change or improvement to feeding)

How is it treated?

If your baby is diagnosed with tongue tie which is affecting their feeding, then the usual treatment is for the tight lingual frenulum under the tongue to be separated or divided releasing the tongue to be able to move normally. This is called frenulotomy or tongue tie division.

Frenulotomy is the medical name given to separating, dividing or cutting the lingual frenulum under the tongue. It is a simple procedure which can be performed safely on young babies without anaesthetic.

What can I expect if I attend for a tongue tie assessment?

Tongue tie appointments at the clinic last 60 minutes. The first 20-30 minutes includes observing your baby feed if possible and assessing your baby’s mouth and tongue. The examination will assess the appearance of the lingual frenulum and the functionality of the tongue’s movement. To undertake this examination the baby will be placed on the couch, wrapped in a towel and an over head light will be used to examine your baby’s mouth.
The results of the assessment will then be discussed with you.

The following 30 minutes depends on whether frenulotomy is indicated or not. If frenulotomy is indicated and performed, this will take the rest of the appointment time, around 30 minutes. Should frenulotomy not be indicated parent(s) can either leave after the results discussion or decide to stay 30 minutes for further infant feeding discussion and advice.

Immediately after frenulotomy procedure the baby will need to be fed either breast or bottle. Parents will be advised to leave the clinic only when any bleeding has stopped and the baby is calm. Parent(s) can be present throughout the whole appointment.

Important Note: During the frenulotomy, one parent (or appropriate accompanying adult) will need to hold the baby’s head still during the procedure. This is very simply to do but some parents are not comfortable performing this role. Please decide this beforehand and bring another adult family member or friend who is willing to the appointment.

Are there any risks associated with frenulotomy?

The risks and complications of performing frenulotomy are very small and rarely occur. However, it is important that parents are aware of them. They are:

•   Pain immediately after the procedure which could cause the baby to be unsettled for 24 to 48 hours
•   Small amount of bleeding immediately afterwards is usual on occasions this could be heavier than usual
•   Infection in the wound site
•   Sometimes the tongue tie can reform.

Whenever frenulotomy is performed at the clinic, parents will be given full information on how to prevent complications occurring and on what to do should any of them occur.

What criteria must be met to be suitable for the procedure?

  1. The person attending the clinic with the baby must be the legally recognised parent or guardian of the baby.
  2. The baby can be fed either by breast, bottle or both.
  3. Should frenulotomy be offered, the baby needs to have previously had vitamin K immediately after birth either orally or by injection. (Vitamin K is offered routinely immediately after birth in the UK).
  4. Babies need to be between 3 days and 8 weeks old. It is possible for babies outside of this age to be assessed but it is unlikely that the procedure will be offered and performed.

Meet the midwife: Louise Armstrong

Louise has been a specialist midwife with a special interest in infant feeding for over 30 years. She has worked both in clinical practice and university midwifery education.

She qualified as a registered nurse in 1984 in Sheffield before undertaking her midwifery education at St Mary’s hospital in Paddington, London. Right from the beginning of her midwifery career, Louise developed an interest in infant feeding and helping mothers get breastfeeding off to a good start.

Pursuing her interest and passion in helping mothers with their choice of infant feeding, Louise trained to Masters level in the practice of frenulotomy (tongue-tie division) at the University of Wolverhampton. The clinical practice was at the tongue-tie clinic in the Russell Hall hospital in Dudley which is one of the largest specialist clinics of its kind in England.

Louise is a member of the Royal College of Midwives (RCM), the Association of Tongue Tie Practitioners (ATP) and an associate member of the lactation consultants UK.

Fees:

Tongue tie assessment: £75.00 – Full appointment time is 60 minutes, with the assessment usually around 30minutes of this allocated time. Please be aware that if you have had an assessment at another clinic you will still need this appointment with our midwife to ensure there are no differences in opinion. The treatment is charged in addition to this fee.

Frenulotomy: £145 – this can be done in the assessment appointment.

Additional infant feeding advice: £30.00 – should frenulotomy not be indicated parents have the option of additional feeding advice for 30 minutes. This cannot be booked as a stand alone appointment.

Follow up call after the procedure: FREE – this is usually made around 10-14 days after the procedure.

This Tongue Tie and Frenulotomy service is regulated by the CQC.