What is tongue-tie?
Under everyone’s tongue is a small fold of tissue called the lingual frenulum. In some babies it is short, thick or attached close to the tip of the tongue, which can stop the tongue lifting and moving forward properly. This is called tongue-tie, or ankyloglossia.
Dr Tina sees newborn babies up to six weeks old. Many babies with a tongue-tie feed perfectly well. For others, the restricted movement makes it hard to latch and feed efficiently, which can be tiring for the baby and painful for a breastfeeding parent.
Fig. 07 · Tongue-tie
What a tight frenulum changes.
- ITight frenulumA short band under the tongue holds the tip down, which can make it hard to latch and feed.
- IIAfter releaseOnce the band is released, the tongue can lift and move forward more freely.
- IIIWhat we assessHow far the tongue lifts, extends and moves from side to side, and how your baby feeds.
A quick procedure, with feeding straight afterwards.
Signs it may be affecting feeding
In your baby:
- Difficulty latching, or slipping off the breast or bottle
- Clicking sounds during feeds
- Very long or very frequent feeds, or seeming hungry soon after
- Poor weight gain
- A tongue that looks heart-shaped when lifted, or cannot lift towards the roof of the mouth
For a breastfeeding parent:
- Sore, cracked or misshapen nipples after feeds
- Low milk supply or engorgement
These signs can also have other causes, so it helps to be assessed by someone who looks at the whole feed, not only the tongue. If you are working with a midwife or lactation consultant, bring their notes with you.
How the assessment works
Dr Tina will ask about your baby’s feeding, weight and general health, then gently check how the tongue lifts, extends and moves from side to side. If possible, she will watch a feed. She will then explain whether the tie is likely to be contributing to the feeding difficulty and whether release is likely to help, or whether other support may be the better first step.
If release is recommended, you can decide in your own time. Nothing is done on the day without your agreement, and you receive the fee in writing first.
The procedure (frenotomy)
A frenotomy is a quick procedure in which the tight frenulum is released so the tongue can move more freely. It usually takes only a few minutes. Your baby is swaddled and held securely, and you can be close by throughout. Dr Tina will explain beforehand exactly how the release is carried out and how your baby will be kept comfortable.
Straight afterwards, we encourage you to feed your baby. This settles them and helps stop the small amount of bleeding that is normal.
Aftercare
- A small white or yellow patch under the tongue is normal while it heals and is not a sign of infection
- Your baby may be a little unsettled for a day or two
- Some babies feed better straight away, while others take a few days or longer to adjust; ongoing feeding support often helps
- Dr Tina will tell you about any aftercare she recommends and when to come back for a check
Contact us straight away if there is bleeding that does not stop with gentle pressure and feeding, if your baby refuses to feed, or if they have a fever.
Risks
Frenotomy is a minor procedure and complications are uncommon. The main ones are bleeding, infection, and the tie reattaching as it heals, which occasionally means the procedure needs repeating. Dr Tina will talk you through these before you decide.
Book an assessment
If you think a tongue-tie may be affecting your baby’s feeding, book an assessment with Dr Tina. For older children’s dental care, see our children’s dentistry page.
