Tongue-Tie (Ankyloglossia) Assessment and Division
I am a Medical Doctor, International Board Certified Lactation Consultant (IBCLC) and Tongue Tie Specialist.I assess and treat babies with tongue ties and help mums on their breastfeeding journey. I also help bottle fed babies overcome feeding challenges due to oral restrictions.
I also support mums with low milk supply, mums who want to relactate or induce lactation.
I help with all concerns around lactation, such as engorgement, mastitis, blocked ducts, shallow latch, sore nipples, inverted nipples and many more.
What is a tongue-tie?
A tongue-tie (also known as Ankyloglossia) is caused by a short or tight membrane under the tongue (the lingual frenulum).
Where the membrane is attached at, or close to the tongue tip, the tongue tip may look blunt, forked or have a heart shaped appearance. However, where the membrane is attached further back the tongue may look normal.
Research suggests that approximately 1 in 10 babies may be born with some membrane under the tongue. But only about half of those babies display significantly reduced tongue function, making breast or bottle feeding difficult.
These babies are likely to benefit from treatment to release the restriction that the membrane is having on the tongue and enable the baby to feed effectively.
Tongue-tie practitioners often talk to parents who have had conflicting advice around whether or not their baby has a tongue-tie so it may be helpful for parents, and professionals who do not assess and divide tongue-ties, to have an understanding of what an assessment for tongue tie involves.
The decision on whether or not a tongue-tie is impacting on feeding and whether it is appropriate to offer to divide it should be made after a detailed feeding history has been taken. This will usually include information about the pregnancy and birth and the medical history of both mum and baby. The baby is usually observed at the breast. This may be done by the person who divides tongue-ties or by someone who has been supporting you with feeding, prior to you being referred for division, such as a MW, HV or breastfeeding counsellor/lactation consultant. The function of the tongue will also be assessed to establish if the baby is tongue-tied and if this is impacting on feeding.
Assessment for tongue-tie requires training and skill and involves placing a finger in the baby’s mouth. It cannot be done by just taking a look. Assessment is usually carried out with the baby on the assessor’s lap or a flat surface such as a table or couch. It involves observing how the baby uses their tongue.
Professionals assessing babies for tongue-ties should assess elevation, lateralisation and extension. Elevation can most easily be assessed when a baby cries. With the mouth wide open, the tongue tip should lift up to at least the mid mouth. In tongue-tied babies the tongue often stays quite flat in the floor of the mouth or the edges curl up to form a bowl shape or ‘v’ shape. Babies should be able to poke their tongue tip out well over the bottom lip when the bottom lip is stimulated. When the assessor runs their finger along the top ridge of the bottom gum the tip of the baby’s tongue should follow the finger so the tongue sweeps side to side (lateralisation).
Some assessors perform a suck assessment by placing their finger in the baby’s mouth (pad side up, nail side down) and feeling how the baby is cupping and using their tongue. Assessors sweep their fingers under the baby’s tongue so they can feel the extent of the tongue tie and the tongue will also be lifted to visualise the frenulum. The appearance of the frenulum is also documented including the shape of the tongue tip, where it attaches to the floor of the mouth and the underside of the tongue and how long and stretchy it is.
How can you feed a baby with a tongue-tie?
Tongue‐tie is often recognised as a cause of poor breastfeeding because the infant is unable to attach or stay latched on. In addition, it can cause the baby to swallow air, to get frustrated about not extracting enough milk and falling asleep prematurely while feeding.
As an infant breastfeeds, the tongue moves with peristalsis over maternal lactiferous sinuses and extracts milk. When the infant’s tongue movement is restricted, as is the case with severe tongue‐tie, reduced movements may affect milk extraction, and friction may be present between the tongue or gums and the nipple, causing damage to the nipple and maternal pain.
Problems which may be due to a tongue-tie:
- Sore/damaged nipples
- Nipples which look misshapen or blanched after feeds
- Low milk supply
- Exhaustion from frequent/constant feeding
- Distress from failing to establish breastfeeding
- Restricted tongue movement
- Small gape resulting in biting/grinding behaviour
- Unsettled behaviour during feeds
- Difficulty staying attached to the breast or bottle
- Frequent or very long feeds
- Excessive early weight loss/ poor weight gain/faltering growth
- Clicking noises and/ or dribbling during feeds
- Colic, wind, hiccoughs
- Reflux (vomiting after feeds)
Your baby may not display all of these signs and there can be other causes for these symptoms so thorough assessment by a practitioner skilled in breastfeeding is essential.
Can babies grow out of tongue-tie?
No, the tongue-tie will not improve spontaneously. In older children and adults, tongue‐tie has been implicated as a cause of speech delay, abnormal dentition, poor oral hygiene and inability to play wind instruments. Occasionally the speech can be affected if the tongue-tie has been missed in the neonatal period, and it is blocking the tongue from moving properly during speech. If this is the case, the surgeon will need to perform a frenulotomy (release of the tongue-tie) under general anaesthesia. After the frenulotomy, the speech should improve with the help of a speech and language therapist, unless there are other causes for the speech difficulty.
Is tongue-tie surgery painful for babies?
The surgery is not painful as the tongue-tie has no sensation. The baby may cry for a few minutes because he/she needs to be held steady during the procedure. We usually allow the baby to breastfeed immediately, and this is the most effective way to calm down your baby.
In conclusion, tongue-tie surgery is done for the following reasons:
To improve feeding in babies
To improve speech in toddlers when they are struggling with speech because of the tongue-tie
For babies, there is no need for painkillers or general anaesthetic.
What to Expect
- You will be given an appointment for a home visit or clinic consultation.
- You should avoid feeding the baby for an hour before the appointment so he or she will be interested in feeding during the consultation.
- If coming to a clinic bring your red book and a blanket to wrap the baby in and if the baby is having top ups or is bottle fed bring some expressed milk or if using formula a carton of the ready made formula you usually use. In the home you will need to provide a flat clean surface, such as a kitchen/dining table, clean changing mat, good lighting and blanket for swaddling.
- I will take a detailed medical history for both mother and baby, birth history and feeding history from you and I may observe baby feeding.
- I will assess tongue function and then discuss my findings with you.
- We will go through strategies, which may be more appropriate than tongue-tie division, or which may be needed alongside division, to improve feeding such as positioning and attachment, boosting milk supply, suck training, etc.
- If tongue-tie division is appropriate I will go through the potential outcomes and risks of the procedure with you so you can make an informed decision on whether to go ahead or not.
- You will be asked to sign a consent form. There is no obligation to go ahead and I am quite happy for parents to go away and spend time researching and thinking more about the procedure if they wish to.
- I will swaddle your baby in a towel or blanket and place them on the couch in the clinic room under a bright lamp or surgical lighting. In the home they will be placed on a changing mat on your table or other flat, clean surface.
- If I have an assistant in the clinic then they will hold your baby’s head (unless you prefer to). However, if I am working alone then a parent will need to hold the baby’s head.
- Using my index finger to lift the tongue I will visualise the frenulum (tongue-tie) and snip it using a pair of single use, sterile, curved, blunt tipped scissors.
- Once the frenulum has been fully divided to form a diamond shaped wound I will place a piece of gauze under the baby’s tongue and pass the baby to mum to feed. Babies usually latch on within a minute and bleeding is usually very light and stops quickly once the baby is feeding. Most babies tolerate the procedure well with just a short cry before they feed.
- I will observe baby feeding and provide support with this.
- I will also go through some simple, gentle tongue exercises you can do with your baby and explain to you what to expect in terms of healing and recovery.
- A feeding plan will be agreed with you to manage any ongoing feeding issues and get feeding back on track.
- I will stay with you until any bleeding has settled.
As an IBCLC (Lactation Consultant) I offer full breastfeeding assessment and support as an integral part of my tongue-tie service.
I offer clinic consultations in Northampton. I also offer home visits for frenulotomy within 30 miles travelling distance when I have capacity.
The area covered includes :
- Bedford, Biggleswade, Dunstable and Luton.
- Coventry, Peterborough, Kettering, Corby, Lutterworth, Rugby, Market Harborough, Royal Leamington Spa, Trapson, Wigston, Leicester.
- Aylesbury, Tring, Berkhamsted, Hemel Hempstead, Watford, Borehamwood and Northwood.
- Stevenage, Hitchin, Welwyn Garden City, Harpenden, Hertford, St Albans, Potters Bar, Epping, Harlow and Bishop’s Stortford.
- Milton Keynes, Bletchley, Leighton Buzzard, Buckingham, Newport Pagnell, Towcester, Daventry, Northampton, Wellingborough, Rushden and Kimbolton.
At the Practice: £250
Home Visits: £250*
Prices above include assessment and procedure. The initial assessment is charged at £150. If the procedure is required, the additional £100 will be payable.
Follow-up consultations: £120
*We are happy to travel up to 50 miles to your home for most treatments. Please see pricing above to see if home visits are offered for your treatment.
Mileage is charged at £1 per mile (one-way only). No mileage charged for locations within 10 miles.
Consultations last between 1 – 2 hours.
For same-day appointments please email email@example.com