Tongue Tie

  • Reference Number: HEY-393/2016
  • Departments: Maternity Services

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This leaflet has been produced to give you general information about your baby’s possible tongue tie.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your health professional, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a healthcare professional qualified to assess your baby and perform the division of tongue tie procedure, if necessary.

What is Tongue Tie?

When a lingual frenulum (tongue membrane), is either tight and/or short, thereby restricting the normal function of the tongue in relation to feeding, it is known as a tongue tie.  It is more common in boys than girls and there is often a family history of this.  Sometimes, the membrane extends right to the tip of the tongue or the lower gum ridge; sometimes it is only part way along the tongue.  Most are thin translucent membranes but some are thicker.

Why might your baby need this procedure?

Babies who are tongue tied and are trying to initiate breastfeeding may find it difficult to latch far enough onto the breast. Others struggle to maintain a vacuum seal at the breast throughout the feed and make repeated attempts to reattach. Both situations reduce the amount of milk the baby can access, leading to an unsettled baby who is likely to lose too much weight or only gain weight very slowly. Breastfeeding mothers, who have a tongue tied baby, often develop sore nipples from poor attachment at the breast.  Poor milk removal increases the risk of breast engorgement (full of milk), mastitis and a faltering milk supply.

Babies who are tongue tied and are initiating bottle feeding may find it difficult to create an effective seal around the bottle teat, resulting in excessive dribbling and long feeds during which only small amounts of milk are swallowed. Changing teats does not appear to help. This group of babies may also lose too much weight or only gain weight very slowly.

Division of tongue tie will help your baby to feed more effectively by restoring the range of tongue movement necessary to breast or bottle feed.

Other considerations

At weaning age, a baby with an untreated tongue tie may find swallowing lumpy foods more difficult as a result of impaired tongue movement. As the child grows, it may be unable to clear food with its tongue from around the teeth and gums, which may increase the risk of dental decay.  A child who is tongue tied may experience other difficulties such as pronouncing some letters, licking an ice-cream or licking his/her own lips.

Can there be any complications or risks?

There is a minor risk of infection (1 in 6000 cases).

How do I prepare my baby for this procedure?

There are no special preparations that you have to undertake.  The procedure is usually done when your baby is ready for a feed.

What will happen?

Your baby will be wrapped in a blanket or towel and taken to a separate room for the procedure, while you prepare to feed your baby. The practitioner’s assistant will gently hold your baby’s head and shoulders so that it does not move during the procedure.

The practitioner will stimulate your baby to open its mouth and then use a finger to lift your baby’s tongue to visualise the tongue tie and then make a simple snip to release the tongue tie. Usually there are just two or three spots of blood and the practitioner will place a piece of gauze square under the tongue and hold it there.  Your baby is carried back to you and the gauze removed immediately before your baby begins to feed.

What happens afterwards?

You will be given assistance to feed your baby and your health professional will document any noticeable improvements and effectiveness of feeding.  There is no further follow up required. The area under the tongue where the membrane is snipped may look like a white ulcer for a few days but it is not harmful and soon heals.

Referral System:

Babies born in Hull and East Yorkshire Hospitals NHS Trust, who are up to 28 days old can be reviewed on Rowan Ward.

  • Whilst an inpatient
  • Following telephone referral from Community Midwife, Health Visitor or GP

To make a referral please contact the infant feeding coordinators on (01482 607838. Alternatively, if no reply please leave patient contact details with Rowan ward staff on (01482) 605383, so the information can be recorded in the infant feeding coordinators folder and a Frenotomy Practitioner will contact them at the first possible opportunity.

 Information needed includes: name of mum and baby, baby’s unit number, contact details, baby’s date of birth and method of feeding.

Babies not born in Hull and East Yorkshire Hospitals NHS Trust

  • Referrals can be made as above.

Babies born in Hull and East Yorkshire Hospitals who are now over 28 days.

  • Referrals can be made by a GP or health visitor to Mr Fleet (Paed Cons) by faxing details to 01482 382604 and marked FAO Sister Jo O’Conner, Paediatric Out Patients Department.

This leaflet was produced by the Infant Feeding Coordinator, Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in April 2019

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Your newborn baby’s NHS number

An NHS number is allocated to everyone whose birth is registered with a Registrar of Births and Deaths in England and Wales. You already have an NHS number and your baby will be assigned an NHS number soon after birth. Your NHS number is unique to you and provides a reliable means of linking you to the medical and administrative information we hold about you. NHS numbers are allocated on a random basis and, in themeselves, provide no information about the people to whom they relate.