The following information is adapted from an information sheet provided by Mr Mervyn Griffiths, Consultant Paediatric and Neonatal Surgeon at Southampton General Hospital of whom our tongue-tie practitioners at The One to One Midwives are trained with.
The meaning of the term tongue-tied?
Tongue-tie can be defined as a structural abnormality of the lingual frenulum. When the frenulum is normal, it is elastic and does not interfere with the movements of the tongue in sucking, eating, clearing food off the teeth in preparation for swallowing and in speech. When it is short, thick, tight or broad it has an adverse effect on oromuscular function, feeding and speech.
The most easily visible tongue-ties, the frenulum is joined to the tip of the tongue, which looks heart-shaped when the baby tries to extend their tongue, but the frenulum can be joined anywhere along the underside of the tongue which maybe difficult to see without a careful examination from a trained professional.
Why divide tongue-ties?
Some babies with tongue-ties can breastfeed perfectly fine. However, others have difficulty breastfeeding and a few have difficulty bottle-feeding. For breastfeeding babies, the difficulty is because the tongue-tie prevents the baby from attaching efficiently to the breast (failing to latch on). This is due to a combination of the baby not opening its mouth widely, the tethered, short tongue not covering the lower gum, and the disordered movements of the tethered tongue when sucking. Just imagine the piece of skin is holding down your baby's tongue. The inefficient attachment to the nipple (poor latch) doesn't remove milk from the breast properly and isn't easy to maintain. So, the baby slips off the breast, chomps on the nipple with both gums and then slips off completely. As a result, the baby isn't breastfeeding, but nipple feeding, which is inefficient and can be excruciatingly painful for the mother. It is very frustrating for both mother and baby, who may be very unsettled unless on their mother’s breast and fusses a lot when feeding waving it's arms about. Some babies will fall asleep very soon during the feed as it's harder work for them to feed as they cannot use their tongue correctly and get tired. Mum will then try to put baby down but baby wakes shortly after crying again to feed. This vicious cycle can be very exhausting and stressful for all the family and most mothers dread each feed and then feel guilty for feeling this way towards their baby.
With bottle-feeding babies, the difficulty is that they can't make a good seal around the teat. The suck is inefficient, and the feed takes two to three times as long as for an efficient baby. As the seal is leaky, babies dribble milk in varying amounts, and may need a bib or muslin during the feed or a change of clothes afterwards. A few babies are so inefficient that they squirt (not just dribble) the milk out of the side of their mouths. As the milk leaks out, air gets in and is swallowed. This can make the baby very 'windy' with the possibility of increased colic and irritability. Many parents try multiple types of teat or have to hold the bottle in a precise position for optimal feed efficiency.
National Institute of Clinical Excellence (NICE guidelines) suggests that frenulotomy (divide) is usually safe for young babies and could help with breastfeeding problems (2005).
What are the Signs and Symptoms of tongue-tied baby?
- Creased/flat/blanched nipple after feedings
- Cracked/blistered/bleeding nipples
- Discomfort while nursing
- Plugged ducts
- Sleep deprivation (Because baby is not able to nurse efficiently they compensate by nursing more often, leading to frequent night feedings.
- Difficulty latching on or falls off the breast easily
- Gumming our chewing the nipple while nursing
- Unable to hold a dummy or bottle
- Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
- Poor weight gain
- Excessive drooling
- Baby is not able to fully drain breast
- Choking on milk or popping off to gasp for air while nursing
- Falling asleep during feedings, then waking a short while later to nurse again
- Sleep deprivation (due to the need for frequent feedings)
- Extended nursing episodes
- Clicking noises while sucking
- Popping on and off breast often
- Biting – Babies who have trouble grasping the nipple
- Gap between teeth/jaw issues
How are tongue-ties divided?
Dividing your baby's tongue-tie doesn't need a general anaesthetic. It only takes a minute or so, though it may well seem longer.
Will the procedure hurt?
We cannot say for definite if dividing is painful or not. However, a significant number of small babies (about one in six) are asleep when their tongue-tie is divided and stay asleep during the procedure! Older babies don't like being wrapped up so they usually cry out and it can sometimes be quite difficult to know whether dividing their tongue tie is painful, as they are already complaining at being wrapped up. Following division, the baby is promptly unwrapped and handed back to you for cuddles and feeding. Although some babies will cry for up to 60 seconds, the average is just 15 seconds (and some just stay asleep).
What about the wound?
A few drops of blood are normal, but this always stops quickly and is never a problem. The inside of the mouth heals much faster than most of the rest of the body because the lining of the mouth is being worn away and renewed all the time. Often there is a white creamy patch under the tongue in a diamond shape, which takes 24-48 hours to heal. This doesn't seem to cause the baby any discomfort although some babies can appear unsettled for the first few days after treatment.
Unfortunately, some baby's tongue-ties can reappear. It is suggested that babies that breastfeed every 2-3 hours whilst the wound is healing are less likely to experience a recurrence. However, even for these babies, we cannot guarantee the tongue-tie will not reappear.
There is no evidence to support after care treatment to prevent tongue-tie recurrence, however, some practitioners document that massage and stretching the tongue can reduce the risk of the tongue-tie from coming back.
We suggest that you massage and stretch your babies tongue three times a day from day 1 with a clean finger for 10-14 days.
Please view these videos for demonstrations on massage and stretching.
Osteopaths work to rebalance the structure and function of the body, looking at all the factors contributing to the body's disturbed state of natural health rather than simply treating the apparent problem.
The mechanical action of feeding helps remoulding and the resolution of retained compressive forces in the baby's head. The suck should be strong, symmetrical and sustained (with natural pauses). The throat and cranial base should be free of tension to allow proper suck and tongue motion.
Birth compression, tongue-tie or the cord around the neck can all affect the throat and suck. Birthing practices affect breastfeeding and also the way the palate develops. Early events such as the cord being clamped too early or cut too quickly, stalled, short labour or induction, the use of forceps, ventouse or C section and the drugs used in labour (which reduce babies early respiration and the strength of the first breath) can all influence the mechanics, shape and function of the palate and cause narrower arches. It is not our intention to question a mum's birth experience or to engender a feeling of despair. Good, sensible birth preparation of both body and mind is sensible, and cranial osteopathy may do much to resolve these difficulties.
Face, jaw, head or chest tension patterns can affect the body's ability to coordinate sucking, swallowing and breathing. The sinuses of a baby are tiny but the nasal passages and throat must be clear and open to allow the baby to breathe while feeding. Head tension patterns often reflect in the face. Cranial sessions can help resolve any membranous tension in the head, allowing the face to move and work properly.
If the baby is breastfeeding or bottle-feeding well, then the tongue-tie doesn't need to be divided. Most tongue-ties in new-born babies are thin, but those remaining in three-year-olds are mostly thick. So, the thin ones must either have been divided by the lower teeth as they come through, or they are accidentally torn by a parent putting a teaspoon of food under, rather than over, the tongue, or the infant thrusts a toy into their own mouth. Although some babies can breast- or bottle-feed well, they may have problems coping with lumpy food. They may not be able to transfer food from the front to the back of the mouth or chew properly. Tongue-tie division, at any age, will help these infants. A few tongue-ties do persist and may cause speech or other problems, but this won't really be apparent until the child is at least three years old. If there is a problem, the tongue-tie can be divided under a very short general anaesthetic. Most children with a tongue-tie and a speech problem improve following division.
Useful links and supporting evidence
- http://milkmatters.org.uk/2011/04/15/hidden-cause-of-feeding-problems-however-you-feed- your-baby/
Tongue Tie Information (160 KB)