You’ve probably heard other mothers talk about it, but what is tongue-tie and how does it affect babies? Read our guide to this breastfeeding hurdle, which is a lot more common than you might think

The name may suggest that this condition relates to older babies who are stumbling over their words, but tongue-tie is a condition that has very little to do with talking and much more to do with your baby’s ability to breastfeed from birth.

As many as one in 10 babies in the UK is born with tongue-tie, a condition where the skin that connects the tongue to the bottom of the mouth (known as the frenulum) is shorter than normal, which sometimes makes it difficult for babies to move their tongue effectively, causing problems with breastfeeding. This can happen at the front (anterior) or the back (posterior) of the tongue.

How are babies with tongue-tie diagnosed?

Unfortunately although the first few days are crucial when it comes to breastfeeding, particularly in terms of building up the mother’s milk supply, tongue-tie assessment is not part of the routine newborn health check so the condition often goes undiagnosed at this stage.

Instead, the first most parents know about tongue-tie is when their babies struggle to feed.

Symptoms of tongue-tie include constant feeding, an unsettled baby during feeding, restricted tongue movement and nipples that look misshapen or blanched after feeds.

View a full list of symptoms from the Association of Tongue-Tie Practitioners here.

If your baby does appear to be struggling to feed, Independent health visitor and tongue-tie practitioner, Sarah Oakley, has this advice: “Parents may need to seek out a lactation consultant (most work privately but many volunteer in breastfeeding support groups) or the infant feeding co-ordinator at their local hospital to get a diagnosis.”

What issues can arise from tongue-tie?

The two main problems are a fall in the milk supply of the mother and low weight gain or even a drop in weight for the baby.

Oakley says: “Early diagnosis, as soon as possible after feeding problems arise will help minimise complications associated with tongue-tie, such as a fall in milk supply and poor weight gain.

“Prompt treatment will help ensure mums are able to continue with breastfeeding ,as obviously the longer a mum and baby struggle to breastfeed the more complex the problems can become and the more stressed and demoralised mum will feel.”

What treatment is available?

A frenulotomy (in which the frenulum is cut to allow for more free movement), also known as a division, is only performed to improve feeding as per NICE Guidance, but the procedure is not offered everywhere.

Oakley says: “NHS provision is patchy. In some areas there are very good NHS services with short waiting lists and access to skilled breastfeeding support and follow up.

“However, in many areas services are poor with long waiting times and no breastfeeding support at the time of division or afterwards. Some areas do not have an NHS service at all and most NHS services set age limits with some treating babies only up to the age of 4 weeks, even though many babies are not diagnosed until much later than this.”

If your NHS provider doesn’t offer a frenulotomy you could look for a private nurse or midwife with specialist lactation qualifications (usually IBCLC), who can provide prompt treatment and follow up — skilled breastfeeding support after division is crucial as division is not always an instant fix and ongoing support may be required until effective feeding is established.

But what about the risks involved with the procedure? There’s no escaping the fact that the procedure will result in your baby bleeding from the mouth, which can be a traumatic thing for a parent to witness. You should also ensure your milk supply is good prior to having a frenulotomy (by expressing after each feed) as breastfeeding immediately after the division with help soothe your baby as well as heal the wound.

But don’t let this put you off — according to NICE (National Institute for Health and Care Excellence) current evidence suggests that there are no major safety concerns about division of ankyloglossia (tongue-tie).

Oakley says, “Obviously breastfeeding has huge benefits for mum and baby in terms of short term and long term health outcomes so the risks of not breastfeeding far outweigh the risks of doing a frenulotomy.”

You can source a private provider at tongue-tie.org.uk

words: Sally Coffey

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