Dr. John Boyle is a member of the Association of Tongue-tie Practitioners and recently presented a talk at their annual conference in the UK.
Tongue-tie (ankyloglossia) is a condition in which the thin piece of skin under the baby's tongue (the lingual frenulum) is abnormally short and may restrict the movement of the tongue tip. Sometimes tongue-tie causes no problems at all and requires no action. Tongue-tie can interfere with a baby's ability to suckle efficiently at the breast. This may lead to nipple pain and trauma, poor breast milk intake and a decrease in milk supply over time.
The decision to release a tongue-tie often depends on a clinician's belief about the possible impact on feeding. Currently, clinicians are divided in opinion, which can lead to confusion for parents. Clinicians who work with breastfeeding mothers and babies will base their decision on management, following assessment of the baby's mouth, breastfeeding and maternal comfort. If breastfeeding is painful, there is poor milk transfer and there is a significant tongue-tie, then release has been found to improve the baby's ability to breastfeed.
Tongue-tie is more commonly found in boys (60%) and there will often be other family members who have had this problem. The most immediate impact of tongue-tie is on the baby's ability to breastfeed effectively. There may be an effect on ongoing oral hygiene. The effect of tongue-tie on speech development remains controversial.
Indications of a significant Tongue-Tie
- Nipple pain and damage.
- A misshapen nipple after breastfeeding.
- A compression / stripe mark on the nipple after breastfeeding.
- The baby often loses suction whilst feeding and sucks in air.
- A clicking sound may be heard whilst the baby is feeding.
- The baby fails to gain weight.
- Tongue cannot protrude beyond the baby's lips.
- Tongue cannot be moved sideways.
- Tongue tip may be notched or heart-shaped.
- When the tongue is extended, the tongue tip may look flat or square instead of pointed.
A lactation consultant or experienced clinician will conduct a thorough assessment of breastfeeding and infant tongue mobility to determine whether release is required.
If the frenulum is thin and the baby is less than four months of age, the frenulum can be released as an outpatient procedure without any anaesthesia. A baby who is older than four months of age or one whose frenulum is thick, will usually be referred to a specialist.
The release of a tongue-tie involves the clinician placing a finger and thumb under the baby's tongue to gain clear access to the frenulum. The frenulum is released with a small pair of sterile scissors.
A drop or two of blood at the release site is normal and is rarely a problem. Many babies may actually sleep through the procedure whilst others may be unhappy at being held still and having fingers placed in their mouth. Occasionally an infant will be startled when the release is performed but will settle quickly once comforted.
Following the procedure, the infant will be returned to the mother for feeding. The feed will be assessed by both the mother and the clinician.
Possible complications of the procedure are bleeding or infection, but the incidence of these occurring are extremely rare. There is no specific aftercare required.
The healing procedure results in a white diamond shape at the back/base of the tongue. This may be yellow if your baby is jaundiced. It shrinks gradually and will usually be gone by one week.
Risk of bleeding is minimal. If oozing starts, apply pressure with a clean cloth for 5 minutes and bleeding should cease.
Evidence suggests that babies do not feel much pain or soreness, however a few babies have cried a lot and/or not fed. Whilst this is not pleasant, your baby will usually settle within 24 hrs.
If your baby is unable to breast feed, try some expressed milk from spoon or cup to assist with calming and try again. If you are formula feeding and your baby won’t take the teat, try giving some milk from a sterile spoon.
A small percentage can grow back. This is currently being researched. Try to actively encourage the tongue to protrude.
If you have any concerns following the procedure, please contact your lactation consultant, maternal and child health nurse, paediatrician or your general practitioner.
The total cost for a tongue tie division for private patients is €150. The breakdown is €50 for the assessment and €100 for the procedure.
If you have a valid medical card the total cost is €100.
Private Medical Insurance
Unfortunately the procedure isn’t covered by insurance companies.
We visited Dr. Boyle to have Clodagh's tongue-tie released on February 28th 2017. I was informed as soon as Clodagh was born that she had tongue-tie. Initially I was upset as I had planned on breastfeeding as I had with my other two children. After a day or two it was sore when Clodagh latched on which I knew wasn't normal. I asked to see the lactation consultant in the hospital who gave me Dr. Boyle's contact details.
I rang for an appointment on Monday and they had availability for Tuesday afternoon. Clodagh was only 5 days old and I was a little apprehensive about the whole procedure. We arrived early not realising that they were closed for lunch but we were met at the door by Dr. Boyle who let us into wait in the reception area, which was the beginning of a very positive experience.
We were called for our appointment promptly, we were met by a lovely nurse (Mary Kelly) who explained the procedure to us, and answered any questions that we had. I was obviously concerned about whether my little baby would be in pain and if this pain would continue for the rest of the day. Mary assured me that the procedure was just like having an injection for the baby and that most babies have no problems after.
Dr. Boyle was very gentle and thorough. The procedure was over very quickly and my husband felt that Clodagh was more upset by being held than she was by the procedure. She was handed to me to feed her straight away and we have never looked back. Mary checked to ensure Clodagh was latched correctly and spent time with us, and answered any questions that we had. By that evening it was no longer sore when Clodagh latched on.
I would have no hesitation in recommending Dr. John Boyle to any new Mother to have their babies tongue-tie released. Clodagh is nearly 5 weeks now and is still breastfeeding with no issues.
I was absolutely delighted with the service I received from Dr. Boyle.
My baby was was born on a Wednesday. Breastfeeding was very painful initially but after breastfeeding my last baby for 11 months I knew the pain would subside. However it did not subside, it intensified. Over the weekend breastfeeding was agony and I began to dread feeding my baby. I had the typical signs of tongue-tie: cracked nipples, painful feeding, infant feeding all the time, lipstick shaped nipple after feeding.
On Monday I was on the cusp of giving up when my Public Health Nurse rang. I told her my story and she suggested that I contact Dr. Boyle. He made every effort to fit me in that morning. He explained the procedure and the tongue tie was dealt with in a matter of seconds. My baby breastfed straight away. He allowed me to stay in a private room to continue breastfeeding. Straight away feeding was less painful and after 2-3 days it was pain free.
Three months on I am still breastfeeding. I cannot thank Dr. Boyle and his team enough for their empathy, kindness , skill and efficiency. Had I to wait one more day I think, I would have had to give up reluctantly.
We welcome referrals from lactations consultants and midwives as well as other GPs. For more information, please see our referral page.