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.
Queries or Problems
If you have any queries or problems either before or after your child's tongue-tie release please contact us at the clinic on (065) 686 8140.