Visible Lingual Frenulum (Tongue Tie)
Beneath the tongue is a piece of skin which attaches the front of the tongue to the floor of the mouth. This is called the lingual frenulum (lingual means tongue). In some new born babies the frenulum can be abnormally short and restrictive to the movement of the tongue—known as a Tongue Tie. This means the tongue does not move up and forward as it would with a normal frenulum.
Many visible frenulum’s’ do not cause any problems at all and do not need to be treated
What problems can tongue tie cause?
A restricted frenulum – otherwise known as a tongue tie, may cause problems with breast feeding and less often bottle feeding. The problems caused by tongue tie during breastfeeding are due to trouble with latching. Latching is the name given for the connection between the baby’s mouth and the mother’s breast.
Problems for the mother
- Sore, cracked nipples
- Mastitis (painful, swollen breasts)
- Poor latch
- Short, frequent or longer feeds. This can be exhausting for the mother.
- Frustration and a sense of failure with breastfeeding
Problems for the baby
- Difficulty in staying on the breast or bottle during feeding
- Slow to gain enough weight
- Leaking milk from side of mouth whilst sucking
- Clicking during feeding
- Colic and wind (caused by the baby swallowing air during feeds).
My baby is feeding well but has a visible frenulum:
If your baby is feeding well, tongue-tie division is not considered necessary; as your baby grows the tongue-tie may stretch or naturally divide. However, it is important to reconsider dividing your baby’s tongue tie if the transfer of food from the front to the back of the mouth and ability to chew properly appears to be affected when you introduce solid foods. Tongue tie division may then be indicated clinically; however older babies will require a light general anaesthetic, as they are less likely to remain still during the procedure.
Whilst the majority of children who have a frenulum under their tongue that is not divided have no difficulties with their speech, the presence of a tongue tie has been shown to influence the ability to pronounce certain sounds in some children. However, it is not possible to predict which children will be affected, or to determine whether intervention as a baby will prevent this. Some babies that have tongue tie division still go on to need further intervention as a child. This will normally be noticeable when your baby reaches three years of age and may necessitate referral to a speech and language therapist, who will advise you as to whether or not division of the tongue tie under a general anaesthetic will be of benefit.
Where can I have my baby’s tongue tie released?
If you are having problems feeding your baby and suspect there is a tongue tie you can contact your GP, midwife or health visitor. If there are no feeding issues, we cannot offer the procedure at this Trust. They will know how to refer you to our local assessment service within our local Lancashire Teaching Hospitals NHS Foundation Trust.
During this appointment, your baby’s mouth and tongue will be assessed for suitability of releasing the Tongue Tie. Releasing the Tongue Tie may not be appropriate if the assessment identifies adequate tongue movement which shows the frenulum does not restrict the tongue. In this case the specialist will suggest other ways in which we can help you with your feeding concerns.
How long will it take to get an appointment in Tongue Tie Clinic?
Once a referral has been sent you will be contacted regarding an appointment within 7 working days. Please be advised that in periods of high demand, priority for appointments will be made on clinical need.
What happens at the clinic appointment?
During the appointment, your baby’s mouth and tongue will be assessed for suitability of releasing the Tongue Tie. Releasing the Tongue Tie may not be appropriate if the assessment identifies adequate tongue movement which shows the frenulum does not restrict the tongue. In this case the specialist will suggest other ways in which we can help you with your feeding concerns. If after assessing your baby’s mouth and tongue tie, it is deemed as suitable for division, the practitioner will discuss the procedure and gain your written consent.
The procedure does not need a general anaesthetic or local anaesthetic. It is not appropriate to give a local anaesthetic because the frenulum has a poor blood and nerve supply. All risks and benefits will be discussed during the consultation.
We ask that you are able to feed your baby following the procedure, and may also require an observation of a feed during the consultation.
Further Information
Our service can assess babies in our midwife led outpatient clinic up to the age of 12 weeks at the time of the appointment and live within Central Lancashire.
For further information, please contact our Infant Feeding Specialist Midwife on 07591 988 954 or via email at: tonguetieclinic@lthtr.nhs.uk
