What is a Tongue Tie?
Here comes the science!!!
Tongue tie is also known as ankyloglossia.
NICE (2005) defines it as “a congenital anomaly characterised by an abnormally short lingual frenulum which can restrict mobility of the tongue” this often means that the baby’s tongue cannot protrude past the lower gum line or lip line and has other factors such as elevation and lateralisation, which impact how the tongue can function.
It is thought (depending on what study you look at) that somewhere between 5- 16% of babies are affected by tongue tie (Hong 2013, Illing 2019), it should be mentioned here that even with a tongue tie diagnosis about 50% of babies will breastfeed successfully without the need for a frenotomy/division.
However, whilst it can’t be agreed exactly how many babies are affected the evidence suggests that it is more prevalent in boys than girls: 2:1 (Brookes and Bowley 2014, Hopkins 2022).
Currently there appears to be no known explanation as to why some babies develop ankyloglossia (Tongue Tie) whilst others don’t, aetiology suggests a genetic link has been reported (Becker & Mendez 2021).
The physiological cause of a tongue tie is the presence and development of……MORE SCIENCE…… abnormal collagen fibres occurring in a thin layer of tissue (submucosal) surrounded by abnormally tight mucous membranes underneath the tongue – The lingual frenulum or tongue tie.
A classic anterior tongue tie always has a posterior component behind it and the presence of abnormal collagen fibres result in persistent tongue restriction (Ghaheri, 2014).
Frenulotomy (or tongue tie division) is a small surgical procedure where a cut is made to the lingual frenulum with a pair of scissors specifically designed for this purpose. For division your baby will be wrapped snuggly in a large muslin or blanket (please provide this). Division is performed under direct visualisation with good lighting, the head will need to be supported, please ensure there is someone there to do this (you don’t have to watch if you don’t want to)
Tongue-tie surgery causes minimal discomfort for infants and is done without the need for anaesthesia. Some parents may choose to give paracetamol prior to the procedure if the baby is old enough for over-the-counter medication (8 weeks +).
As with any surgical procedure, a tongue-tie procedure carries risks of complications, including:
- Bleeding. (1in 3-5000)
- Infection. (1in 10,000)
- Injury to the saliva ducts in your mouth. (Very rare)
WHO CAN IDENTIFY AND TREAT A TONGUE TIE?
NICE (2005) and the Association of Tongue Tie Practitioners (ATTP, 2020) both state that tongue tie practitioners should be registered health care professionals who have additional experience and an understanding of lactation, enhanced breast and feeding anatomy and be actively supporting women with feeding.
Tongue-Tie Training FAQs | ATP
Many NHS Trusts have a tongue tie service which babies can be referred to and be reviewed at for free. There is usually a waiting list and this will vary from Trust to Trust.
WHAT IS INCLUDED IN AN APPOINTMENT?
For an assessment I spend time with you family reviewing and taking notes on:
- The history of your pregnancy, labour and birth
- Your feeding journey so far, and any previous history you may have of feeding a previous baby/child
- I do a gentle full body and oral assessment on your baby to look at not only the visual anatomy but also how well the tongue moves and functions. I do this with the full co-operation and consent of your baby. If they tell me no, we wait!
- I will discuss my finding with you, what this means and how this might be impacting your baby specifically.
- I will show you how to do the oral exercises, although I like to call them “games” as it seems more of a fun thing to do which will hopefully make it more interactive for you and your child/baby
HOW MUCH DOES IT COST?
For home visits:
- Tongue tie assessment with feeding review = £225.
This appointment usually takes 1.5-2 hours. - Tongue tie assessment with feeding review and division (if indicated) is £325
This appointment usually takes about 2-2.5 hours.
Once your booking appointment has been agreed you will be sent a booking confirmation for the appointment which will include 3 attachments for you to read, A booking form and an invoice. I only hold spaces for 24 hours once these have been sent to you, so please make sure BOTH the booking form and payment are made within this timeframe. If you cancel your appointment within 24 hours of our scheduled appointment then 50% of the payment will be returned to you. If you give more than 24 hours then the full fee will be returned to you.
IF THERES A TONGUE TIE WILL MY BABY NEED A DIVISION?
Not all frenulum’s require division immediately or even at all, and often conservative measures may be recommended first, this will be discussed with you at your assessment. If conservative measures are recommended initially but then division is indicated at a later date this will only cost the difference between assessment and division (eg: an additional £100 due), as long as this is within 2 weeks of the original appointment, after this another full assessment will be required.
AFTERCARE AND SUPPORT
For all bookings I offer remote support for up to 4 weeks following your appointment. If you wish for a follow up face to face feeding support appointment this will cost £130 per visit.
Extra Resources for reading:
Association of Tongue Tie Practitioners UK which includes helpful resources for parents.
Private Midwives in South London