Tongue-tie

Tongue-tie is a hot topic amongst new mums, often accused as the culprit to breast-feeding problems.
So what’s the deal?
Tongue-tie (Ankyloglossia) is defined as, restricted tongue movements caused by the ‘frenulum’ (piece of skin attaching the tongue to the base of the mouth) being short and tight.
It’s said tongue-tie affects up to 2% of the nation, is more prevalent in boys and is often hereditary.
Tongue-tie may affect a baby’s feeding and in rare/severe cases can cause a lisp or speech impediment.
Many parents become anxious at the mention of tongue tie, but it’s not always an issue. I’ve created a guide to help you identify problems and give options of what to do next.

What’s the difference between anterior and posterior tongue tie?
An anterior tongue tie, is when the frenulum attaches to the tip of the tongue. Movement of the tongue beyond the lip is restricted and the tongue forms a heart shape at the end.
This type of tongue tie is easy to spot and might be picked up by a midwife or doctor shortly after birth.

A posterior tongue tie is more difficult to diagnose. The frenulum is situated at the base of the tongue under a thin layer of skin (mucous membrane). The tongue appears short and the sides curl up when the tongue is lifted.
Also note:

* There are varying degrees of tongue tie, which may or may not affect breastfeeding.
* The tongue is a muscle which stretches, strengthens and adapts over time. Early problems may rectify with appropriate support.
* The anatomy of a baby’s mouth changes at 4-6 months of age. Babies often become more efficient at breastfeeding by this stage.
* Every mother’s anatomy and physiology is different, size of breasts, nipples, sensitivity, milk flow.
Every baby’s anatomy is different, mouth shape, palate, chin, lips, strength of suck. Combinations of mother’s and baby’s anatomy can have an impact on breastfeeding with a tongue-tie.
A low birth weight or premature baby will not have the same sucking strength and rhythm as a term baby. Tongue-tie in these babies may cause more problems, although releasing the tie is not always a cure.

How could tongue tie affect my breastfeeding?
Nipples:
* Cracked, bleeding, blistered or damaged.
* White line down the centre after feeding
* Lipstick shape or squashed appearance.
* Pain – feels like biting, pinching, gumming or scraping.
Latch:
* Baby slips off the breast during feeds or struggles to latch on.
* Baby makes a clicking sound during feeds.
* Baby’s cheeks are sucked in
* Baby’s mouth looks small at the breast.
* Baby can’t latch onto the breast at all.
Breasts:
* Breasts are lumpy and engorged.
* Breasts get mastitis, thrush or a bacterial infection.
Baby:
* Insufficient weight gain.
* Prolonged feeding times of one hour+ and baby not satisfied.
* Feeding frequently, every one to two hours with cluster feeds.
* Windy.
* Green poo.
Thrush in your baby’s mouth.
Unsettled and fractious. (You may have a combination of these symptoms)

How do I identify if my baby has tongue-tie?
* Have you noticed your baby’s tongue does not reach out beyond its lip? TIP: Whilst baby’s awake, using a finger, stroke down your baby’s nose, lips and chin or stoke baby’s cheek from the mouth outward. Baby should react by sticking their tongue out.
* Does your baby’s tongue form a heart shape at the end?
* Can you see an obvious piece of skin attached to the tip of baby’s tongue, restricting upward and outward movement?
Does your baby’s tongue look short and curl at the sides during crying?
These are all signs.

What should I do if I think my baby is tongue-tie?
Seek professional advice in order to clarify your suspicions and get support.
* Have a specialist assess your baby’s tongue. This should be someone knowledgable, preferably a lactation consultant or breastfeeding specialist. Some midwives, health visitors or G.P’s may not be able to help you.
* You should have a consultation, noting details of your birth, any medical problems and a history of baby’s feeding so far. A full feed should be observed to rule out other potential problems. You may need 2 consultations depending on your individual case.
For more information look at this site:
www.tongue-tie.org.uk

What are my options?

Private:
* Check reviews or go with a recommendation.
* Ensure your practitioner is certified and experienced.
Ensure practice is safe and sterile.
Pay from £100-350 (higher price for a surgeon).

NHS:
* Go to your local breastfeeding support group (list provided by your hospital on discharge)
* Have a consultation and assessment.
* Get a referral to your local hospital’s tongue-tie clinic.
* Average waiting time is one week to one month. This will depend on your referrer, hospital and availability.
* To find a practitioner in your area check:
http://www.tongue-tie.org.uk

What would the procedure involve?
(Termed frenulotomy)
* Most practitioners will request you restrain from feeding baby for 2 hours beforehand as it helps if your baby is awake for the procedure to be able to feed straight after.
* You might want to take a relative or friend for support.
* Your baby is swaddled and head held gently in place. A professional uses an instrument to lift the tongue and then snips the frenulum with sterile scissors.
* Babies under 3 months have few vessels in this area so bleeding is minimal and generally stops once your baby is feeding.
* Anaesthesia is not required as your baby’s nerves haven’t developed in this area. Babies do not feel any pain.
For older babies a general anaesthetic may be required.

After procedure:
* Support is given latching baby straight onto the breast. This helps healing and stretching the tongue. It also calms baby and helps stop bleeding.
Some practitioners suggest massaging the wound to prevent re-adherence of the tongue-tie. This is NOT necessary and there are alternative tongue exercises if preferred.

Risks:
* Infection, as with any surgical procedure although this is rare, especially if your baby is breastfed immediately after. Breastmilk is a natural antiseptic, as is saliva.
* If baby is unusually fractious, spikes a temperature or becomes unwell, has green poo, excessive saliva, bleeding or under the tongue looks green or swollen, seek medical assistance straight away.
The wound will look white under the tongue whilst it’s healing.
Reoccurrence – the tongue-tie grows back and the procedure may need repeating. There is less risk of this if your baby is solely breastfeeding.

Follow up:
Professional guidance from a breastfeeding specialist / lactation consultant within the first week helps to check how you’re doing. Often mums and babies need to re-learn technique.

Can tongue tie cause speech impediments?
Only in rare and severe cases. Many people with tongue tie don’t realise they have it!