What is a tongue-tie?

Nowadays, many parents are exposed to a lot of information around baby feeding through things like social media and online parenting groups. As a result, they are becoming more aware of issues surrounding tongue-tie and its possible impact on feeding. Here is some information to help you understand what it is and how it can be managed, including some common FAQs. It is important that, if you experience any issues with feeding your baby, you seek support from your midwife or health visitor.

What is a tongue-tie?

A tongue-tie happens when the skin that joins the baby’s tongue to the floor of their mouth is too short, tight and over-developed. This stops the tongue moving normally and your baby may find it harder to breastfeed. This is because they may have a shallower latch onto the breast, causing nipple trauma and issues with milk transfer. Tongue-tie can also cause milk-flow issues for bottle-fed babies who may find it harder to latch onto the teat of a bottle.

As tongue-tie practitioners in the UK, we focus on positioning and attachment advice before recommending a surgical procedure (called a tongue-tie division). Midwives, GPs and health visitors can refer your baby for tongue-tie assessment at local NHS services. If you contact a private practitioner, it is important to know that only healthcare professionals registered with the Care Quality Commission (CQC) should perform a tongue-tie division. You should use the Association of Tongue Tie Practitioners website to find a practitioner in your area. If the practitioner recommends a tongue-tie division, they will explain the reasons for this in full detail and talk you through the procedure.

What is a tongue-tie division?

A tongue-tie division (also called a frenulotomy) can be performed in a home or clinical setting. It is a very quick procedure and usually parents can be present. The practitioner will lift the tongue to expose the tongue-tie and will then divide it with a pair of sterile scissors. It’s natural to be worried about your baby’s reaction to this procedure but is usually similar to having an immunisation and they are quickly soothed by feeding.

Symptoms of tongue-tie

Symptoms of tongue-tie for a breastfeeding mother may include:

• sore, damaged and misshapen nipples
• pain during feeds that does not improve with a change in positioning and attachment
• re-occurring engorgement, mastitis, blocked ducts and milk blisters
• producing little milk or what seems to be lots of milk due to the milk not being transferred to the baby
• exhaustion and anxiety from frequent feeding for a long time
• experiencing a clamping or grazing sensation when the baby feeds.

Symptoms for your baby may include:

• finding it difficult or not being able to attach to the breast            
• frustration at the breast or ‘headbobbing’
• slipping off the breast easily
• weight loss or slow weight gain up to approx. 3 months old
• falling asleep from exhaustion during a feed rather than fullness
• making clicking noises, grinding, chewing of the nipple whilst feeding
• showing symptoms of wind, colic or reflux
• coughing or choking whilst feeding.

Babies who bottle feed may experience:

• long feeds
• being unable to seal their mouth around the teat of the bottle and dribbling milk
• being noisy, clicking, lip-smacking during each bottle feed
• slow or no weight gain and weight loss
• showing symptoms of colic and/or reflux.

Does taking folic acid during pregnancy cause tongue-ties?

This can be a hot topic on parenting forums and in the infant feeding community.  There are no published research papers that show a link between taking folic acid and tongue-tie.

How long should you breastfeed for?

Breastfeeding can continue as long as you wish. The World Health Organisation recommends at least 6 months if this is possible and healthy for you and your baby. Breastfeeding is not always easy, so seeking support and help early on is key. Don’t hesitate to contact your midwife or health visitor if you are concerned. You can also find help through online breastfeeding support groups.

What is a correct latch?

The main points for a correct latch onto the breast are that it is comfortable, with a calm baby. Signs that your baby is getting enough breastmilk include:

• seeming relaxed and fall asleep at the end of the feed
• visible swallowing
• seeing milk in the mouth or dribbling out when coming off the breast 
• having frequent feeds (8-12 in 24 hours)
• showing acceptable weight gain from day 5 onwards (many babies will lose weight in the first 3 days)
• regular wet nappies and stools that are gradually changing from black through green to yellow.

Is it normal for breastfeeding to hurt?

Breastfeeding should not hurt. The sensation is like pressure or pulling. It may feel strange and a little uncomfortable at first, but nipple trauma or damage should not occur. If breastfeeding is causing you pain, don’t hesitate to seek help. Midwives will help with breastfeeding support on the postnatal ward and new parents will always have follow-up contact in the community after having a baby.

Should I be ‘topping up’ while breastfeeding?

Bottle top-ups of expressed milk or formula milk should only be considered with the advice of your GP, health visitor or midwife. The reason that a top-up may be needed is based on very individual circumstances. Partners may like to give bottle-feeds to help them bond with the baby but there are other things to try, including bath time, skin to skin, burping baby, cuddles, tummy time etc.

Best wishes on your infant feeding journeys. Wishing you all the support and care you need!

You can find out more about Samantha Tanak on her website, facebook or follow her on instagram for tongue tie advice/tips.

Our midwives say…

Always seek support if you are struggling with breastfeeding or have any concerns with your baby’s feeding. Midwives, health visitors, breastfeeding counsellors are all available and happy to provide support and advice. Issues and difficulties with breastfeeding can have a real impact on your emotional and mental wellbeing. Remember you are not alone – many women have difficulties and there is support available, so please do not hesitate to reach out. Remember that baby tongue-tie does not always need surgical treatment. Health professionals will always try to focus on support with correct positioning, latch etc. before resorting to surgery. Currently the availability of support differs depending on your area. If you have any concerns it is always best to start with your midwife, health visitor or GP who can advise you on next steps. There are a range of breastfeeding support services who you can also access for support after speaking to your midwife or health visitor as detailed below:

• Trained local volunteer mothers (peer supporters) – ask your midwife for details
• Local breastfeeding drop in centres - Baby Café is a network of breastfeeding drop-in centres. Find your nearest drop-in by entering your postcode.
• National Breastfeeding Helpline 0300 100 0212
• Association of Breastfeeding Mothers 0300 330 5453
• The Breastfeeding Network provides breastfeeding support and information.
• La Leche League offers mother-to-mother support with breastfeeding.