What is a tongue-tie?
A tongue-tie is when the piece of tissue under the tongue is shorter or tighter than normal. This is also called ankyloglossia. Sometimes a tongue-tie can cause problems with feeding.
Signs and symptoms
Signs and symptoms your baby may have a tongue tie include:
- Painful, damaged or sore nipples
- Issues with milk supply
- Mastitis
- Problems attaching to the breast or slipping on and off the breast
- Feeding for very long periods of time or very often
- Weight loss or not gaining weight as expected
- Baby is unsettled after feeds
Who can check for a tongue-tie?
Your baby needs to learn to feed after birth. We don't check for tongue tie straight away because lots of things can affect how well baby feeds, including:
- How your baby was born
- How many weeks pregnant you were
- What pain relief you had in labour
If you or your baby are having feeding problems that do not get better with help from your midwife, you will be referred to the infant feeding team. The infant feeding team can help you with feeding problems and check for tongue tie.
What next?
Our infant feeding team will work with you to make a plan of care. Sometimes feeding can get better with lots of support with latching your baby. If your baby has a tongue tie and feeding is not getting better you will be given an appointment in our feeding clinic where you can choose to have the tongue tie divided. These clinics take place at University Hospital of North Durham or Darlington Memorial Hospital.
Frequently Asked Questions (FAQs)
A specialist midwife will watch your baby feed and talk to you about what you are worried about. The midwife will look in your baby's mouth and check how well your baby can use their tongue. If your baby has a tongue tie and it is causing a feeding problem then you will be offered a division of tongue tie. The specialist midwife will discuss the risks and benefits of division with you. It is important to know if your baby has had their Vitamin K at birth. We cannot divide a tongue tie if your baby has not had Vitamin K.
Division of tongue-tie is very safe but there can be risks, including:
Bleeding
A few drops of blood is normal. Feeding your baby straight away stops the bleeding in most cases. 1 in 400-600 babies may have a little more bleeding. If this happens we will press down under baby's tongue to stop the bleeding. 1 in 7,000 babies will have more bleeding. If this happens we will ask our doctors to come and help. They will put some drops of medications on the wound to stop bleeding.
Infection
The risk of infection is 1 in 1000.
Other risks
- Salivary gland damage
- Reattachment
- No improvement in feeding
The NICE guidance for tongue-tie only talks about breastfeeding. Some bottle feeding babies do have feeding problems with a tongue tie. We will see bottle feeding babies if they have lost a lot of weight or if they have dropped more than two centiles on their chart in their red book. Our service is midwife led and we see babies up to 6 weeks, it can take a little longer to know if a bottle feeding baby needs a tongue tie to be divided. This means we might refer bottle feeding babies to a different service.
Your baby will be swaddled to that we can stop them from wriggling and held gently. We will lift their tongue with our fingers and divide the tongue-tie is using a pair of sterile scissors. After the division the baby will be unwrapped and given back to you to offer a feed. Feeding will help to calm baby and will help stop any bleeding.
Most babies settle quickly but you might find that your baby needs a few extra feeds or cuddles that day. The wound under the tongue can look like a diamond or triangle and a white or yellow patch may form under the baby’s tongue. It will usually disappear one to two weeks after the division.
Bleeding after your get home is rare. if you notice any blood in your baby’s mouth, feed your baby because this helps to stop bleeding. If your baby does not want to feed then use a clean gauze to press down under baby's tongue.
If after five minutes the oozing has not stopped go to your local Accident and Emergency Department. If your baby becomes floppy or unresponsive, please call 999.
Make sure that anybody caring for your baby washes their hands well. Make sure that anything that goes in to your baby’s mouth has been washed in hot, soapy water and sterilised. If you are giving formula milk, make sure you are making feeds up correctly with hot water at least 70oC.
You can help your baby to move their tongue by playing simple games. Hold your baby close and talk to your baby, when you pause your baby will start to talk back to you. When they do this they are moving their tongue. If you stick your tongue out at your baby and wiggle it from side to side then your baby will try to copy and this will help them to bring their tongue forwards. Take things slowly to give your baby time to catch on.
We recommend avoiding using a dummy until the wound has healed.
The feeding team will phone within a week of your baby’s division. The team will ask you how feeding is going and if you need any further support they will arrange this for you.
You can contact the infant feeding team directly if you require support or advice.