Tongue-tie assessment for Babies 0-9months
If you have just discovered your baby has a tongue-tie you’re bound to be feeling very anxious.
You may have noticed it yourself, or been told by a doctor or midwife that your baby has a ‘tongue-tie’ and they have referred you to the NHS service. But waiting times can be too long when you’re struggling to feed, and you might even find your baby doesn’t qualify to be treated, as they’re putting on weight or are now too old to be seen.
All too commonly, you may have received conflicting advice around whether or not your baby even has a tongue-tie and you just want to talk to an expert.
If you’re a mum experiencing difficulty feeding your baby, and you think your baby may have a tongue-tie, you should seek expert advice from a qualified CQC registered Tongue-tie Practitioner and Lactation Consultant such as myself.
What is a tongue-tie?
Most people have a stretching membrane under the tongue, called the lingual frenulum. The mere presence of a lingual frenulum, which can be seen or felt, does not mean your baby is tongue-tied
Tongue-tie (also known as Ankyloglossia) should only be diagnosed when this membrane is abnormally short or tight and restricts tongue function (prevents normal movement).
To find out more about anterior vs posterior tongue-tie and how to know when treatment is needed, head to the FAQs below
Feeding difficulties which the mother may experience due to
- Sore/persistently damaged nipples
- Nipple blanching (looking white) after feeds
- Nipples which come out of the baby’s mouth misshapen (lipstick shaped), despite good positioning
- Lowered milk supply, caused by inadequate breast drainage and ineffective feeds
- Mastitis – inflammation of the breast
- Low mood due to discomfort and difficulty establishing breastfeeding
- Exhaustion from frequent/constant feeding
Problems the baby may
experience due to restricted
- Small mouth gape resulting in poor attachment and biting/grinding behaviour
- Unsettled after/during feeds due to wind/frustration/hunger
- Frequent feeding or excessively long and drawn out feeds, only to need feeding again a short time later
- Difficulty maintaining a latch at the breast or bottle
- Excessive early weight loss/poor weight gain/faltering growth
- Clicking/slipping noises and/or dribbling during feeds on breast or bottle
- Increased colic/wind/hiccoughs/reflux (regurgitation of milk after feeds)
Please note: While the feeding difficulties above are often associated with tongue-tie, they can also occur in other circumstances and have other underlying causes,
therefore a thorough assessment by a practitioner highly skilled in breastfeeding is essential.
What does a tongue-tie assessment consultation include?
- 1:1 feeding assessment – observing your baby feed
- Attachment – how to ensure a good latch
- How to identify effective feeding and how to improve things
- Responsive feeding, sometimes called ‘feeding on demand’, explained
- Signs of optimal feeding
- Feeding cues – recognising the early communication signs
- The importance of ongoing skin-to-skin contact
- Lactation advice, composition of breast milk, stages of feeding
- Expressing breast milk
- Bottle feeding advice (as required)
- Mixed feeding advice (as required)
- Information insert for the baby’s ‘Red Book’ and email with follow-up information
- Tongue-tie assessment (objective scoring with HATLFF)
- Discussion about rare risks of procedure and explanations
- Tongue-tie division (frenulotomy) IF required and medically safe to proceed
- Post-frenulotomy observation of feeding
- Post-frenulotomy guidance and advice re tongue exercises/wound management and expectations (see Resources for more info)
Tongue-tie assessment/release appointment at home
PPE: When visiting I will be wearing a mask and gloves and carrying antiseptic wipes for equipment such as baby scales.
I will not visit if I have any suspicion of ill health within myself or my family. It is absolutely imperative that you inform me immediately if you, or anyone in your household is unwell prior to my visit, in order to protect other families with young babies.
Due to the current coronavirus pandemic, home Tongue-tie appointments are available on THURSDAYS + SATURDAYS ONLY, for baby/mums that are having feeding difficulties due to tongue-tie.
Clinic appointments are available on FRIDAYS.
Tongue-tie assessment/release appointment at home
Frequently asked questions about tongue-tie
Anterior tongue-tie – at the front
An anterior tongue-tie is diagnosed when the membrane is attached at, or close to, the tongue tip. The tongue tip may look notched or even heart shaped. The frenulum often runs from under the tongue (near the tip) to just behind the baby’s gum ridge.
Posterior tongue-tie – at the back
When the membrane is attached further back from the tip of the tongue – usually where the tongue is joined to the floor of the mouth – and ONLY if it’s causing a restriction, then it’s classified as a posterior tongue-tie. Sometimes the tongue may appear normal, but the tongue-tie is diagnosed via digital assessment of the tongue function. If a visible or palpable frenulum is not impeding tongue function, then it’s simply a lingual frenulum and not a tongue-tie.
You can find out more about tongue-tie on our blog.
Firstly, I will examine your baby, targeting the head and neck to determine if there are any restrictions with movement – I will gently place a gloved finger into your baby’s mouth and observe how your baby uses their tongue.
A true assessment cannot be made simply by ‘taking a look’, or whilst the baby is sitting on a parent’s lap, or laying in a car seat!
A full assessment is usually carried out with the baby laying on my lap, or on a changing table. The aim of the examination is to determine the degree of tension of the frenulum on the tongue and the surrounding tissue.
This gentle examination will not distress your baby and they often quite enjoy it – as long as they’re not too hungry!
NICE Guidance (2005) states: Division of ankyloglossia (tongue-tie) for breastfeeding should only be performed by registered healthcare professionals who are properly trained. A registered health care professional is someone who holds a healthcare qualification and has professional registration with a regulatory body such as the NMC.
As a registered Midwife, Lactation Consultant and NHS Infant Feeding Lead, I trained to divide tongue-ties at Southampton hospital in 2009. I then went on to run an NHS tongue-tie clinic at a leading hospital in the South East, seeing about 6 patients each week in my feeding clinic.
Since training, as a Tongue-tie Practitioner, over 11 years ago, I have assessed and treated literally thousands of babies! I am very proud to say that I am one of the most experienced Private Practitioners with a great reputation and hundreds of 5* reviews which you can read on my Birth Baby and You facebook page.
There is no evidence that this procedure causes much discomfort in young babies and therefore no anaesthetic is used to perform a tongue-tie release in babies under 6 months (more experienced practitioners, such as myself, will also see babies up to 9 months). This is because many babies do not seem to feel very much discomfort from the procedure and therefore an anaesthetic would be more invasive than the procedure itself.
A small number of babies (usually over 8 weeks), may feel some discomfort for a short time after the procedure. If your baby does cry more than normal you can give them the prescribed dose of Calpol, appropriate to their age. Any perceived discomfort usually settles within 24 hours.
Yes! In Jan 2019 the CQC confirmed that Frenulotomy falls within the regulated activity ‘surgical procedures’ and any HCP carrying out the procedure would have to register with the CQC for inspection.
I am now registered for regulation with the CQC. You can see their widget in the footer of this website enabling you to check my registration.