Tongue Tie FAQs

Some­times it appears obvi­ous that a baby has a tongue tie with the frenu­lum being vis­ibly short or tight, oth­er times it can be dif­fi­cult to tell wheth­er a tongue tie is present. Some signs which sug­gest it might be worth check­ing for a tongue tie include:

• The moth­er has sore or dam­aged nipples.
• The baby has dif­fi­culty latch­ing onto the breast or slips off once latched.
• The baby does not seem to be trans­fer­ring much milk and/or is strug­gling to gain/losing weight.
• The baby is fussy and unsettled on the breast.
• Feeds are long (often over one hour) and or the baby wants to feed constantly.
• The baby makes click­ing sounds when feed­ing (this is a sign the baby is drop­ping on and off the breast)
• The baby finds it dif­fi­cult to man­age the milk flow (is chok­ing and spluttering)

In a bottle fed baby you may see

• Excess­ive drib­bling on the bottle (this often means the baby isn’t get­ting a good seal)
• The baby is fussy on the bottle (tak­ing in excess­ive air)
• The baby finds it dif­fi­cult to man­age the milk flow (is chok­ing and spluttering)

To check for a tongue tie, we observe the move­ments the baby makes with the tongue e.g., can they stick it out? How far does it come out? Can they move it side to side? How high does it lift? If a baby doesn’t exhib­it those move­ments spon­tan­eously then we can eli­cit them with a gentle exam­in­a­tion using a clean gloved fin­ger. We then lift the tongue and observe the frenu­lum, we are look­ing to see where the frenu­lum is attached to the tongue and the roof of the mouth and how short and elast­ic it is. We then input the res­ults of our assess­ment into an assess­ment tool which gives us a clear­er idea of wheth­er divi­sion is likely to be help­ful or not.

Check­ing for tongue tie is not part of the routine checks every baby has after birth and most mid­wives and doc­tors who do these checks are not trained to check for tongue tie. Some mid­wives, health vis­it­ors and lacta­tion con­sult­ants are able to check for tongue tie if asked.

Tongue tie may affect speech or teeth although research is unclear, but this appears to be rare and hap­pens only in a rel­at­ively small num­ber of babies who have a tongue tie there­fore we only divide tongue ties when a baby has an issue with feed­ing. This is in accord­ance with guidelines from the Nation­al Insti­tute of Clin­ic­al Excel­lence (NICE).

Divid­ing a tongue tie car­ries some small risks like any sur­gic­al pro­ced­ure. Please see our detailed leaf­let on ‘ Your baby’s tongue tie’.

Around 1 in 10 babies have a frenu­lum which is short, tight and/or inelast­ic enough to be called a tongue tie although not all of those babies will have dif­fi­culties with feed­ing or will need division.

We are not sure wheth­er there has been an actu­al increase in the num­ber of babies with a tongue tie or wheth­er there is just an increase in diagnosis.

There are lots of the­or­ies about why there seems to be an increase, includ­ing an increase in breast­feed­ing rates (breast­fed babies may be more likely to exper­i­ence feed­ing dif­fi­culties with a tongue tie), more aware­ness among par­ents and health­care pro­fes­sion­als or that there has been an actu­al increase in the incid­ence of tongue tie due to some change in preg­nancy care or the environment.

We only divide tongue ties where this is clearly indic­ated after an assess­ment using a val­id­ated tool, the baby has dif­fi­culties with feed­ing and the par­ents would like it divided.

Most stud­ies sug­gest that around 90% of breast­feed­ing dyads report improved feed­ing after tongue tie divi­sion. We don’t have any evid­ence regard­ing wheth­er divi­sion improves feed­ing in bottle fed babies although anec­dot­ally par­ents report it does. Improve­ment can some­times be imme­di­ate but more often takes a few days or longer to become appar­ent and you may con­tin­ue to need sup­port with feed­ing post divi­sion. We always offer fol­low up.

If after dis­cuss­ing the res­ults and the risks and bene­fits of tongue tie divi­sion you would like to go ahead, I will ask you to sign a con­sent form.

I will then wrap your baby up tightly and wash my hands. I ask you to hold your baby’s head firmly and gently open the baby’s mouth and divide the frenu­lum using a blunt ended pair of scis­sors. This takes up to a minute in most cases.

There is usu­ally small amount of blood, I will then bring the baby to you imme­di­ately for a feed. The feed com­forts the baby, helps settle the bleed­ing and enables you to tell me if the divi­sion has had an imme­di­ate effect.

When you and your baby are happy, you can go home. If you are happy I will write to your GP to let them know your baby had the pro­ced­ure.  I will give you my con­tact details so you can get in touch with me at any time if there are any con­cerns and I will also give you inform­a­tion as to what to do if for example the baby begins bleed­ing again or you are con­cerned about infection.

I will also dis­cuss with you some exer­cises you can do to pre­vent the frenu­lum reheal­ing.  If you are happy I will fol­low up with you in 2 – 3 days to check how things are going and if you need any fur­ther sup­port. You can con­tact me any time.

Please see our price list here. At present we charge £80 for assess­ment and feed­ing sup­port and £120 for the actu­al divi­sion, for a total of £200 for a full assess­ment, feed­ing sup­port and tongue tie divi­sion appointment.

Please do let me know as soon as pos­sible via email. If it is more than 24 hours before your appoint­ment there is no charge. If can­celled with­in 24 hours of the appoint­ment, the £80 assess­ment fee is still owed.

We divide tongue ties on babies aged 0 – 12 months old. We would encour­age get­ting some feed­ing sup­port first so it may not always be appro­pri­ate to divide a tongue tie on a baby of only a few days old but this very much depends on the circumstances.

Lip tie is the term used when the labi­al frenu­lum (the tis­sue between gum and upper lip) is tight, short or inelast­ic, as there is not suf­fi­cient evid­ence to sug­gest divid­ing these ties is likely to improve feed­ing, we don’t offer this.

There are some med­ic­al issues which may pre­clude tongue tie divi­sion par­tic­u­larly if they are related to blood clot­ting or to breath­ing. Please con­tact us when you book to dis­cuss, we may want a let­ter from your baby’s doc­tor to con­firm tongue tie divi­sion is appropriate.