- Providing breastfeeding preparation.
- Postnatal feeding support.
- Frenulotomy (tongue-tie release) procedure.
- Teacher of Developmental Baby Massage and Movement.
- Trainer for tongue-tie release.
What is Tongue-tie?
Tongue-tie (ankyloglossia) is a condition in which the membrane under the baby's tongue (the lingual frenulum)
is abnormally short or tight which may restrict the movement of the tongue.
Where the membrane is attached at, or close to the tongue tip, the tongue tip may look blunt, forked or have a heart shaped appearance. However, where the membrane is attached further back the tongue may look normal.
If a baby's tongue function is significantly affected by a tongue-tie then feeding can be negatively affected. Interestingly, both breast and bottle feeding babies can suffer feeding problems
Possible problems caused.
If the tongue can move effectively even with a tongue-tie and there are no feeding issues then division may not be required at the moment. Perhaps the best plan may be ongoing feeding support with body work.
However, a baby does need to be able to move his tongue effectively in a number of different movements to attach effectively at the breast and maintain this latch during the entire feed.
If the tongue is not able to move freely and effectively, then not only may optimal attachment to the breast be difficult to achieve, but cause sore and damaged maternal nipples as the baby attempts to feed.
This can then result in mastitis, a poor milk transfer, a reduced milk supply, an unsettled and colicky baby, not to mention an exhausted mum! Bottle fed babies with tongue tie can also experience problems with their feeding, such as gagging, excessive dribbling, wind and a general dissatisfaction after a feed.
Additional issues to consider with a tongue that has a restricted movement include possible problems with managing solid foods, oral hygiene, speech development, posture and headaches - to name just a few.
Support with breastfeeding and experimenting with different feeding positions can be of benefit.
Please source help from a lactation expert to assist with the early days of feeding plus body work.
If you think your baby has a tongue-tie that is affecting your feeding, I would be happy to discuss further and carry out a tongue function assessment. This can be performed within a home visit with a view to dividing your baby's tight frenulum at the same visit.
What to expect at your appointment for your baby's tongue-tie release.
Frenulotomy involves a simple low risk procedure to release the tightness under the tongue. It takes only a couple of seconds or so, and without the need for an anaesthetic using sterile, sharp, round ended scissors. Your baby can feed immediately and I will discuss techniques to assist with the continuation of your feeding.
Before our booked appointment I will have:
- Emailed you my 'Before and After tongue-tie release Breastfeeding Matters Information Booklet'
- Advised you on my prices
Please bring to your appointment:
- Your baby's Personal Child Health Record Book (red book)
- Some previously expressed breastmilk (if breasfeeding) of infant formula
- Sterilised dummies or nipple shields (if using)
- A lightweight large blanket to wrap your baby for the procedure
- Liquid Paracetamol (please speak with your GP about the dose if your baby is under 8 weeks)
- Payment method to cover your balance
At your clinical appointment:
- I will take a detailed medical history for both you and your baby, plus your birthing and feeding history from you and I may observe your baby feeding.
- I will assess your baby's tongue function and then discuss with you to develop a plan.
- We will go through strategies, which may be more appropriate than tongue-tie release, or which may be needed alongside division, to improve feeding such as positioning and attachment, boosting milk supply, etc.
- If tongue-tie release is appropriate, I will go through the potential outcomes and risks of the procedure with you so you can make an informed decision on whether to go ahead or not.
- You will be asked to sign a consent form. There is no obligation to go ahead and I am quite happy for parents to go away and spend time researching and thinking more about the procedure if they wish to.
- During the procedure I will swaddle your baby in a towel or blanket.
- As I work alone, I will require you or another adult to hold your baby's head. I will show you how to do this is a comforting but firm way
- At this point please have your phone ready to take a picture of your baby's frenulum before the procedure
- Using two fingers I will lift the tongue to visualise the tight frenulum (tongue-tie) and divide it using a pair of single use, sterile, curved, blunt tipped scissors.
- Once your baby's frenulum has been divided, we will both look at your baby's wound straight after the procedure, take an after picture ahead of you feeding your baby.
- Giving your baby a milk feed will be calming, help your baby feel safe and comforted and the taste of milk help combat the flavour of the small amount of blood in your baby's mouth
- I will observe your baby feeding and provide support with this.
- After this first feed I will again examine your baby's mouth to check that all bleeding has ceased.
- I will also go through some simple, gentle tongue exercises you can do with your baby and explain to you what to expect in terms of healing and recovery.
- A feeding plan will be agreed with you to manage ongoing feeding issues and to help get feeding back on track.
- I will document our consultation in your Baby's Personal Child Health Record Book (Red Book), your Maternity notes if you are still under midwifery care and provide you with the Association of Tongue-tie Practitioners Aftercare leaflet.
- I will email a summary to your General Practitioner/ Surgery.
- We will go through my follow up plans, your ongoing feeding support.
- I am happy to accept payment by all major credit cards, cash or bank transfer. If you prefer a bank transfer then I will provide you with my bank details for you to action after our visit. A receipt will be provided for your payment.
- I will email you my online anonymous surveys for you to provide me with some honest feedback at 1-2 weeks and 2 months after your baby's procedure.
The Association of Tongue-tie Practitioners, supporting parents
of tongue-tied babies to access safe and effective care.
The effectiveness of frenulotomy on infant-feeding outcomes: a systematic literature review (2013) Finigan V and Long T. Evidence Based Midwifery: June 2013
The National Institute for Health and Clinical Excellence (NICE) have produced a comprehensive parent information sheet, about tongue tie, just click the link to access this printable pdf document.
UNICEF UK Baby Friendly Initiative Helping a baby with tongue tie.
Nice Interventional Procedure Division of ankyloglossia (tongue-tie) for breastfeeding, information for the public. December 2005.
Tongue-tie information site.
"Things are still going well for us and the BF is more pleasurable with every day.
The tongue is healing beautifully.
It's amazing how much wider she can now open her mouth now and latching on is so much easier for her."
"Just a note of thanks, she is certainly feeding a lot better and we are positive that the tongue division has helped a lot. I am still a little sore but following your advice and things have started to improve. We have been visited by the midwife and the breast feeding advice lady who basically endorsed everything we had discussed. Once again thank you, if we have any problems we will certainly call again as you were extremely helpful."
"Thanks for your email and for coming over at such short notice on Friday. We are quite relieved to have had the tongue tie problem diagnosed and rectified. "
"his tongue seems fine now, and apart from his complete over excitement when presented with a nipple, which results in lots of head shaking and opening and shutting of his mouth, making getting him to latch on sometimes a bit tricky, he is feeding much better than before."
Professional Indemnity Insurance and Public Liability Insurance is provided by Hiscox Insurance Company Ltd.