Below is a list of frequently asked questions relating to tongue-tie. I hope these are helpful but if you have any other questions or concerns you would like to discuss, then please don’t hesitate to contact me.
Could my baby’s feeding problems be caused by a tongue-tie?
There are many reasons babies can have problems feeding and many can be resolved with optimal positioning and attachment so it is important to get good quality feeding support.
For babies who have a restrictive lingual frenulum (tongue tie), this can restrict tongue movement and make feeding, which is already a hard workout for babies, especially tiring and difficult.
This restricted movement (and often resulting high-palate too) means that an effective latch cannot either be achieved or maintained consistently which can cause symptoms such as clicking, dribbling during feeds, painful latch, tiring quickly during feeds or feeding continuously, shallow latch and slipping of the nipple/teat during feeding. Babies can also be overwhelmed by milk and can have very sensitive gag reflexes which results in gagging, choking, coughing and reflux symptoms.
We often find that tongue-tied babies can be very unsettled during and/or after feeds due to air being taken in (when clicking and dribbling) as a result of the poor/inconsistent seal when feeding.
Will a tongue-tie division (frenotomy) help my baby breastfeed better?
Not all babies who are tongue-tied will necessarily need tongue tie release so getting skilled feeding support and some form of manual therapy (cranial osteopathy, chiropractic, craniosacral therapy etc.) to help relieve any tension that may be contributing to your baby’s feeding difficulties are worthwhile first steps to explore to see if feeding can be improved prior to surgical options.
However, for babies who have impaired tongue function due to the restriction of their tongue tie, research shows that frenulotomy (i.e. frenotomy) can improve feeding in 90-95% of babies. Although there is some variation in these statistics, they are generally above 80%.
It is important to note that tongue tie surgery is not usually a quick fix and it often takes time for babies to adjust to their new tongue through both learning new skills and unlearning old coping mechanisms from before. It is essential that post-release oral-motor exercises are performed regularly to help your baby to build strength and skills with their new found freedom! Having skilled feeding support and manual therapy are also both recommended after the procedure too, to support your baby to make the most of their new abilities!
How soon after birth can a tongue-tie be released?
I can perform tongue tie releases on babies from birth until they are 12 months old.
For some babies it is very clear at birth that a tongue tie is impacting feeding but for many others it can take a little time for both baby and mum to explore and learn together to see if there are improvements before performing a procedure that may not be necessary or helpful at that stage.
Feeding is a learned skill and often symptoms improve with the right support and practice therefore a holistic assessment is important.
Is tongue-tie release painful for a baby and how long does the distress last?
The distress babies experience is considered to be comparable to when they have injections or the heel prick test, based on how long they cry, how intensely they cry and how easily they are soothed afterwards. Babies are fed immediately after the procedure and most babies will cry until they start feeding. For some babies this is within a few seconds and for others they may require a few minutes of rocking and soothing before they will latch to feed, but they are usually calm within 5 minutes.
Local anaesthetic (numbing at the site of the procedure) is not given for the procedure because feeding afterwards is a priority and numbing around the tongue would stop a baby being able to latch and suck effectively. Sucking is important because it reduces bleeding and it also releases endorphins which are the body’s natural painkillers, so babies are usually soothed well by feeding, along with plenty of cuddles.
What does the procedure involve for a baby?
Babies are wrapped and a parent or support person with hold the baby’s head for the procedure. Sterile scissors are used to cut the frenulum. A swab soaked with frozen saline is applied to the wound to help reduce risk of bleeding and then the baby is passed immediately to a parent for feeding and cuddles.
The procedure can last anywhere from a few seconds to a few minutes depending on individual circumstances.
How quickly should I see feeding improvement after release?
Most people with experience instant relief after tongue tie release but this may only be temporary at first. Because your baby will be using their tongue in a different way, they will be using muscles in their tongue, jaw, face, neck etc. in new ways than before so they can get achy and tired. Therefore it is very normal for feeding to be up and down for the first week or so, usually with gradual improvements during and after this time. With time and practice your baby will build the strength they need to maintain the latch consistently which will help reduce their symptoms.
How long is recovery after a baby’s tongue-tie release and what aftercare is needed?
The initial wound healing takes 1-2 weeks but there is a period of rehabilitation for babies after tongue tie release which can vary in length for different babies depending on the unique struggles they are having. This could take a couple of weeks or sometimes a few weeks. Holistic support is really important to give your baby the best support possible to overcome the challenges they face.
Oral-motor exercises are taught at the assessment and are advised to be done before every feed for the first 2 days after the procedure and then continued for a few times a day for 2 weeks, or longer depending on progress.
Touching the wound is not recommended during healing as this can cause pain and aversion to things being in and around a baby’s mouth, which is not what we are aiming for.
What are the risks and complications of a baby frenotomy?
A frenotomy is considered to be a very safe procedure.
The main risk is bleeding which is 1 : 3000-5000. The risk of transfer to hospital for bleeding is 1 : 7000.
The risk of infection is 1 : 10,000.
There is a small risk of damage to the surrounding structures in the mouth but this is so rare that we do not have statistics for this.
There is a 2-4% chance of the tongue tie returning to a degree that impacts tongue function again. If this were to happen, there are scar massages that can be advised (only once the wound is fully healed) which may help to soften the scar tissue prior to exploring redivision. A second division can be performed if needed, but any further reattachment would require referral to the local ENT department for ongoing management due to risk of further scarring.
Will my baby need general anaesthetic or can it be done without?
Most babies can have the tongue tie procedure done without general anaesthetic. General anaesthetic, where you are put to sleep, is generally needed for older babies and young children where it is not safe to do the procedure whilst they are awake. This can be due to their mobility, their teeth or there are anatomical complications that would make it safer for them to be asleep during the procedure.
For most young babies, they tolerate the procedure really well and they calm down quickly with a feed and cuddles from a parent and keeping them awake gives them the benefit of feeding straight away afterwards where they often have the best feed they have ever had!
Do I need to do tongue and lip exercises after the procedure – who teaches them?
Oral-motor exercises are taught during the assessment as they are used to do the assessment so you will get a full demonstration and explanation on the day.
They are advised to be done before every feed for the first 2 days after the procedure and then continued for a few times a day for 2 weeks, or longer depending on progress.
Touching the wound is not recommended during healing as this can cause pain and aversion to things being in and around a baby’s mouth, which is not what we are aiming for.
What are the chances of re-attachment or needing a second procedure?
There is a 2-4% chance of the tongue tie returning to a degree that impacts tongue function again. If this were to happen, there are scar massages that can be advised (only once the wound is fully healed) which may help to soften the scar tissue prior to exploring redivision.
A second division can be performed if needed, but any further reattachment would require referral to the local ENT department for ongoing management due to risk of further scarring.
It is important to note that regrowth of a frenulum is normal as long as tongue function is not impaired.
Can I self-refer to a specialist tongue-tie clinic in the North West or do I need a GP/midwife referral?
Yes, you can self-refer to my specialist tongue-tie clinic in Ilkley, West Yorkshire. If you are unsure if your symptoms or your baby’s symptoms could be due to a tongue tie, then feel free to get in touch to discuss before booking an assessment.
Holistic Tongue Tie Midwife 