Tongue-Tie (or Ankyloglossia) is a mid-line anomaly and occurs as a result of incomplete cell division between the tongue and floor of the mouth at the seventh week of gestation. It is more common in boys (2:1), approximately 1:7 babies will have a tongue-tie and approximately one fifth of these will have posterior or sub-mucosal tongue tie.
In anterior tongue-tie, you can easily see a string of tissue (the frenulum) that attaches the tongue to the floor of the mouth. In posterior tongue-tie this tissue is more difficult to see but can be felt on palpation. If this piece of tissue is too short or tight it can cause restriction of tongue mobility and as a consequence may affect the baby’s ability to breastfeed.
The presence alone of a tongue-tie is not an indicator for treatment with frenotomy. Tongue mobility is the critical factor that affects breastfeeding.
Reasons for treating Tongue-Tie
The treatment for tongue-tie is a procedure called a frenotomy.
Not all babies and children with tongue-tie need treatment, some may be fine without it. National guidance from the National Institute of Clinical Excellence (NICE guidelines) suggests that frenotomy is usually safe for young babies and could help with breastfeeding problems. Frenotomy may be recommended in babies up to 6 months of age if there are;
Difficulties with Breastfeeding (for baby)
Difficulties with breastfeeding for the baby may/may not include the following;
- Poor weight gain
- Prolonged jaundice
- Fractured frequent feeds
- Baby feeding ‘all the time’
- Baby appearing unsatisfied after a feed
- Agitation and frustration whilst feeding
- Head-rocking or waving on approaching the breast for a feed
- Noisy clicking or lip noise whilst feeding
- Dribbling of milk during a feed
- Falling asleep prematurely during a feed
- Multiple attempts at latching or maintaining latch
- Use of expressed breast milk or artificial milk supplements
- Reflux like symptoms (coughing, back arching, hiccups, vomiting)
Difficulties with Breastfeeding (for Mother)
Difficulties with Breastfeeding for Mother may or may not include;
- Distortion and or compression of the nipples resulting in pain, damage, loss of tissue
- Incomplete milk transfer by baby resulting in engorgement and/or mastitis.
- Poor initiation and maintenance of maternal milk supply