True or False Tongue Tie Edition

True or False? Tongue-Tie Myths and Facts

"If they're breastfeeding well, oral function must be good"

False!

Good oral function in babies is about more than just breastfeeding well. It affects how they breathe, sleep, and even how their face and jaw develop as they grow.

A baby with good oral function will have an easier time with other milestones like eating solids, talking, and even smiling.

It's important to pay attention to how your baby uses their tongue, lips, and jaw, not just during feedings but throughout the day.

“If the baby is gaining weight, they can't have a tongue tie”

False!

Babies can still gain weight well and have a tongue tie.

Some mothers have a good milk supply and this may mask other typical symptoms of tongue tie as the baby may be seen to be doing well since s/he is gaining weight.

If your baby is gaining weight but having other symptoms such as

• Reflux

• Painful gas/wind

• Unsettled after a feed or frustrated during a feed

• Clicking sounds during feed or dribbling milk

• Constant feeding

• Consistently getting tired during feeds

Consider a tongue tie assessment, even if you have been told that a baby gaining weight doesn't have a tongue tie. That is false! I have seen many babies with feeding problems caused by a tongue tie that were still gaining weight and mothers that had an oversupply of milk despite the tie.

“All tongue ties are picked up at birth or during the NIPE examination in first 72 hours of baby’s life”

False!

Midwives and doctors are not routinely trained to identify tongue ties. It’s not part of the midwifery training, aside from a brief mention during breastfeeding lectures and possibly practical or personal experiences seen in placement or with their own children. It’s also not part of the Newborn Infant Physical Examination (NIPE) screening examination, so it may be identified if the midwife or paediatrician has had further training, but it may not be as it is not part of the screening. The training for tongue-tie division is a specialist role in the UK and, tongue tie practitioners, such as myself, have done a year long top-up course to be further educated to identify tongue-ties, divide them, and offer aftercare and additional feeding support.

“All tongue ties need to be divided”

False!

Tongue ties can cause problems such as:

Poor weight gain

Painful gas

Long/constant feeding

Reflux

Leaking milk out of the mouth

Clicking sounds while feeding

Sore nipples/damage

Engorgement/mastitis

If these symptoms occur, the baby should be assessed by a tongue tie specialist. When the tie is causing a significant feeding issue, it should be divided. This is not depending on what the tongue looks like, but how it impacts the feeding.

Sometimes tongue ties don’t cause issues and feeding can be further supported with oral exercises, having the baby see an osteopathic/chiropractic treatment before a division, or ongoing lactation support instead. In these cases a division should not be done, or the feeding should be observed and if issues increase, a division could be done later on.

Tongue ties should never be looked at in isolation. It’s important to consider a holistic picture of the feeding, mother, and baby. Of course, it’s also always the parent’s choice to have a tongue tie divided or not, and it’s always alright to go home and think about it first.

“Tongue ties cause feeding issues for both the mother and the baby”

True*

Most tongue ties will cause symptoms for both the mother and the baby. The exception being women who choose to bottle feed only, either with expressed milk or formula. Some tongue ties may cause more symptoms to the baby and the mother may have tolerable or mild symptoms only. Therefore it’s important to seek the advice and an oral assessment from a trained tongue tie specialist. When symptoms are confusing other healthcare practitioners that don’t have specialist training may miss that a tongue tie is causing the issue. Or it may cause a delay in diagnosis because either the baby or the mother is experiencing more severe symptoms and this can lead to other support and techniques being attempted before attending an appointment for oral assessment.

“My baby is bottle feeding, there’s no point in getting his/her tongue tie divided”

False!

Tongue ties can impact on oral function later in life. A baby needs to use their tongue to clean their teeth, swallow effectively, clean food debris off of their tongue etc. A fully functional tongue is useful for a baby as they start to wean onto solid foods. Some babies may not enjoy certain foods if they struggle to swallow them because their tongue is not able to move effectively. Likewise, a baby dribbles food out of their mouth frequently for the same reasons they are dribbling milk, restricted tongue movement can block the flow of food and liquid to the back of the mouth. Restricted tongue function may also impact on a child’s ability to move their tongue side to side (lateralization) in order to clean food particles from their mouth when they are older (think about how you use your tongue to get popcorn kernels out of your teeth), a restricted tongue may struggle with this and can lead to poor oral hygiene or dental problems. There is little to no evidence to suggest that a tongue tie can cause speech difficulties.

Many bottle fed babies struggle with feeding and are frequently uncomfortable and unsettled after feeding. Feeding should be an enjoyable experience for all babies.

“Tongue tie practitioners are just trying to get money off of you. It’s not a real condition.”

False!

As a tongue tie practitioner I will always offer you a holistic assessment. You are always welcome to walk away from an appointment to think about whether a tongue tie division is right for you and your baby. You may want to try other support first such as seeing a lactation consultant or an osteopathic treatment for your baby. You may want to get a second opinion from another practitioner, you can find other private and NHS clinics online.

You can also request to be referred to your local NHS Trust for a tongue tie division. Waiting times on the NHS are variable, some hospitals will only see babies up to a certain age, and some may not offer divisions for bottle fed babies, and some are done by surgical teams and feeding support or follow up care is offered afterwards.

“Tongue tie division is a surgical procedure”

True!

It’s classified as a minor surgical procedure. The division (frenotomy) is done with sterile scissors in most cases, although other forms of division with a laser are available. The risk of bleeding is 1:5,000 the risk of infection is 1:10,000. Every practitioner must be fully insured and registered with the CQC.

“My baby will experience too much pain during a tongue tie division”

False!

The answer to this will depend on the baby's age. Newborn babies will cry in the moment, but will be comforted by the feed afterwards and will usually not exhibit discomfort later. Babies over 8 weeks old will follow the same pattern, but will likely experience some discomfort for about 24 hours and will benefit from Calpol (baby paracetamol). The tongue will likely just ache due to the muscle freedom and it can be strange for a baby to experience that.

“There will be lots of bleeding during the division”

False!

Severe bleeding is a rare occurrence, the risk is about 1:5,000. Most of the time the blood loss is minimal, only a few drops, with 1-4 small gauze pieces being used to stop the bleeding. The majority of bleeding stops with some pressure and a feed afterwards because the sucking will put pressure on the wound and comfort the baby. We have bleeding guidelines to follow if we are concerned. All practitioners carry bleed kits with them and we are trained to stop the bleeding. It’s always an option to transfer into hospital with the baby for the doctors to continue to put pressure on the wound, or prescribe adrenaline to put on it.

If you'd like to book a tongue tie assessment or feeding support with me you can do so here: https://calendly.com/supporting-motherhood