• Reference Number: HEY-393/2022
• Departments: Maternity Services
• Last Updated: 1 February 2022

Introduction

This leaflet has been produced to give you general information about your baby’s possible tongue tie.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your child’s health professional, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a healthcare professional qualified to assess your baby and perform the division of tongue tie procedure, if necessary.

What is Tongue Tie?

A tongue tie is when the lingual frenulum (which is the membrane on the underside of your baby’s tongue), is either tight and / or short, thereby restricting the normal function of the tongue, particularly in relation to feeding at this age.  It is slightly more common in boys than girls and there is often a family history of this.  Sometimes, the membrane extends right to the tip of the tongue or the lower gum ridge; sometimes it is only part way along the tongue.  Most are thin translucent membranes but some are thicker.

Why might your baby need this procedure?

Babies who are tongue tied and are trying to initiate breastfeeding may find it difficult to latch far enough onto the breast. Others struggle to maintain a vacuum seal at the breast throughout the feed and make repeated attempts to reattach. Both situations reduce the amount of milk the baby can access, leading to an unsettled baby who is likely to lose too much weight or only gain weight very slowly. Breastfeeding mothers, who have a tongue tied baby, often develop sore nipples from poor attachment at the breast.  Poor milk removal increases the risk of breast engorgement (full of milk), mastitis and a faltering milk supply.

Babies who are tongue tied and are initiating bottle feeding may find it difficult to create an effective seal around the bottle teat, resulting in excessive dribbling and long feeds during which only small amounts of milk are swallowed. Changing teats does not appear to help. This group of babies may also lose too much weight or only gain weight very slowly.

Division of tongue tie will help your baby to feed more effectively by restoring the range of tongue movement necessary to breast or bottle feed.

Can there be any complications or risks?

There is a minor risk of bleeding (1 in 400), however in most cases blood loss is very minimal, just a couple of drops. We encourage you to feed your baby straight after the procedure as this helps to stop any bleeding.  If the area bleeds more than expected, we would initially apply pressure with a gauze swab.  If necessary, we would apply further pressure with a gauze swab that contains something which helps your baby’s blood to clot. In the unlikely event that the above did not stop the bleeding, then we would seek further medical support.  Very occasionally bleeding may occur at home following the procedure in the rare event that this occurs, then please follow the advice in the aftercare section of this leaflet.

The procedure also carries a minor risk of infection (1 in 6000 cases).  The mouth is not a sterile area and usually heals very quickly and without complication. Please see the aftercare section of this leaflet so you are familiar with what to expect your babies wound to look like and when you should be concerned and what to do.

How do I prepare my baby for this procedure?

There are no special preparations that you have to undertake.  The procedure is usually done when your baby is ready for a feed. You should bring your baby’s Midwifery notes or red book with you to the appointment, so that the review/procedure can be documented.

What will happen?

Your baby will be wrapped in a blanket or towel and taken to a separate room for the procedure, while you prepare to feed your baby. The practitioner’s assistant will gently hold your baby’s head and shoulders so that it does not move during the procedure.

The practitioner will stimulate your baby to open its mouth and then use a finger to lift your baby’s tongue to visualise the tongue tie and then make a simple snip to release the tongue tie followed by a J like movement with their fingers to stretch and ensure that all the membrane has been released.  Usually there are just two or three spots of blood and the practitioner will place a piece of gauze square under the tongue and hold it there.  Your baby is carried back to you and the gauze removed immediately before your baby begins to feed.

What happens afterwards?

Feeding

You will be given assistance to feed your baby and your health professional will document any noticeable improvements and effectiveness of feeding.  There is no further follow up required.

Once back home you should continue to feed your baby normally.

If you are bottle feeding your baby or using dummies, it is important to ensure that you sterilise all equipment.

If your baby is unsettled when attempting to feed, simply putting them skin to skin is usually enough to calm them.

If you have any continued feeding concerns you can use the infant feeding number provided in this leaflet to access support.

Wound healing and what to expect

The area under the tongue where the membrane is snipped may initially look like a white diamond shaped ulcer. After around 24hrs it is also normal for this to appear yellow/orange in colour. This is because the mouth is a wet area and wet scabs appear this colour,  It is not a sign of infection.  You should only be concerned if the area looks swollen, red or inflamed, if your baby develops a high temperature, is reluctant to feed, or is sleepy or irritable. If any of the above occurs, you should contact your GP or if out of hours then 111. The scar under the tongue may last up to 2 weeks, however it is usually gone before this time.

Blood in stool or vomit

If your baby swallowed any blood during the procedure, it is possible that this may appear as a pinkness in your babies vomit or as a small streak of black in your babies poo.   This should last no more than 48 hrs.  If you are concerned beyond this time then please contact your GP or 111 if out of hours.

Bleeding at home

In the very rare event that that bleeding occurs at home then follow the advice below

Offer baby a feed, this will usually stop the bleeding within a few minutes.  If the baby is reluctant to feed then sucking on a clean finger or a dummy will have a similar effect.

If the bleeding is very heavy or it does not reduce with feeding and stop within 15 minutes , then apply pressure to the wound under the tongue with a piece of gauze (or similar material) over one finger for 10 minutes.

If bleeding continues after that time and you are concerned, continue to apply pressure to the wound and call 999, as it is likely your baby will require a hospital review.

Referral System:

Babies born in Hull University Teaching Hospitals NHS Trust, who are up to 6 weeks of age, can be reviewed on Rowan Ward.

• Whilst an inpatient
• Following telephone referral from Community Midwife, Health Visitor or doctor

To make a referral please contact the Infant Feeding Coordinators via Rowan ward on (01482) 605381 / 605383.  Rowan ward staff will either make an appointment for you if there is an appointment time available or alternatively staff will take the details and one of the Infant Feeding Coordinators will call to arrange an appointment at the first possible opportunity.

Information needed includes: name of mother and baby, baby’s unit number, contact details, baby’s date of birth and method of feeding.

Babies not born in Hull University Teaching Hospitals NHS Trust up to 6 weeks of age

• Referrals can be made as above.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Your newborn baby’s NHS number

An NHS number is allocated to everyone whose birth is registered with a Registrar of Births and Deaths in England and Wales. You already have an NHS number and your baby will be assigned an NHS number soon after birth. Your NHS number is unique to you and provides a reliable means of linking you to the medical and administrative information we hold about you. NHS numbers are allocated on a random basis and, in themselves, provide no information about the people to whom they relate.