WHAT IS TONGUE TIE?
It is probably best to first describe what a tongue frenulum is. A tongue frenulum is the connection between the base of the tongue and floor of the mouth. If this frenulum causes difficulties with feeding or restriction of tongue movement (e.g. protrusion) then this frenulum is a tongue tie.
WHAT IS LIP TIE?
A lip tie is a frenulum that is impacting on the ability for the lip to perform its function. For feeding this means being able to flange the lip out to make a good seal. Some babies will bring the lip in tight when feeding in order to make the 'compression' style of feeding more effective. A lip frenulum is any connection between the gum and lip and this is nearly universal.
DO ALL FRENULUMS NEED DIVISION?
No. Up to 10% of the population will have a obvious tongue frenulum. Of these about 45% can have difficulty in feeding related to their tongue frenulum i.e. tongue tie. 30% of infants have a posterior tongue frenulum
I HAVE BEEN TOLD THAT THE FRENULUM IS "TOO SMALL/MINOR" TO CAUSE A PROBLEM WITH FEEDING. IS THIS TRUE?
This is incorrect. The physical appearance of the tongue frenulum, in terms of how far forward in the mouth it comes, is not a predictor of functional difficulties. We have treated many babies who have Type 4/posterior tongue ties, with good results, who have been told this. The lack of elasticity and short height of the frenulum are better indicators of feeding difficulties.
I AM HAVING DIFFICULTY BREASTFEEDING. WHAT SHOULD I DO?
Seriously consider getting support and advice from a lactation consultant, those with an IBCLC qualification. There are many reasons for breastfeeding problems and a lactation consultant will assess your feeding and advise how best to improve your situation There are some public lactation consultants around the country and also a number working in private practice. If you can get a personal recommendation this would be best. Look on the external links page for some starters.
BREASTFEEDING IS OFTEN PAINFUL IN THE FIRST FEW WEEKS OF LIFE. IS THIS TRUE?
This is an often-quoted misconception. Breastfeeding can be uncomfortable in the first couple weeks but it should not be painful. If this is your experience then seek lactation support.
I HAVE BEEN TOLD IF I JUST KEEP FEEDING THE PAIN WILL SETTLE. IS THIS RIGHT?
Discomfort will usually settle but painful feeding is a red flag for feeding problems. Again seek lactation support.
MY BABY HAS A TONGUE FRENULUM, IS FEEDING VERY WELL AND NEITHER ME NOR THE BABY HAS ANY SYMPTOMS . SHOULD THIS BE DIVIDED?
If your baby is feeding well then there is no need to intervene. You should enjoy your feeding experience.
DOES MY BABY NEED TO HAVE VITAMIN K?
The reason for giving babies Vitamin K is to prevent Vitamin K deficiency bleeding. The best protection is offered by giving this as an intramuscular injection. It can be given by mouth but needs to be given at birth and repeated at a week and a month of age.
WHEN IS MY BABY LIKELY TO BE SORE AFTER THE PROCEDURE?
Most babies sail through the procedure and aftercare. A few babies are sore about 2-6 hours after the procedure. Another group are sore about 36 hours after the procedure. This is because this is when the inflammation of healing in the wound is at its maximum, in much the same way that if you twist your ankle it doesn't swell until the following day. It is this swelling that makes movement of their tongue sore. Paracetamol and/or ibuprofen is effective in managing this discomfort and should be given.
CAN MY BABY SWALLOW THEIR TONGUE AFTER A DIVISION?
This is an often quoted myth about tongue tie and the simple answer is no. There have been many thousands of tongue tie divisions every year, around the world, without such incident. There are two case reports of children who had Pierre-Robin sequence, which is a rare condition with cleft palate, large tongue and small lower jaw, who did have airway problems following tongue tie release. These problems have not been seen with children who do not have Pierre-Robin sequence.
SHOULD I USE A SOOTHER AFTER TONGUE TIE RELEASE?
If you are breastfeeding then it is preferable to avoid using a soother following tongue tie release. Soother use can encourage a chomping or biting movement when using the soother and can impede the transition to a more effective sucking movement. If you are bottle feeding then using a paced bottle feeding technique can help encourage the correct sucking motion and soother use can also interfere with this. Once the new feeding pattern is established after a couple of weeks then soother use can be resumed. If your baby can only settle with their soother then you may need to compromise on the above recommendation. It also inhibits the tongue resting up on the roof of the mouth so prolonged soother use is not recommended.
CAN I JUST ATTEND FOR A CONSULTATION?
You are welcome to attend for a consultation only.
WHAT DOES THE PROCEDURE INVOLVE?
A local anaesthetic gel is applied under the tongue, and if applicable also under the upper lip.
Your baby is then swaddled and eye protection goggles put on. Young babies are also given a few drops of sugar solution for pain relief. Their tongue tie +/- lip tie is then divided using the laser.
We do everything we can to make sure the procedure is as comfortable and stress-free as possible. Our laser room is baby friendly and we play soothing white noise to help your baby relax. Young babies are given sucrose solution before the procedure. Babies are held prior to swaddling, spoken to and soothed during the procedure and picked up immediately afterwards. Your baby is then returned to you, for a cuddle or a feed - whichever they prefer. Older babies are distracted with appropriate toys. Once your baby has fed and we have gone through the aftercare you can be discharged home.
ARE THERE ANY SIDE EFFECTS?
Nearly all babies will cry during the procedure due the elevation of the tongue. This usually lasts for less than a minute. For most infants the procedure is comparable to a blood test or vaccination. There is little to no bleeding with laser division. However, if there is a family history of bleeding problems or your baby did not receive Vitamin K at birth it would be important to mention this during the consultation.
There is a very small risk of infection, approximately one in ten thousand. If this happens there will be an area of red and inflamed skin beside the mouth ulcer. Treatment with oral co-amoxiclav (Augmentin®) is effective in treating this.
There is the possibility of the tongue tie reattaching itself back together. This can be up to one in twenty-five of anterior tongue ties but one in ten posterior tongue ties if no, or inadequate, wound care is done. You will be shown the wound care exercises which, when done effectively, reduces the risk to one to two in a hundred. You will also be shown mouth care exercises to help improve the tongue function.
IS IT EFFECTIVE?
Both published research and an audit in South Tipperary General Hospital show that the procedure is 95% effective at improving feeding difficulties.
There are three possible pathways that your baby can take following division. The first is the ‘eureka’ moment and then every feed is improved and goes well. The second is the ‘slow and steady’ group; for example there is one better feed per day which becomes two which becomes three and so on. It can take between two to six weeks for your baby to have effective feeds every feed. The third group, albeit a very small group, find that their feeding ‘program’ doesn’t work for how their tongue moves following division of the tie. This group have to re-learn how to feed with the altered dynamics of their tongue. They can be very frustrated in the first 24 to 48 hours whilst they make these changes but then would improve rapidly and be feeding well within 7 days.