Tongue-tie

The symptoms in a baby

• inability to open their mouth widely.
• biting or chomping on the breast.
• unsettled behaviour during feeds.
• slipping off the breast.
• frequent or very long feeds.
• excessive early weight loss, poor weight gain or faltering growth.
• clicking noises and/or dribbling during feeds.
• colic or excessive wind.
• reflux (vomiting after feeds).

Symptoms a mother may experience

• sore or damaged nipples.
• nipples that look misshapen (‘lipstick’ shape, flat) or blanched after feeds (vasospasm).
• mastitis.
• low milk supply or oversupply.
• exhaustion from frequent or constant feeding.
• distress due to breastfeeding not established.

Diagnosis

Tongue-tie should be diagnosed by a tongue-tie practitioner, who specialises in assessing and treating this condition. GPs, midwives, health visitors, paediatricians, are not always trained to diagnose a tongue-tie (this is why often it’s not picked up at birth). However, they may use simple assessment tools to identify tongue restrictions and put a plan in place to support feeding. If your baby is between 4 days and 28 days old and is still struggling with feeding, you may be referred to the tongue-tie clinic.

Treatment

Treatment is not usually needed if tongue-tie is not causing any problems.

If it's causing problems, such as difficulty feeding in babies, treatment may include:

• breastfeeding or bottle-feeding advice from a trained health professional
• a small surgery to cut the piece of skin connecting the tongue to the bottom of the mouth

In young babies, the surgery is usually done without any anaesthetic. In older babies (and children and adults) the surgery is usually done with general anaesthetic.

After surgery, most babies get better quickly and are able to feed better.