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Tongue tie information for parents

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What is Tongue Tie?

The fraenulum is a string like membrane that attaches the tongue to the base of the mouth. Where there is a short, tight or thick frenulum this is called a tongue tie. This can restrict tongue mobility and cause feeding challenges. The incidence of tongue tie is 3-11% of babies and it is more common in boys than in girls.

Positioning baby on the breast

Good positioning and attachment of your baby to the breast is really important. When your baby is positioned and attached well, your baby will come closely onto your breast so that your breast is deep in your baby’s mouth ideally at the junction of the hard and soft palate or the comfort zone. Your baby will feed better and you will feel more comfortable.

Treatment

Not all babies with tongue tie need treatment some will not have any feeding difficulties or challenges. For other babies who have a tongue tie it may interfere with their ability to feed well at the breast. This may lead to difficulties such as challenges to position and attach well onto the breast, nipple pain and trauma. Tongue tie may result also in poor milk intake by the baby with resultant poor weight gain and decreased milk supply for the mother.

Challenges for the baby with a tongue tie include

  • Difficulties in achieving and maintaining deep attachment to the breast
  • Weight loss or challenges to gain weight
  • Restless, tiring and unsettled feeds
  • Noisy or clicking sounds during the feed
  • Dribbling of milk during feeds

Challenges for the mother breastfeeding a baby with a tongue tie

  • Distorted nipple shape after a breastfeed
  • Bleeding, damaged or ulcerated nipples resulting in nipple pain  
  • Incomplete milk transfer by the baby resulting in engorgement and /or mastitis

The importance of lactation support

It is really important for you to get good lactation support if your baby has a tongue tie. Techniques such as improved positioning and attachment can help with feeding challenges and further treatment may not be necessary.  For some babies a frenotomy (division of the tongue tie) may be needed.  Assessment of a tongue tie should be carried out as part of lactation support. The ideal healthcare provider for lactation support is an International Board Certified Lactation Consultant (IBCLC). In the absence of a lactation consultant, midwives, clinical midwife specialists, public health nurses, GPs, neonatologists and paediatricians are in a position to provide support if your baby has a tongue tie.

Your midwife or public health nurse also may be an IBCLC. The following is a link to find your nearest Lactation Consultant in private practice http://www.alcireland.ie/find-a-consultant/

Support from Health Care Professionals

When the tongue tie is identified as contributing to feeding problems or challenges, and the appropriate lactation supports are put in place, your baby should be promptly referred to an appropriately trained health care professional to assess the severity of the tongue tie and possible frenotomy. The following is a link for health care professionals on the management of a tongue tie developed by the Health Service Executive (HSE). http://www.hse.ie/eng/about/Who/clinical/natclinprog/paediatricsandneonatology/resources/TongueTieinEarlyInfancy.pdf  

The frenotomy procedure is performed by a trained health care professional.  Prior to the procedure the health care professional will discuss what is involved with you the parents and answer all of your questions. Consent is then obtained to perform the frenotomy.  Frenotomy is usually performed without anaesthesia, although local anaesthetic is sometimes used. Your baby will be swaddled in a blanket and supported at the shoulders to stabilise the head. The tongue tie is then divided by scissors. There should be little or no blood loss and breastfeeding may be resumed immediately.

Follow up and support

It is important that both you and your baby are followed up after the procedure. Skilled breastfeeding information and support is essential following frenotomy. There is a wide range of breastfeeding support available in Ireland offered by both hospital and community based lactation consultants, Public Health Nurses, voluntary groups such as La Leche League, Cuidiu, and Friends of Breastfeeding. Links to nationwide support include:

You can search a nationwide database of hospital, public health and voluntary breastfeeding support at https://www.breastfeeding.ie/Support-search/

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