Maternity services
This information has been developed for parents in line with the best available global evidence, with the support of South Tees Maternity Voices Partnership and local Health Visiting Services.
What is a tongue tie?
A tongue tie, also known as ankyloglossia is an unusually short, thick or tight band of tissue (lingual frenulum) that attaches the tongue to the floor of the mouth. This can affect how well a baby uses their tongue, which can sometimes cause difficulties with feeding. Some difficulties associated with tongue tie can be improved or resolved with breastfeeding support.
When should my baby be assessed for tongue tie?
Your baby will not be routinely assessed for a tongue tie unless there are problems with feeding that are not resolved with help and support. It can sometimes take several days for your baby’s feeding skills to develop – it is therefore important that we support you during this time. Sometimes feeding problems associated with tongue tie may not become apparent until your baby is a few weeks or months old.
If you are no longer receiving maternity care, your local Health Visiting infant feeding team can assess your baby for tongue tie and support you with any feeding issues.
Signs and symptoms that a baby may have a tongue tie
For mum
- Painful, sore or damaged nipples
- Recurrent mastitis or blocked ducts
- Problems with milk supply
For baby
- Feeding very frequently, for very long periods of time or very unsettled following most feeds
- Difficulty attaching to the breast or difficulty staying attached
- A clicking or slurping sound during most feeds
- Losing weight or not gaining weight as expected
Will a tongue tie affect my baby’s speech and
language?
There is no high-quality evidence to suggest babies speech and language is affected due to a tongue tie. This procedure is only be completed in young babies to improve feeding.
Who can assess for a tongue tie?
We have a team of infant feeding champions in Maternity and Health Visiting who are qualified to assess for tongue tie. If your named Midwife or Health Visitor is not a tongue tie assessor, we can arrange for you to be seen by one.
What next?
Ongoing assessment and feeding support can help to improve feeding in some cases. However, if an assessment indicates a suspected tongue tie and you are having ongoing feeding difficulties, you will be referred to the tongue tie clinic at James Cook Hospital for assessment. An appointment to be seen is usually within 2 to 3 weeks.
Whilst you are waiting for further assessment, it is important that your breastmilk supply is maintained. If your baby is unable to latch onto the breast at all or frequently feeds for less than 5 minutes, it is suggested that breast milk is expressed by hand or a breast pump 8 to 10 times in 24 hours.
Videos on how to hand express are available from the UNICEF baby friendly website
What will happen at the tongue tie appointment?
A tongue tie practitioner will carry out a thorough assessment of breastfeeding and of your baby’s tongue function to decide whether a tongue tie division is required. A feeding plan may be put into place initially, and you may then be asked to return the following week to see if feeding has improved.
If a tongue tie division is needed, this will be offered at the same appointment. It is important to know whether or not your baby received Vitamin K at birth. If your baby has not had vitamin K, we might be unable to perform the procedure.
We will ask you about family history of any bleeding disorders or any excess bleeding during your baby’s newborn blood spot.
The tongue tie practitioner will talk you through the risks and benefits of the procedure. These include:
- We cannot guarantee that the procedure will improve breastfeeding in all cases
- Bleeding 1:400 will require some pressure applying to the area to settle the bleeding. Rarely, bleeding will requires cauterisation (less than 1 in 77,000) (Griffiths et al. 2020)
- Infection 1:1000
- Salivary duct injury
- Scarring to the floor of the mouth
- There is some limited evidence to suggest that the frenulum (the piece of tissue that connects the tongue to the bottom of the mouth) can reattach though we are unsure how common this is.
Sometimes babies can have difficulties latching onto the breast as they need to adapt to their different tongue movement. Care needs to be taken not to disturb the wound. For this reason, it is best to avoid using a dummy for at least 48 hours after the procedure to help reduce the risk of infection. You will be able to stay with your baby throughout the procedure.
How is the tongue tie divided?
Tongue tie division is a quick and simple procedure – it takes a few minutes. Your baby is wrapped in a sheet to prevent wriggling and is held still by a member of the feeding team. The frenulum is cut using a pair of sterile scissors. A drop or two of blood is normal and rarely a problem. A small amount of bleeding following the division is common and to be expected (a few drops of blood).
Babies generally don’t like to be held still so will usually cry as soon as they are wrapped and held for the procedure. Your baby does not require any anaesthetic or medication because the frenulum is poorly supplied with nerves and blood vessels.
Following the division of tongue-tie
Your baby will be unwrapped and returned to you for feeding. Feeding immediately after a division is the best way to calm baby and stop any bleeding. The mouth heals very quickly.
There is often a small diamond shaped white or yellow ulcer underneath the tongue lasting 1 to 7 days. Your baby may be a little unsettled for a few days but this doesn’t usually require any pain relief. Lots of cuddles and frequent breastfeeding will help. Occasionally the division may leave a scar which should not affect your baby in any way.
What if bleeding occurs at home?
It is very unlikely that your baby will bleed from the wound after leaving the clinic, but if you notice any blood in your baby’s mouth, feed your baby straight away.
If your baby will not feed or if the bleeding continues after a feed, wash your hands thoroughly and apply pressure to the wound with a piece of gauze for 10 minutes – you will be provided with some sterile gauze to take home at your appointment.
It is unlikely that bleeding will continue with pressure but if this does happen then bring baby to the Children & Young People’s Emergency Department (CYPED) at James Cook University Hospital.
If your baby is floppy, blue or unresponsive call 999.
Preventing infection
Under your baby’s tongue there is a small, open wound site. To reduce the chance of infection, please ensure you or anyone else touching or feeding your baby washes their hands thoroughly with soap and water before and after. Ensure all feeding equipment is washed thoroughly with hot soapy water and sterilised in accordance with manufacturer’s instructions.
Contact us
If you require further information please contact us on:
- Telephone: 01642 850850 ext. 57240
- Email: [email protected]
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]