Having a newborn can be tiring enough, breastfeeding adds a whole other level of challenge to caring for your newborn for many mums and if you add to this a potential tongue tie and the whole experience can be mentally and physically exhausting. Before having your baby you may have never heard of the term ‘tongue tied’ and if your baby is bottle fed then the tongue tie might not even cause a problem. But with around 10% of babies being tongue tied, and the heavy reliance on the tongue movement for successful breastfeeding, it is worth gaining a better understanding to support your baby and decide the best next steps for your family.
What is a tongue tie?
Tongue-tie (ankyloglossia) is a condition limiting and restricting the tongue’s range of movements which some babies are born with. The restricted motion of the tongue is caused by an unusually short, thick or tight band of tissue between the tongue and the floor of the mouth. Initially, a tongue tie will be most obvious in breastfed babies because of the reliance of the movement on the tongue in the process of breastfeeding. But a tongue tie can also cause problems for babies drinking from a bottle and as the child grows up they may experience problems with eating, speaking and swallowing if the tongue tie is left untreated.
Types of tongue tie
The type of tongue tie your baby has depends on where the tongue and the floor of the mouth are attached:
- The most well-know type of tongue tie where the tie is at the very tip of the tongue.
- The tie is further back towards the middle of the tongue.
- The tie is located at the base of the tongue.
- The 4th type is a posterior tongue tie- the tie is underneath the mucous membranes and must be felt for a diagnosis. Usually, this condition is mistaken for a short tongue.
How does a tongue tie impact breastfeeding?
A tongue tie can be more obvious in a baby that is breastfed rather than bottle fed. This is because when breastfeeding, baby needs to keep their tongue over their lower gum for an effective latch. If tongue movement is restricted because of a tongue tie then baby might chew at the nipple instead of using the tongue to suck and effectively transfer milk. Therefore a tongue tie can cause significant nipple pain and interfere with your baby’s ability to get breast milk. This is why many breastfeeding mums choose to get the tongue tie procedure done; to allow for a better breastfeeding experience for both mum and baby. In the meantime, to maintain milk production, some mums may be advised to express and feed their baby via a bottle until the procedure is carried out. It is worth noting that a tongue tie will still cause issues even if baby is taking their milk from a bottle so switching to formula milk rather than getting the tongue tie cut isn’t necessarily the best option.
Does a tongue tie impact bottle feeding?
A tongue tie can be less obvious if your baby is bottle fed; some babies with a tongue tie are able to take a bottle well and there are no obvious issues for the baby. However some bottle fed babies can struggle to create a good deal on the tear of a bottle because of their tongue tie which can result in ineffective sucking. A poor seal can lead to milk leaking if of the baby’s mouth. Additionally, a poor seal is likely to mean that baby will swallow air, resulting in an uncomfortable and ‘windy’ baby.
How to identify a tongue tie.
Not all tongue ties cause issues, but if your baby’s tongue movements are restricted and it is causing difficulties with regards to feeding then it is worth getting them checked over by your midwife, health visitor or GP. You may notice some of the following issues in helping you to identify a tongue tie: difficulty attaching to the breast, feeding for a long time with a short break before feeding again, being unsettled and frequently hungry, poor weight gain, making a clicking sound as they feed. Other ways to identify a tongue tie would be if your baby appears to have difficulty in lifting their tongue up, sticking their tongue out or if their tongue looks heart-shaped when they lift it up.
Should I cut the tongue tie?
It is not essential to cut the tongue tie if you do not think this would benefit your baby. The NHS guidelines explain that treatment isn’t necessary if your baby can feed well in spite of their tongue tie. If their feeding is affected, and you believe cutting it would be beneficial, the treatment involves a simple procedure called tongue tie division. It is worth being aware that although a tongue tie mostly impacts a baby’s ability to drink milk efficiently, it can cause speech problems later in life with some tongue-tied children struggling to pronounce the letters ‘t’, ‘n’ or ‘d’ effectively because of their inability to lift their tongue.
Who cuts the tongue tie?
After the initial check by your midwife, health visitor or GP you will be referred to your local children’s hospital for the procedure to be carried out. Alternatively, because of longer waiting times for the procedure to be carried out, you may wish to take your baby to a private practice to have the tongue tie dealt with quickly. Whether you wait for your NHS appointment or you go private, the first step will involve a consultation where the doctor will examiner your baby’s tongue once again and explain the procedure and aftercare. If the treatment is required, the doctor will snip the piece of skin which is connecting the tongue to the bottom of the mouth. The tongue tie procedure is quick, simple and often painless. Often the baby won’t need any pain relief but if breastfeeding you will be encouraged to feed immediately after to help calm baby.
What to expect after tongue tie has been cut.
The discomfort from the procedure is thought to last less than 24 hours; during this time your baby may seem more clingy or grumpy than usual while they adapt. Breastfeeding and skin to skin will calm baby down but if baby is really fussy or refuses to feed then some pain relief may be beneficial in those first 24-48 hours. There is usually very little blood following the initial bleed immediately after the procedure, but if baby does bleed then apply pressure to the area using cotton pads. Your doctor will advise you on stretching exercises that you could do to aid recovery and reduce the chance of the tongue reattaching. If you have any issues following the treatment then inform your GP so that they can monitor your baby’s reaction closely.
If you think your baby might have a tongue tie, they’re showing some of the key signs and feeding is a struggle, then you may want to consider getting them checked by a midwife, health visitor or your GP. It may seem daunting but if it helps your baby to feed more effectively and use their tongue more freely in speech as they get older, then the quick procedure will be beneficial. If your baby has got a tongue tie and you’re continuing to breastfeed be proud of yourself- it isn’t an easy process at the best of times so well done for persevering through this challenging time.
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