Tongue tie assessment & division for babies (frenulotomy)
We are able to assess and treat babies between 3 days and 16 weeks old for frenulotomy. An appointment includes a feeding assessment of your baby (breast or bottle) followed by an oral assessment, determining your baby’s tongue function and movement. Frenulotomy (division) is then offered as necessary.
You will be asked to send us a couple of photographs/videos of your baby’s mouth and a completed questionnaire about your experiences so far, prior to the appointment taking place. Full details will be given when booking an appointment.
What is Tongue Tie?
Tongue tie is defined as ‘ a congenital anomaly characterised by an abnormally short lingual frenulum, which restricts the mobility of the tongue’ (NICE 2005)
This means that some babies are born with a tighter than usual piece of skin between the underside of their tongue and the bottom of their mouth. As the lingual frenulum is shorter than usual, the tongue movement is restricted. it can run in families, occurs more in boys than in girls and when babies are born prematurely.
How do I know if my baby has it?
Sometimes it is possible to see that the lingual frenulum is tight and appears to restrict the baby’s tongue movement. Other times it is not visually obvious and the mother may be experiencing difficulties and/or pain with feeding the baby.
Occasionally soon after birth, a midwife or doctor examining your baby may have suggested to you that your baby has tongue tie. However until your baby has been feeding for a few days, it is not possible to know if it is significant or not.
How can my baby’s feeding be affected?
Tongue tie can affect both breast and bottle feeding. The effects are often more obvious with breastfeeding. Due to the tongue movement being restricted, often the baby finds it difficult to ‘latch’ onto the breast and/or cannot maintain the ‘latch’ on the breast – the baby slips off frequently causing nipple pain/damage, breastfeeding takes a long time and occurs frequently. Baby may appear restless, unsettled and hungry. Eventually weight gain could be affected.
If bottle feeding, the baby may also take a long period of time to feed, or drink only small amounts or dribble lots of milk when feeding. (It is important to note however that these issues may NOT be caused by tongue tie and therefore full consultation needs to be undertaken. It is also possible that performing frenulotomy affords no change or improvement to feeding)
How is it treated?
If your baby is diagnosed with tongue tie which is affecting their feeding, then the usual treatment is for the tight lingual frenulum under the tongue to be separated or divided releasing the tongue to be able to move normally. This is called frenulotomy or tongue tie division.
Frenulotomy is the medical name given to separating, dividing or cutting the lingual frenulum under the tongue. It is a simple procedure which can be performed safely on young babies without anaesthetic.
What can I expect during a tongue tie appointment?
Tongue tie appointments take 60 minutes and will usually be facilitated by two practitioners. It includes an observation and assessment of your baby’s feeding (breast or bottle) and an assessment of your baby’s mouth for tongue function and the appearance of the lingual frenulum. These results will then be discussed with you.
Should frenulotomy be indicated, this will be explained fully to you and should you wish to proceed, asked to sign a consent form.
Immediately after the frenulotomy procedure, the baby will need to be fed with either breast or bottle. Parents will be advised to leave the clinic only when any bleeding has stopped and the baby is calm. Parent(s) can be present throughout the whole appointment.
What follow up care will there be?
All follow up care is free of charge. Parents will receive a follow up phone call to ask about wound healing, how feeding is going and any other questions they wish to discuss. Should parents have any concerns following frenulotomy, they are advised to call the Clinic and a practitioner will contact them as soon as possible. Parents can make a face to face follow up appointment if they desire (no charge).
16 weeks or older Tongue Tie Assessments
The assessment involves you and your baby attending for a face to face appointment. During this appointment you will be asked about the feeding experience with your baby and your baby’s mouth would be examined. Although the tongue tie (if diagnosed) may not be treated by frenulotomy at the clinic, the results of the examination will be shared and discussed with you. A letter summarizing the details of the assessment findings will then be emailed to you.
Louise Armstrong RM, BSc (hons), MSc, PGCEA, BFLqL
Louise has been a registered midwife with a special interest in infant feeding for over 30 years. She has worked both in clinical practice and university midwifery education.
She qualified as a registered nurse in 1984 in Sheffield before undertaking her midwifery education at St Mary’s hospital in Paddington, London. Right from the beginning of her midwifery career, Louise developed an interest in infant feeding and helping mothers get breastfeeding off to a good start. It was here she developed experience with all aspects of infant feeding.
Having a passion for teaching, Louise become involved in working as a university lecturer overseeing student midwives in their training. Pursuing her interest and passion in helping mothers with their choice of infant feeding, Louise trained to Masters level in the practice of frenulotomy (tongue-tie division) at the University of Wolverhampton. The clinical practice was at the tongue-tie clinic in the Russell Hall hospital in Dudley which is one of the largest specialist clinics of its kind in England.
Louise is a member of the Royal College of Midwives (RCM), the Association of Tongue Tie Practitioners (ATP) and an associate member of the lactation consultants UK.
Louise lives with her husband locally in York and enjoys walking and meeting up with friends socially
Advanced Neonatal Nurse Practitioner
Deb Wilson MSc MA BSc (Hons) ANNP IBCLC
Please meet Deb Wilson, an Advanced Neonatal Nurse Practitioner, Independent Prescriber, Tongue-tie Practitioner and Lactation Consultant. Deb has worked within neonatal services since qualifying as a paediatric nurse in 2002. After starting her professional career as a staff nurse on the neonatal unit at RVI in Newcastle she took the opportunity offered by St Georges Hospital Tooting London in 2009 to complete the Advanced Neonatal Nurse Practitioner (ANNP) programme at London South Bank University. Furthering her professional career she transferred to East Surrey Hospital in 2015 where she was able to take on a more teaching and supportive role whilst still maintaining clinical skills working on the middle grade medical rota.
It was during her time at East Surrey that Deb completed her training as a Tongue-tie Practitioner, completing the Wolverhampton University Postgraduate Course ‘Advanced Clinical Skills in Tongue tie (Ankyloglossia) Management’ and worked within a small NHS team of practitioners to support a weekly tongue-tie clinic, providing breastfeeding support, tongue-tie assessment and division when required.
Deb is now working freelance as an ANNP, lactation consultant and tongue-tie practitioner. She is an honorary member of the Association of Tongue-tie Practitioners (ATP), former chair and current Treasurer. Deb is also a member of the Royal College of Nursing (RCN) and registered with the Nursing and Midwifery Council (NMC). Insurance is through Hiscox.