Tongue tie – fad or fact?

Tongue – Tie – the latest fad??

I am SO tired of hearing that mums are being told by a wide range of health professionals that “tongue-tie is a ‘fad’ ”.  I was even more surprised to hear one brazenly tell me the same thing recently!

It’s like the latest ‘must have accessory every fashionista wants…. ’

Thankfully the other professionals in the same meeting looked mortified and shared their experiences and beliefs of the unexplained, but none the less very existent rise in this condition.

Interestingly the NHS website still states that only between 4 – 11% of babies are affected in the UK.  Like the professionals above, we have seen an enormous increase in mums seeking support for breastfeeding and I can tell you that at least 50% of our mums attending our coffee afternoon in Warwick are in fact struggling to feed a baby with tongue-tie – which in turn leads to a miserable breastfeeding journey for both mother and baby – and many mums will understandably decide to switch to bottle feeding instead.

It’s heartbreaking to see this happen – especially when mums REALLY wanted to breastfeed – and especially when so many of them could have enjoyed a totally different journey with the right support.   Read women’s experiences here. 

I know some health professionals claim that tongue tie is being “over-diagnosed” – and I know that I believe it is being “under-diagnosed”.  Either way, it would be great to find a middle ground that supports mother / baby / heath worker in achieving feeding that was less painful – both physically and emotionally.

So what is Tongue-Tie? (ankyloglossia)

We all have a piece of skin (frenulum) under our tongue that tethers our tongue to the base of our mouths.  The frontal part will usually begin to “dissipate” at around 8 – 10 weeks gestation – leaving a flexible piece under the tongue out of view.

In some babies that frontal piece never disappears (anterior tongue tie) or the hidden piece remains too thick and short (posterior tongue tie) which impedes the tongue movement.

When you are breastfeeding tongue movement is critical to help drain the breast by providing compression against the upper pallete.  A baby that is affected by tongue tie is likely to ‘rub’ against the nipple which in turn can lead to nipple injury – or not be able to maintain a suction so the baby can’t stay on the breast for long.

In short these issues lead to damaged breasts, or a baby that just feeds continuously.

Typical signs include

• A tongue that is obviously heart shaped or restricted in movement (thought this is NOT always the case)
• Struggling to latch
• Regular ‘bobbing’ on and off as baby loses suction during feeding
• a nipple that looks misshapen after a feed (often with a ‘lipstick’ end)
• a nipple that is traumatised or sometimes may have a white compression mark after feeding
• clicking noises during feeds
• reflux (this may be diagnosed by a Dr without the realisation that it is often caused by the baby swallowing too much air during feeds due to poor latch)
• a baby that clearly becomes distressed during each feed

A reduction in effective feeding means that your breast isn’t being asked on a regular enough basis to “provide” breastmilk – and that in turn will lead to a reduction in supply.  This really is a vicious circle that after only a short time can be very tricky to break.  So what can you do?

GET HELP!!!

Firstly – seek out the support of an experienced Breastfeeding Specialist. There is a confusing range of help available – from Breastfeeding buddies, Counsellors and Consultants.  All have different credentials and experience – and of course personal opinions!

Pleasingly, an increasing number of hospital trusts are now offering tongue tie assessment and division where necessary – you would want a speedy referral and ideally you would be seen within baby’s first week.   Unfortunately as many midwives are still gaining training and experience in this area mums commonly report that the tongue tie was undiagnosed or “misdiagnosed” as being of no consequence.  It is all too common for us to hear that a mum has been told her baby does not have a tongue tie based on a Health Care Professional  just “looking” at the baby’s mouth then this is not acceptable. The diagnosis is based on a detailed assessment of function, not on the visible appearance. In the same way that a good latch is determined by comfort and the effectiveness of milk transfer, rather than it looking “good”.  If you are unhappy, then we encourage you to trust your instinct and keep asking for help until you get it.

I would suggest you join a number of local Facebook groups for mums and ask the question ‘who do you recommend?’  Reputation in this arena is hard earned!  The majority of breastfeeding specialists offer their services free of charge at some point in the week – or they may be able to refer you on to another local supporter that can help.

Alternatively you could contact one of the national helplines listed below – although it is always better to see someone face to face whenever possible so that they can observe both you and your baby.

Counsellors or Consultants will be able to offer a number of suggestions that may help your baby to latch more deeply, and help you with breast and milk supply management until you can access further help.

If a tongue tie is suspected they should refer you to a private specialist who can assess your baby’s tongue function quickly and then may suggest a “frenulotomy” or snipping the frenulum to free it up for more mobility.  This procedure is very quick and often leads to a marked improvement quite quickly.  You will be given after care guidelines for use at home and specialists should offer follow up support and contact following the procedure.

An in depth booklet for parents can be found here if you would like to understand the condition and it’s treatment in more detail.

I can’t tell you how often our mums say the words ‘I wish it had been identified earlier’…

Don’t be one of those women!!

La Leche League Great Britain – 0345 120 2918

National Breastfeeding Helpline – 0300 100 0212

Association of Breastfeeding Mothers Helpline – 08444 122 949

NCT Breastfeeding Line – 0300 330 0771