Tongue Tie and Infant Feeding
What is ‘Tongue Tie’ (Ankyloglossia)?
Tongue tie, is where the lingual frenulum, a thin band of tissue that tethers the tongue to the floor of the mouth, has a restriction. This band of tissue can be thickened, tight and/or short, leading to restriction in tongue function.
What is the difference between Anterior and Posterior/Submucosal tongue tie?
There is a misconception that a visible lingual frenulum is a tongue tie. We are all born with a lingual frenulum. Some are highly visible, whilst others are located far lower back in the mouth and, as such, cannot be seen.
If your baby can move its tongue freely to feed and there are no additional feeding issues, then it is unlikely that your baby has a tongue tie. Unfortunately, visible frenula are often misdiagnosed as tongue tie and visa-versa. For example, babies that do not have visible frenula, are often discounted as not having a tongue tie. This can be upsetting and confusing for parents and may lead to greater feeding issues, mental health problems and later than effective diagnosis.
An anterior tongue tie is visible and can be seen as thin strip of skin that attaches the tongue to the base of the mouth, just behind the gums or even to the ridge of the gum line.
A posterior tongue-tie (also known as submucosal) is located much further back in the mouth, thus making it more difficult to spot.
How is tongue tie diagnosed?
At first, I would like to have a chat with you and take a history. I generally like to call you, before an appointment, to take a brief history and understand the issues that you and your baby are facing.
I would then offer an appointment to suit you, at your own home. At this appointment, we will have a lengthy chat together, during which I would like to find out all about your feeding journey and issues you and your baby may be experiencing. I will also go through with you, in detail, what to expect from the assessment and the procedure itself, if this is needed. This includes, any risks of the procedure, the aftercare and will also give you the opportunity to ask any questions prior to the assessment being undertaken.
At this point, if you are happy and would like to go ahead with the assessment, baby will be swaddled using a soft, clean towel. I will then do an oral assessment, (using a Hazelbaker tool), to assess if your baby has a tongue restriction. The use of this tool, allows me to assess how your baby is using its tongue. I will assess the extension, (how well your baby can stick its tongue out), elevation, (how well your baby can lift its tongue towards the roof of its mouth) and lateralisation, (how well baby can move its tongue from side to side). I will then assess baby’s ability to suck using a clean, gloved finger and then observe under the tongue for visible signs of tongue tie, such as shape of the tongue, length, thickness and stretch of the lingual frenulum.
If, following this assessment your baby’s score meets the threshold and I feel that your baby would benefit, I will offer a procedure called a ‘frenulotomy’, to release the tight, restrictive lingual frenulum. Alternatively, if your baby does not meet the threshold, then I am not able to offer the procedure. However, I will always fully discuss this with you and offer any advice and support that I can, to help you with your feeding journey.
What to expect when baby has a frenulotomy tongue tie released?
The parent present, will be asked to steady baby’s head for the procedure. Using an ‘aseptic’ (sterile) technique, I will then perform a small incision, using sterile scissors, to snip the frenulum and release the tongue tie. I will then apply a small sterile gauze to the upper side of baby’s tongue, to stem any bleeding. Baby will be handed to you immediately afterwards, for a feed. This helps to further stem any bleeding that may be present and helps to calm & sooth baby. During this feed, I will help you with any issues you may have with feeding and we can discuss further any questions you may have.
Whilst frenulotomy is a simple and minor procedure, I completely understand that any procedure involving your baby, can cause high levels of anxiety to you, as parents. Please be reassured, that I will always give you the space to feel that you are fully informed and comfortable with your decisions.
The Breastfeeding Journey...
The breastfeeding journey starts well before your baby arrives. I believe that good support and knowledge in the antenatal period will help you to feel more confident when you do embark on that special journey with your baby.
Trying to take on board the information surrounding feeding straight after your baby is born can be difficult, particularly if you have had a lengthy or traumatic birth.
Having that good foundation prior to birth, makes the learning process much easier. Remember it’s a learning curve for you and your baby.
Breastfeeding should not be painful. Getting the positioning and attachment right in those early days is vital. I can help guide you with tips and practical advice to help you feel confident and well supported.
PRICES
Initial Telephone Consultation
NO CHARGE
At first, I would like to have a chat with you and take a history. I generally like to call you, before arranging any appointment, to take a brief history and understand the issues that you and your baby are facing.
Frenulotomy – Tongue Tie
Initial In-Person Assessment and Procedure
£200
At the initial in-person appointment, at your home, I will go through what the assessment and procedure involves, any risk factors and aftercare required. It has been shown that tongue tie procedures can have a profoundly positive impact on infant feeding problems. However, I am fully aware that any procedure that your baby may require, can be daunting and I want you to feel comfortable, so you can ask any questions and be able to make an informed decision, without pressure.
If, after my assessment, I deem that your baby does not meet the threshold for the tongue tie procedure, then I charge £125 for the in-person consultation. I will provide follow up advice on any feeding issues you may be having.
Reformation Procedure
(If Required)
NO CHARGE
Research shows that between 2- 4% of babies having a tongue tie procedure, will require a ‘reform’ procedure. I will give you advice during any initial procedure, if undertaken, on how best to prevent this happening. It is not known why some babies tongue tie reforms. Therefore, I do not feel that it is fair or correct to charge for this follow up reformation procedure, when it is random and unpredictable if this will occur. If there are signs that feeding issues have started to reappear, or you suspect that the tongue tie has reformed, then please do not hesitate to contact me via telephone.
Antenatal Feeding
Education
£125
I offer ‘one off’ antenatal feeding sessions, in the comfort of your own home. This involves a lengthy chat, generally 1-2 hours on infant feeding choices. I go through what to expect as new parents when your baby is born, how to improve initiation of feeding after birth, how to understand and recognise baby’s feeding cues, positioning and attachment and I do this using a demonstration doll and puppet.
I feel it is important to see and be able to hold the doll yourself, to truly get a good grasp of positioning and attachment, what this should feel like and how to reposition baby and if baby’s latch does not feel right. I will discuss responsive feeding, supply and demand, mixed and bottle feeding, hand expression and give you the opportunity to ask any questions that you may have. I know that taking in large volumes of information, straight after the birth of your baby, is not easy and, therefore, having good knowledge before your baby is born, will stand you in good stead.
Postnatal Infant
Feeding Support
£125
I will arrange a suitable appointment with you, in your own home. I will take a full history of your birth and feeding journey to date and talk with you about any issues you may be experiencing. I will go through the early baby feeding cues, practical advice on positioning and attachment and how to recognise when your baby is, or isn’t, latched correctly.
Some mums continue to feed baby, even when this is very uncomfortable and, possibly, very sore. I have heard numerous times, that mums have been told that the positioning and attachment looks fine and that baby appears to be feeding well, however, if your feeding is sore throughout, then this is not correct and adjustments may need to be made.
Feeding is a huge learning curve for both mum and baby, in the first few days and weeks and, rest assured, it does take practice! I will support and reassure you, whilst giving you all of the information & tools to help in your feeding journey. If you are planning to mix breast feed and bottle (formula) feeding, I will go through practical advice on hand expressing, using a breast pump, how to prepare bottles safely & the recommended guidelines, sterilizing equipment, pace feeding, effective winding techniques and give you the opportunity to ask any questions that you may have.
About Me
I am NMC Registered and fully qualified Midwife, with a 1st Class Honours Degree in Midwifery from the University of Worcester. I was an NHS Community Midwife for many years and for the past 4 years I have practiced as a Private Midwife, within my own private practice, Maternology Ltd.
I have helped many families in their feeding journey, both in the antenatal and postnatal period. It is a subject area that I am very passionate about. As a Community and Private Midwife, I have encountered many babies that have had feeding issues and that I have referred in the past to both NHS and private practitioners, for assessment and tongue tie procedures.
I have seen firsthand, the profoundly positive impact that tongue tie assessment & procedures have had on feeding journey’s and I knew that this was an area that I wanted to learn everything about and undertake the training to do myself. I have been fortunate enough to do my training within the NHS, alongside a Breastfeeding Lead and Tongue Tie midwifery practitioner, with decades of experience. Here I learned these new skills, and saw after a huge breadth of diverse and interesting tongue tie cases.
I am thrilled to have been signed off as being a competent tongue tie practitioner, after performing multiple procedures and running the local NHS tongue tie clinic myself. I can now offer this service to both my own Maternology clients and any other family who may be concerned about their baby’s potential tongue tie, or experiencing feeding issues.
NMC Registered: 16A0069E
The Association of Tongue Tie Practitioners (ATP)
Insured and CQC registered via Private Midwives
