Tongue Tie
Tongue tie (Ankyloglossia)
Tongue-tie is a problem affecting some babies with a tight piece of membrane between the underside of their tongue and the floor of their mouth (lingual frenulum).
General points:
* Not all babies with a tongue tie need referral as at least 10% of babies have one.
* What needs to be assessed is the degree to which the tongue tie is affecting the baby’s ability to stick out its tongue and make an effective scoop shape and milk the milk from the breast or bottle. This depends on assessing how far forward the tongue tie is as well as how tight it is, and what it is like for that particular baby’s tongue length.
* A tongue tie will not be divided simply because it happens to be there or because of concerns about potential problems with future speech.
When to consider referral:
The tongue tie must be causing a feeding problem, most commonly:
- difficulty attaching at the breast
- sore nipples
- poor drainage of milk leading to mastitis
- greater than 7.5% weight loss (if > 10% this usually means admission so discuss with paediatric admitting team)
- ongoing poor weight gain
- regularly taking over 1hr to feed and/or feeds less than 1hr apart
- dribbling lots of milk
- ‘clicking’ while feeding
Management prior to referral:
The mum MUST have been properly supported by the midwifery and/or health visiting team (and possibly the breastfeeding peer support groups too) to make sure that common mistakes have been addressed and corrected and that feeding is as optimal as it can be.
Referral criteria:
The infant is aged 12 weeks* or younger (*age corrected)
and
2. The infant has a tongue tie which is persistently preventing successful feeding, which could result in the infants faltering growth and that is not helped by additional infant feeding support.
and
3. The infant has not undergone a previous tongue tie division.
and
4. There are no signs of infection.
Please refer to the Infant Feeding Team by emailing rcht.infantfeedingteam@nhs.netso that they can assess clinical priority and contact the parents to make an appointment.
It must be stressed to the parents that this referral is for an assessment and the procedure will only be done if it is actually deemed necessary.
If it is appropriate then it will usually be done during the appointment.
Infants who have one or more of the following are not suitable for treatment in the primary care service setting. Referral to secondary care for opinion and subsequent treatment must meet the criteria set out below.
1. The tongue is thick and vascular.
or
2. There are aberrant structures beneath the tongue.
or
3. There is a family history of coagulation disorder.
or
4. The infant has congenital abnormalities (such as cleft lip/palate, trisomy 21, trisomy 18) and an opinion from ENT, orthodontics, oral and maxillofacial surgery has been sought confirming there is a need for tongue tie division
In this case refer to the oral maxillofacial surgeons.
Infants older than 12 weeks of age up to and including adults:
Treatment for all patients older than 12 weeks (*age corrected), is not routinely commissioned.
Lip tie:
The surgical correction of lip tie, where the lip is connected too tightly to the upper gum, is not routinely commissioned.
*Age corrected, or adjusted age, is your premature baby’s chronological age minus the number of weeks or months he was born early. For example, a one-year-old who was born three months early would have a corrected age of nine months. (Raising Children, 2016)
Information for parents:
https://www.nice.org.uk/guidance/ipg149/informationforpublic
References:
KCCG Commissioning Policies 2018/2019 – Tongue tie division. Approved February 2019. http://doclibrary-kccg.cornwall.nhs.uk/DocumentsLibrary/KernowCCG/IndividualFundingRequests/Policies/CommissioningPolicies.pdf
RCHT Tongue Tie Assessment and Management of Ankyloglossia Clinical Guideline V2.0. June 2020.
Author:Dr S Burns, GP
Contributors:
Helen Shanahan, Infant Feeding Co-Ordinator, RCHT.
Sian Harris, Consultant Paediatrician, RCHT
Date:May 2021
Review Date:May 2022