Tongue Tie

 

This guideline applies to babies suspected of having tongue tie.

 

 

• Tongue tie (ankyloglossia) is when the frenulum is abnormally short or dense and limits the range of tongue movement.
   
• Tongue tie is common and can impact feeding (although the majority are able to breastfeed without difficulty).
   
• Not all babies need referral as at least 10% of babies have one.

 

Key Features of Assessment

Symptoms of tongue-tie:

• Maternal nipple pain/trauma
• Recurrent blocked ducts or mastitis
• Latch problems
• Abnormal sounds during breastfeeding e.g. clicking, noisy feeding, loss of suction sounds
• Very prolonged or frequent breastfeeds
• Poor weight gain or dehydration
• Clicking whilst feeding
• Regularly taking over 1hr to feed and/or feeds less than 1hr apart
• Dribbling lots of milk

 

Signs of a significant tongue-tie:

• Heart-shaped or notched tip of tongue
• Poor lateral movements of the tongue
• Tongue not being able to extend beyond the baby’s lips

 

 

• 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.
   
• Give information on breastfeeding advice and support.

 

If no problems with feeding, reassure the parents that referral is not needed and frenulotomy for prevention of future speech/dental problems is not advised.

 

Before 12 weeks:

• Tongue tie issues should normally be identified by the 6-8 week check to allow time for referral.
   
• Refer urgently to RCHT infant feeding team for consideration of frenulotomy under local anaesthetic: rcht.Infantfeedingteam@nhs.net. Providing they meet ALL of the following criteria:
  • Infant is aged 12 weeks or younger (age corrected for gestation)
  • 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 feeding support.
  • Infant has not undergone a previous tongue tie division.
  • There are no signs of infection.
  • See Cornwall and Isles of Scilly Commissioning Policy.
• Inform the parents that this referral is for an ASSESSMENT and the procedure will only be done if it is actually deemed necessary.
   
• Note if the infant has any of the following they will require referral to the oral maxillofacial surgeons: (Note - they can also be seen by the infant feeding team for assessment and specialist feeding support up to 12 weeks)
  • The tongue is thick and vascular
  • There are aberrant structures beneath the tongue
  • There is a family history of coagulation disorder
  • The infant has congenital abnormalities (e.g. cleft lip/palate, trisomy 21, trisomy 18) and an opinion from ENT, orthodontics and maxfax has been sought confirming there is a need for tongue tie division.

 

After 12 weeks (up to and including adults):

• Treatment for all patients older than 12 weeks (age corrected if premature), is not routinely commissioned.
   
• If needed - refer urgently to MaxFax for consideration of frenulotomy under general anaesthetic.

 

Lip tie:

• Generally lip ties do not negatively impact feeding even when significant (as the top lip rests against the breast or teat, it does not need to curl back or extend).
   
• The surgical correction of lip tie, where the lip is connected too tightly to the upper gum, is not routinely commissioned.

 

For professionals:

• American Academy of Pediatrics – Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad
• RCHT Infant Feeding Team

 

 

Review date	14 June 2024
Next review date	14 June 2026
Clinical editor	Dr Madeleine Attridge
Contributors	RCHT Infant Feeding Team