Some babies are born with a congenital anomaly known as Tongue Tie, which has the medical name Ankyloglossia. The most up to date research about the anatomy of the frenulum can by found here: What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum

This research has informed us much further than ever before and it is accepted that a tongue tie is a midline fold of in the floor of the mouth fascia connective tissue that on raising the tongue is shorter/tighter than usual, restricting movement of the tongue. This in turn can cause dysfunction in the feeding process. 

Other research can be found here: https://www.tongue-tie.org.uk/research

If you are having any of the below feeding issues, it is important to see a tongue tie trained specialist to perform a full assessment of the function of the tongue. Don’t be embarrassed to please ask the professional you are seeing if they have completed the specialist training as it is a specialist skill and currently not routinely taught within the scope of Midwifery, Paediatrics or General Practitioner Medicine. An IBCLC may have the knowledge to suspect a Tongue Tue but it is also outside their remit of practice to diagnose it. Only Health Professionals who have been regulated by the Care Quality Commission for Surgical Procedures are legally able to perform tongue tie division surgery. Please ensure your practitioner has the correct training and insurance.

Tongue Tie can cause many feeding difficulties, particularly with breast/chestfeeding.

Such as:

• Painful breast/chestfeeding
• Sore and/or damaged nipples
• Issues with the mothers milk supply
• Shallow latch onto the breast
• Noisy feeding (clicking/slurping)
• Slipping off the breast regularly
• Unsettled during and unsatisfied following feeds
• Poor weight gain
• Increased weight loss (than expected)
• Excessive dribbling
• Excessive wind/hiccoughs
• Reflux
• Colic
• Vomiting

These challenges may or may not be as a direct result of the baby having a Tongue Tie, however they would definitely warrant further detailed assessment of the function of the tongue by a health care professional adequately trained to identify Tongue Tie.

If the health professional is unsure, a referral should be made to a more experienced professional in tongue tie assessment. Referral within the NHS may be possible, however waiting times may be lengthy which is why many families will seek the advice of a private Tongue Tie practitioner.

Some practitioners believe that if a baby with Tongue Tie has difficulty breastfeeding, surgical division of the Tongue Tie, called Frenulotomy, could be indicated after a full consultation, oral assessment and especially if any non-invasive approaches such as Craniosacral Therapy and Osteopathy have already been considered. This may enable breast/chestfeeding to succeed, rather than having to switch to artificial feeding. 

If you are having to wait for an appointment with a specialist, support is available from local Infant Feeding Teams and IBCLC’s regarding positioning and attachment, which is key to get right, even in the presence of a tongue tie. This will ensure that feeding is as effective as possible.  Some further wider support can be found here: https://www.tongue-tie.org.uk/infant-feeding-support

Also consideration should be made to see a bodyworker for help with relieving any muscular and fascial tensions in the baby’s neck or body, that could be making feeding even more difficult. See here for links to the 3 most common modalities of bodywork used for babies:

Craniosacral Therapy Association: For a calming, soothing, treatment to support your baby’s recovery from birth and adjustments to the world.

Website: https://www.craniosacral.co.uk/practitioner-directory/

General Osteopathy Council: A practitioner directory

Website: https://www.osteopathy.org.uk/register-search/

Chiropractic Council: A practitioner directory

Website: https://www.gcc-uk.org/search/chiro_results?chiro_fullname=hand

See here for further information about Tongue Tie from the ATP (Association of Tongue Tie Practitioners) : https://irp.cdn-website.com/f3c762d5/files/uploaded/ATP%20INFANT%20FEEDING%20LEAFLET%20REVISED.pdf