What does the procedure involve?

You must ensure your baby has received either the vitamin K injection at birth or at least 2 doses of oral vitamin K before I can perform the procedure.

You will be asked to bring your baby to the appointment ideally settled but willing to feed immediately post procedure.

The first part of your appointment will include my taking a full feeding and medical history. I will discuss tongue tie with you in more detail including the benefits and potential risks of division and what to expect in the days after the procedure. You will have the opportunity to ask questions.  
Once you have signed the consent form allowing me to assess and treat your baby if appropriate, I will perform a thorough oral assessment to confirm a tongue tie.
If your baby is tongue tied and you are happy to proceed your baby will be swaddled in a blanket to keep their arms still during the procedure. A parent or other support person will be asked to assist by holding baby’s head still whilst I divide the tongue tie.  
To prevent the risks of infection I wear disposable gloves. The scissors used to divide the tongue tie are single use and sterile.  The procedure itself takes no more than a few seconds. Gauze is applied to the wound site to absorb the tiny amount of blood and your baby is brought straight to mum for feeding.  Feeding is important in soothing your baby and helps in assessing any immediate improvement to feeding.  Breastfeeding mothers will be supported with positioning and attachment.  
I may also recommend additional support or treatments. (See below) Once your baby has completed a feed I will check their mouth to confirm bleeding has stopped before you are discharged home.
 
If there is no tongue tie I will offer recommendations for ongoing feeding support.

What symptoms might I see if my baby is tongue tied?

There are many signs and symptoms of a tongue tied baby. You may experience a couple of them or you may notice several.
The most common problems for mum are sore damaged nipples, pain during feeding which persists after the initial latch, a misshapen nipple (lipstick shape) post feed, reduced milk supply or repeated episodes of engorgement or mastitis.
Tongue tied babies can have difficulty latching resulting in nipple feeding or they may have trouble maintaining a latch so slip off the breast frequently.
Your baby may lose more weight than expected in the first few days after birth. Babies should have reached their birthweight by two weeks. Tongue tied babies can take much longer. Babies with tongue tie can have slow weight gain, static growth or continued weight loss, sometimes dropping percentiles.
Your baby may tire very quickly during feeding, spend a long time feeding & still be unsettled afterwards or want to constantly feed. Hiccups, and wind are very common in tongue tied babies.

If you are bottle feeding your baby may take a long time to complete a feed, dribble milk out the sides of their mouth, choke or splutter and be very noisy when feeding

I'm not sure if my baby is tongue tied

Some tongue ties are easier to diagnose than others. In general midwives, health visitors & GP’s are not trained in tongue tie diagnosis.  I frequently see parents with a tongue tied baby that hasn’t been diagnosed or incorrectly diagnosed. If you are experiencing any of the symptoms I have mentioned & you think your baby might be tongue tied despite being told otherwise, I recommend you book an appointment with me so that I may carry out a thorough oral assessment of your baby. I will then discuss appropriate treatment options with you.
 
Please visit the gallery where you will find photographs of babies with tongue tie and additional information.

Will it hurt my baby?

Parents who have brought their baby to me have themselves had a tongue tie division as an adult.  They felt it as nothing more than a sting similar to if you accidentally cut yourself for example.  The procedure takes just a few seconds. Feeding and closeness with a parent is a wonderful way to soothe your baby both immediately after the division and in the couple of days afterwards.  Older babies may benefit from paracetamol. Ensure you follow guidance from the manufacturers.

What additional support or treatments might you suggest?

Tongue tie division should not be seen as a stand alone procedure or miracle cure. Whilst it’s benefits are widely evidenced babies need time to adapt to the increased mobility of their tongue. On going breastfeeding support is hugely beneficial during this time. This can be provided by midwives, health visitors or local breastfeeding support groups. If you would like 1:1 support you can arrange a follow up with myself for a small additional fee.
If there is concern about reduced milk supply I may recommend that you express for a few days to increase your supply. .
I might also suggest you seek treatment for some body work from an Osteopath or Chiropractor.   My rationale would be based around the position your baby was lying during your pregnancy, your birth experience or the type of delivery you had. It is entirely your decision as to whether you seek this as a follow on treatment.

What is the recovery time after the procedure?

All babies are unique. Your baby will need time to figure out how to use their tongue more efficiently after the restriction has been released.  They may also have a small ulcer under their tongue where the division took place that can be a little sore. In general babies are a little unsettled for approximately 48hrs.
It can take at least two weeks, sometimes longer for everything to settle down, the wound to heal and feeding to get established.

What follow up support do you provide?

Parents can contact me Monday to Saturday 8am – 6pm if they have questions or concerns.  I follow up all parents by text 2-3 days after their appointment. Depending on the situation I may continue to follow up parents for as long as is necessary. Sometimes up to 4 weeks after the procedure. For parents who would like a 1:1 follow up with me, I offer support for a small additional charge.

Do you divide lip ties?

Currently in the U.K. there is no solid evidence to support such a thing as a lip tie let alone the need to divide one.  It is incorrect to suggest that the upper lip needs to flange out during breastfeeding. The upper lip remains in a neutral position during breastfeeding and serves to stabilise the breast in the baby’s mouth. If it was to flange out the baby wouldn’t have a good seal around the breast resulting in a shallow latch and nipple feeding.  Sometimes a tongue tied baby might flange out their top lip as a compensatory mechanism because they can’t use their tongue correctly. The issue can be resolved once the tongue tie is divided.
 
For more information on lip ties please visit the Association of Tongue Tie Practitioners website.

What are the benefits of a private tongue tie division service?

Accessing my services means that your appointment is personal & tailored to the needs of you and your baby. No two mums & babies are the same.

Whilst some NHS trusts provide a tongue tie division service there are many that don’t and this can lead to longer waiting times. For a mum struggling with feeding this can be the make or break as to whether she continues breastfeeding.

Some hospitals will divide anterior tongue ties but not posterior ones. Some only divide tongue ties in breastfed babies up to a few weeks of age. Some will only divide if there are concerns over baby’s weight. In some hospitals babies remain in their car seats for the procedure and after a few minutes you are allowed home. Not all hospitals provide feeding support immediately post division and it’s not unusual not to receive any follow up.

The benefits of a private consultation with me include the option of a clinic appointment or a home visit. It’s a 1:1 appointment usually within a few days of contact. Sometimes I can see parents the following day.

I am a registered midwife and lactation consultant so you have access to skilled feeding support after the division. Your appointment will last around an hour. I will take a full feeding history from you, discuss tongue tie in greater detail, and you will be given the opportunity to ask questions. You will be supported with feeding immediately post division and together we will develop a feeding plan.

All parents receive telephone follow up after a couple of days. I am available 6 days a week so you can contact me for support and to discuss any questions or concerns you might have. I also provide a follow appointment service for ongoing feeding support or possible further division.