Tongue Tie Assessment and Release

I am currently offering appointments in the comfort of your own home throughout County Wexford.

I am also able to offer appointments to many families living in Counties Kilkenny, Carlow, Waterford and Wicklow although there may be an additional mileage charge depending on location. Please enquire prior to booking.

What is a Lingual Frenulum?

The lingual frenulum is a thin band of connective tissue that connects the underside of the tongue to the floor of the mouth. The presence of a lingual frenulum is completely normal with about 98 - 99.5% of humans having one which is visible or palpable. In most cases it stabilises the tongue for functions such as eating, drinking and speech, while allowing for a full range of motion around the mouth, gums and beyond the lips. Some people can even touch their nose with their tongue, a party trick with the medical term “Gorlin’s Sign”.

What is a Tongue Tie?

Some babies are born with a lingual frenulum that is shorter, tighter, or positioned in such a way that restricts the normal movement and function of the tongue. This condition is known as "ankyloglossia" or, more commonly, "tongue tie." A tongue tie can cause feeding and digestive challenges for infants and may lead to a range of issues as the individual grows older, including problems managing solid food, swallowing, saliva management, dental hygiene, headaches or challenges with speech.

Research suggests that about 10% of babies are born with a tongue tie, but only half of these babies will struggle with a significant restriction to their tongue function that impacts their ability to breast or bottle feed. These babies may benefit from a frenotomy, a simple procedure that can be performed to release the restrictive lingual frenulum, allowing for improved tongue movement and function.

Symptoms of Tongue Tie

The infant and maternal symptoms of tongue tie can vary in severity and not all babies with tongue tie will experience the same range of symptoms. Below, I list some of the more common issues associated with tongue tie, but it’s important to note that tongue tie isn’t the only cause of some of these symptoms and that these symptoms only indicate that an assessment from a qualified Tongue Tie Practitioner is advisable.

Infant Tongue Tie Symptoms

Difficulties with breastfeeding

  • Shallow latch

  • Inability to maintain latch (slipping)

  • gagging

  • pulling off breast/arching

  • clicking/smacking noises while feeding

  • chomping the breast

  • lip blisters

  • unsettled/frustrated/fussy

    during feeds

  • prolonged feeding sessions

  • baby not settling after feeds

Difficulties with bottle feeding

  • choking/spluttering on bottle

  • excessive milk dribbling during feeds

  • excessive lip blisters

  • poor suck

  • chomping the teat

  • unsettled/frustrated/fussy

    during feeds

  • prolonged feeding sessions

Difficulties with solid food

  • difficulty chewing lumpy food

  • gagging on food

  • food aversion

Other Issues

  • Irritability

  • Reflux

  • Colic-like symptoms

  • poor weight gain

  • weight loss

Maternal/Parental Tongue Tie Symptoms

Breastfeeding Issues

  • Nipples which look compressed/misshapen after feeds

  • Nipples that blanch and are painful after feeds (vasospasm)

  • Sore/damaged nipples

  • Mastitis (often early onset or recurring)

  • Breast Abcesses

  • Low milk supply

  • Excessive milk supply

  • Fast/strong let-down

Other Common Issues

  • Exhaustion from frequent/constant feeding

  • Distress from challenges to establishing breastfeeding

  • Postnatal mental health concerns

  • Concern for infant weight challenges

  • Concern for infant health

Tongue Tie Assessment

A thorough approach is essential in order to assess an infant for tongue tie, and it’s important that you feel comfortable with every step and that your baby feels safe and cared for. I will discuss the process with you and undertake the following steps in an unhurried manner:

  • History - a full history of your pregnancy, birth and baby’s story so far, including any family history of tongue tie

  • Listen to your account of both your and your baby’s symptoms

  • Physical assessment - a top to toe check of your baby’s strength, mobility and symmetry. Torticollis and asymmetry of strength/movement is common when tongue tie is present

  • Oral assessment - I will evaluate your baby’s ability to stick their tongue out (extension), move their tongue around their mouth (lateralisation) and lift their tongue (elevation). I will also assess their suck, their palate, cheek muscles and the shape of their tongue, before observing the frenulum itself

After this assessment I will talk to you about my findings and offer my opinion on your options going forward.

Tongue Tie Release (Frenotomy)

If your baby is found to have a tongue tie that is significantly restricting their tongue function, one of the options is a minor surgical procedure called a “frenotomy”. It involves making a small incision into the lingual frenulum, releasing the short or tight connective tissue that is the cause of your baby’s restricted tongue function.

Should a frenotomy be recommended, I will discuss the risks and benefits of the procedure. You do not have to decide immediately, and are welcome to take your time to consider whether this is the right option for you and your baby.

Should you consent to a frenotomy, I will talk you through the process outlined below. The procedure is very quick and your baby will be back in your arms swiftly once the release is completed.

  • Baby is wrapped securely in a large muslin cloth or blanket

  • One parent steadies the baby’s head

  • I will lift baby’s tongue and, with sterile scissors, make a small incision through the frenulum, ensuring that I release the full restriction

  • I apply some gauze to the wound to stem any bleeding (there are usually a few drops after the procedure), unwrap your baby and give them straight to you to feed. Feeding compresses the incision site and encourages any bleeding to stop very quickly, whilst providing your baby with comfort.

  • I will then advise you regarding aftercare and follow up with you later the same evening

Aftercare

There is no current research to support wound massage or stretching after frenotomy, but there are some exercises that may help your baby get used to their new tongue function and I will discuss these with you prior to any frenotomy. Any exercise that involves putting your hand into baby’s mouth should be undertaken with clean fingers and short nails.

  • Poke your tongue out - you, your family, friends and siblings should regularly poke your tongue out at baby which will encourage them to copy you

  • Tug of War - allow baby to suck on your finger and then play a little tug of war, pulling your finger out a little and letting them suck it back in.

  • Around the Gums - sweep your finger around their lower gum line to encourage them to follow your finger with their tongue (lateralistaion)

  • Chipmunk Cheeks - sweep your finger from the top of their inner cheek to the bottom, rounding out the cheek and helping to release any tight buccal (cheek) muscles. Repeat on both sides

Any other specific exercises that may benefit your baby will be discussed after your baby’s assessment.

I also recommend that any baby who has a tongue tie and those who have a frenotomy are seen by:

  • A Craniosacral Therapist, Cranial Osteopath or Chiropractor who is qualified and experienced in working with infants.

    Infants with tongue tie present with tight, overworked muscles and associated issues which can benefit from gentle release.

  • An IBCLC qualified lactation consultant for ongoing breastfeeding support. You and your baby have coped with the issues brought by tongue tie, but after a release your baby will be learning to use their tongue in a completely different way. Having good support from an expert is highly recommended during this period of adjustment.