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Tongue Tie Division to Improve Breastfeeding

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A tongue tie is a tight or short membrane under the tongue (frenulum). The tongue tip may be blunt, forked, or have a heart shaped appearance and may not be able to protrude beyond the lower gum. The membrane may be attached at the tongue tip, or further back.

Possible signs of problems due to Tongue Tie
Tongue-tie can cause problems with breastfeeding, due to a poor latch, which can lead to:
• Sore or damaged nipples. A clear sign of a poor latch is a pinched ‘lipstick’ shaped nipple when baby releases the breast
• Inefficient milk transfer
• Excessive weight loss in the early days (>12% of birth weight)
• Diminishing milk supply
• Babies may have a small gape and poor suckling function
• They may seem restless while feeding or have difficulty maintaining latch
• Feeding frequently or for a long time
• Clicking noises or dribbling are also indicators, along with colic

Assessment
Many tongue ties are asymptomatic and cause no problems. A tongue tie can vary from mild to severe. An assessment of feeding will be carried out and support given before a referral for a division is made. The neonatal examination must have taken place first and if your baby is under the care of the Paediatric team, there will be a team discussion to agree on the most appropriate treatment option as a division may not be appropriate.

Treatment
Your baby will be supported at the head and shoulders during the procedure. The tongue tie division is performed using a pair of sharp, blunt ended scissors to gently release the membrane (Frenulum). There is little, if any, pain or bleeding. You will be encouraged to breastfeed your baby straight after the procedure. Breastfeeding support from appropriately trained staff will be available.

Aftercare
There is no need for any kind of wound management. You will be encouraged to exclusively breastfeed and avoid dummies, teats etc. Problems are extremely rare but could include some pain or some bleeding and rarely ulceration which may lead to scarring. If you have any concerns regarding your baby post procedure, please contact your GP or if it is an emergency, please take your baby to the Accident and Emergency department.

Tongue tie can be corrected in Milton Keynes University Hospital
We are able to offer this service to babies aged six months or under, where the intention is to breastfeed and tongue tie division is clinically indicated. This procedure can be performed by an Oral Maxillofacial Surgeon. NICE guidance (2005) does not support the division of tongue ties where a baby is intended to be formula fed. If the baby is having feeding difficulties or weight issues
these cases will be considered.

Referral Pathway
• Direct referral from a hospital midwife or paediatrician
• Direct referral from your community midwife, maternity support worker, health visitor or GP

Further Information
You have the right to be fully informed and to share in decision making about the treatment you receive. The NICE website (www.nice.org.uk) has further information about the Interventional
Procedures Programme and offers full guidance on division of tongue-tie. The evidence that NICE considers, and a report called ‘Breastfeeding for longer – what works?’ are also available from the NICE website.

Further information is available at:
• National Breastfeeding Helpline 0300 100 0212
• NCT Breastfeeding Helpline 0300 330 0700
• La Leche League Helpline 0845 120 2918
• Association of Breastfeeding Mothers 0300 330 5453

This information has been produced by Milton Keynes University Hospital NHS Foundation Trust and is for general information only. Please speak to your midwife, health visitor or doctor for specific advice concerning your baby.

References
• National Institute for Health and Clinical Excellence (NICE)
• Division of Ankyloglossia [tongue-tie] for Breastfeeding. December 2005.
• www.babyfriendly.org.uk
• www.unicef.org.uk