Tongue-tie and Breastfeeding Symposium

Find out the latest on Tongue-tie from international speakers – including diagnosis, treatments, prevention of reccurrence following surgery and updates on lactation and breastfeeding.

Date: Friday 5th September 2014

Time: 9am-5pm

Venue: The Gainsford Lecture Theatre, Weston Education Centre, King’s College Hospital, Denmark Hill, London, SE5 9RS.

Cost: £120 to include lunch plus morning and afternoon break refreshments.

Key speakers:

Dr Lawrence Kotlow DDS

The New Breastfeeding Dyad; Everything you need to understand about the assessment and treatment of ankyloglossia and maxillary lip
ties, and prevention of recurrence following surgery.

Catherine Watson Genna BS, IBCLC

Disorganised Suck and Fussiness in rapidly growing Tongue-tied infants.

Shailesh Patel: Consultant Paediatric Surgeon, King’s College Hospital

Assessment and treatment of recurrent Tongue-tie.

Plus six other speakers.

To book your place, please complete the booking form and post with a cheque made payable to King’s College Hospital to:- Katherine Fisher, Team Leader, Tongue tie Clinic, Caldecot Centre, Caldecot Rd, London, SE5 9RS. Any enquiries – please email katherine.fisher@nhs.net.

What to Expect after Frenulotomy

Following the procedure some mothers and their babies find an immediate improvement in feeding. For others it will take longer, sometimes weeks or more for feeding to improve as the baby acquires new skills to Breastfeed. Whilst having a Tongue-Tie both mother and baby have acquired adaptations to their feeding to work around their difficulties. After the procedure, it can take some time for some mothers to gradually transition from the use of
for example, nipple shields, finger or syringe feeding expressed breast milk or artificial milk, whilst their Breastfeeding gradually improves.

It is important that you view Frenulotomy as part of a plan to improve your feeding; it is not always an instant fix.

For more information about our Tongue-tie procedure, please read the Tongue-tie Assessment, Diagnosis and Treatment Guide.

Anterior or Posterior Tongue-tie?

Oral examination is always required to determine how the Tongue-Tie affects the function of the tongue. Examinations will confirm if the tongue is able to elevate, lateralise and if it can protrude over the lower gums.

Anterior Tongue-Tie

In anterior Tongue-Tie, you can easily see a string of tissue (the frenulum) that attaches the tongue to the floor of the mouth.
Anterior Tongue-Ties can be of varying degrees; from 100% where the frenulum is attached to the tip of the tongue i.e. 100% of the tongue is tethered to just 25% of the tongue, causing the tongue to poorly elevate and ‘squaring’ the tip.

Posterior Tongue-Tie

Posterior (sometimes called sub-mucosal or hidden) Tongue-Tie is where a wide band of tissue restricts the tongue’s movement. The distance between the band of tissue to the tip of the tongue is shorter than usual. Elevation of the tongue is affected; protrusion and
lateralisation can be assessed on oral examination

For more information about our Tongue-tie procedure, please read the Tongue-tie Assessment, Diagnosis and Treatment Guide.

Reasons for Treating Tongue-tie

The treatment for tongue-tie is a simple procedure called a frenulotomy (sometimes called frenotomy or frenulectomy). Not all babies and children with tongue-tie need treatment, some may be fine without it. National guidance from the National Institute of Clinical Excellence (NICE guidelines)suggests that frenulotomy is usually safe for young babies and could help with breastfeeding problems. Frenulotomy may be recommended in babies up to 6 months of age if there are;

Difficulties with Breastfeeding for baby which may/may not include the following;
  • Poor weight gain
  • Prolonged jaundice
  • Fractured frequent feeds
  • Baby feeding ‘all the time’
  • Baby appearing unsatisfied after a feed
  • Agitation and frustration whilst feeding
  • Head-rocking or waving on approaching the breast for a feed
  • Noisy clicking or lip noise whilst feeding
  • Dribbling of milk during a feed
  • Falling asleep prematurely during a feed
  • Multiple attempts at latching or maintaining latch
  • Use of expressed breast milk or artificial milk supplements
Difficulties with Breastfeeding for Mother may include;
  • Distortion and or compression of the nipples resulting in pain, damage, loss of tissue
  • Incomplete milk transfer by baby resulting in engorgement and/or mastitis
  • Poor initiation and maintenance of maternal milk supply

The presence alone of a visible or anterior sub-mucosal (hidden/posterior tongue-tie) is not an indicator for treatment with frenulotomy. Tongue mobility is the critical factor that affects breast feeding.

In the UK, the National Institute for Clinical Excellence (NICE) operational guidance regulates our practice in the treatment of tongue-tie. NICE states that the procedure to divide a tongue-tie should be carried out only to assist mother and baby to breastfeed more effectively. Frenulotomy should not be undertaken as a procedure for concerns that parentsmay have about their baby’s future ability to speak, eat or for cosmetic reasons.

For more information about our Tongue-tie procedure, please read the Tongue-tie Assessment, Diagnosis and Treatment Guide.

What is Ankyloglossia (Tongue-tie)?

Tongue-tie or Ankyloglossia is a mid-line anomaly and occurs as a result of incomplete cell division between the tongue and floor of the mouth at the seventh week of gestation. It is more common in boys (2:1), approximately 1:7 babies will have a tongue-tie and approximately one fifth of these will have posterior or sub-mucosal tongue tie. Tongue-tie can also occur in more than one family member.

In anterior tongue-tie, you can easily see a string of tissue (the frenulum) that attaches the tongue to the floor of the mouth. In posterior tongue-tie this tissue is more difficult to see but can be felt on palpation. If this piece of tissue is too short or tight it can cause restriction
of tongue mobility and as a consequence may affect the baby’s ability to breastfeed.

For more information about our Tongue-tie procedure, please read the Tongue-tie Assessment, Diagnosis and Treatment Guide.

How to Spot a Tongue-tie

Some Tongue-ties may be noted at the newborn examination undertaken usually by a Pediatrician or a Midwife with additional competency; others may be diagnosed whilst the mother and baby are still receiving post-natal care or when baby is older, by a Health Visitor, Breastfeeding Specialist or GP. The following clues may be present;

  • Visible membrane or ‘string’ joining the tongue to the lower gums or the floor of the mouth.
  • The tip of the tongue may be, ‘flattened’, ‘heart –shaped’ or ‘notched’ at the tip.
  • The tongue doesn’t lift up fully to the roof of the mouth particularly noticeable when baby is crying. It may also be ‘squared-off’ when lifting or sticking out rather than pointed.
  • The centre of the tongue may be ‘humped’ or have a hollow shaped depression in it when lifting it.
  • If you pass your clean finger under your baby’s tongue you may feel a restriction or ‘speed bump’. This may blanch if the tongue is lifted.
  • The tongue may not be able to protrude beyond the lower gum, therefore not cushioning the nipple from pressure during breast feeding causing damage, compression or distortion of the nipple.

For more information about our Tongue-tie procedure, please read the Tongue-tie Assessment, Diagnosis and Treatment Guide.