The trouble with tongue ties – signs to look out for in breastfed babies

I have been a health visitor for the past six years and have two young children of my own. My second child was born with a significant tongue tie which made breastfeeding painful. Thankfully he was able to transfer the milk effectively so he didn’t have any weight loss. My training meant I knew the tongue tie signs to look out for.

I was able to diagnose my son soon after he was born, and from there I was able to assist his latch to allow him to feed more effectively from the breast. So how can you find out if your baby has a possible tongue tie? What are the signs to look out for? Let’s firstly start by understanding what a tongue tie is and how it can affect a baby when breastfeeding.

What is a tongue tie?

According to the Association of Tongue Tie Practitioners, 1 in 10 babies are born with a tongue tie. Half of these babies will have difficulty feeding and may require treatment. 

So what is a tongue tie? Tongue tie is where the skin that joins the baby’s tongue to the bottom of their mouth (frenulum) is shorter and tighter than it should be. This can potentially make breastfeeding difficult for the baby because they are unable to move their tongue sufficiently and effectively. In turn, this can make it painful for the mother.

Tongue tie is where the skin that joins the baby’s tongue to the bottom of their mouth (frenulum) is shorter and tighter than it should be.

It’s important to recognise that some babies have tongue ties and are able to successfully breastfeed with no issues at all so a thorough assessment is often required. Sometimes doing an exaggerated latch is enough to get that deep latch that babies need. The exaggerated latch is something I used with my baby. Although it didn’t eliminate the pain it helped significantly and my nipples didn’t become too damaged which meant I could continue exclusively breastfeeding.

Signs a baby has a tongue tie

These are all signs a baby has tongue tie – but this is not a definitive list. Always look to have a tongue tie assessment done by a professional.

• Restricted tongue movement is visible (unable to stick tongue out). Sometimes this is only noticed when a professional completes an oral examination.
• The tip of the tongue is heart-shaped.
• Difficulty latching onto the breast or staying attached. 
• Weight gain slower than expected or weight loss.
• Being unsettled and appearing hungry all the time.
• Painful feeding experience for mother.
• Mother is suffering from cracked nipples.
• Engorgement for mother or mastitis (due to insufficient milk transfer).

What treatment is there for tongue tie?

The treatment for tongue tie is known as tongue tie division. This is where the practitioner divides the tongue tie using sterile medical scissors. It is vital to have breastfeeding support prior and post-procedure.

In the UK tongue tie services on the whole appear to be improving. As little as four years ago there were very limited services and mothers were being referred to different counties for treatment which is far from ideal when you have a newborn baby that is very often unsettled due to feeding difficulties.

As little as four years ago there were very limited services and mothers were being referred to different counties for treatment

It now seems that more local areas have invested in tongue tie assessment and treatment programmes along with better support pre and post surgery. Unfortunately, waiting lists can be fairly long in the NHS so some people decide to go to a private lactation consultant. I have personally experienced private and NHS treatment and I must say I was blown away by the professionalism of the NHS. It was a brilliant service.

What to do if you think your baby has a tongue tie

If you’re having difficulties breastfeeding then make sure you contact your health visitor for support. Health Visitors are all now trained in tongue tie assessment which wasn’t the case just a few years ago, so it’s come on a long way. We hear stories from parents who say they don’t feel they’ve received adequate support for tongue ties but we hope this will improve as time goes on.

It’s important to recognise that health visitors all have different areas of expertise and you may discuss your concerns with a health visitor who doesn’t feel confident in that area but they should be able to refer onto someone who can help such as a local infant feeding team.