A tongue tie is a band under the tongue that is short or attached too far forward, limiting how far the tongue can lift and extend. It matters when it interferes with feeding or speech. Many babies have a visible band and no problem at all.
Tongue tie release, or frenotomy, divides the band of tissue under the tongue that is restricting its movement. In a young baby with feeding difficulty it is a quick procedure, often done with local anaesthetic, and feeding can resume immediately. It is indicated when tongue movement is restricted and causing a problem, not simply because a band is visible.
Everyone has a frenulum under the tongue. It becomes a tongue tie when it is short enough, thick enough or attached far enough forward to stop the tongue lifting to the palate or extending past the lower gum.
The commonest reason to treat in a newborn is feeding. A baby who cannot cup and lift the tongue struggles to latch, slides off the breast, feeds for a long time without being satisfied, and often causes considerable nipple pain. Weight gain can suffer. Where those things are happening and the tongue is clearly restricted, release usually helps quickly.
Equally, a great many babies have a visible frenulum, feed perfectly well, and need nothing. Releasing those achieves nothing and exposes the child to a procedure for no reason. Assessment is therefore of function, watching a feed where possible, rather than of appearance.
In older children the question is usually speech. Here the picture is less clear cut: most speech problems are not caused by tongue tie, and a speech and language assessment should come first. Release helps where a child genuinely cannot achieve the tongue positions certain sounds need.
The decision rests on restricted function. A visible frenulum in a baby who feeds well is not an indication.
Tongue movement is assessed and, where possible, a feed is observed. The decision rests on what the tongue can do, not on how the band looks.
The baby is swaddled and the tongue lifted to put the band on stretch and expose it clearly.
The band is divided precisely in the avascular plane, away from the ducts and muscle beneath.
Light pressure with gauze for a minute or two. Bleeding is usually a few drops.
The baby is fed straight away. It comforts, it confirms the effect and it helps stop any bleeding.
Feeding resumes immediately. Some babies are unsettled for a few hours. A white or yellow patch appears under the tongue as it heals, which is normal and not infection.
Healing is quick. Gentle tongue movement during feeds is usually enough; aggressive stretching is not recommended routinely.
Feeding pattern settles. Ongoing lactation support if the latch had been poor for some time.
Review if feeding has not improved, because the original problem may not have been the tie.
Where feeding difficulty was genuinely due to restriction, improvement is often noticed within a feed or two, and nipple pain frequently settles quickly. Where the restriction was mild or the feeding problem had another cause, release changes little, which is why assessment beforehand matters. Feeding support after release is important: a baby who has been latching badly for weeks has learned a pattern and often needs help to relearn. In older children treated for speech, release provides the range; speech therapy provides the change.
This is a small procedure, but it is not nothing, and it should be done for a reason.
Feeding straight afterwards is both comfort and treatment.
Many babies have a frenulum that is visible and entirely harmless. If feeding and weight gain are fine, releasing it achieves nothing.
It rarely does. The great majority of childhood speech difficulties have other causes, which is why a speech and language assessment should come before any release.
It often helps quickly where restriction was the cause. But a baby who has fed badly for weeks has learned a pattern, and lactation support afterwards is usually needed.
Routine aggressive stretching is not supported and distresses babies. Normal tongue movement during feeding is generally sufficient.
The most valuable thing here is an honest assessment of whether release will help. Many babies referred with a visible tie are feeding badly for other reasons, and dividing the frenulum will not fix those.
Release for a functional feeding problem is commonly covered by health insurance and by government schemes. Cost is modest for a simple frenotomy in a young baby and higher where a general anaesthetic is needed in an older child. A written estimate follows assessment.
The questions that come up when tongue tie has been mentioned by someone else.
Ask your question →Only if tongue movement is restricted and it is causing a problem. A visible band in a baby who latches well and gains weight does not need dividing. Assessment should include watching a feed wherever possible.
There are few nerve endings in the frenulum and young babies typically cry more at being held still than at the division itself. Most settle within a minute of being fed.
Often within a feed or two where restriction was the cause. Sometimes it takes longer because the baby has to unlearn a poor latch, which is why lactation support afterwards is important.
The band can reattach in a small number of cases and may need a second release. Normal tongue movement during feeding helps; routine aggressive stretching is not recommended.
Usually not. Most speech difficulties have other causes. A speech and language assessment should come first, and release is considered where a child genuinely cannot make the tongue positions that particular sounds require.
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