Maternity and local Health Visiting Services
This information has been developed for parents in line with the best available global evidence, with the support of South Tees Maternity Voices Partnership and local Health Visiting Services.
What is a tongue tie?
A tongue tie, also known as ‘ankyloglossia’, is an unusually short, thick or tight band of tissue (lingual frenulum) that attaches the tongue to the floor of the mouth. This can affect how well a baby can use their tongue, which can sometimes cause difficulties with feeding. Many feeding difficulties associated with tongue tie can be improved or resolved with breastfeeding support.
When should my baby be assessed for suspected tongue tie?
Your baby should not be routinely assessed for a tongue tie unless there are problems with feeding that aren’t resolved with the usual help and support. It can sometimes take a number of days for your baby’s feeding skills to develop. It is therefore important that we support you during this time. Sometimes, feeding problems associated with tongue tie might not be obvious until your baby is a few weeks or months old.
If you are no longer receiving maternity care, your local Health Visiting team can assess your baby for Tongue tie and support you with any feeding issues you might come across.
We can also offer you an assessment If you have had any concerns about your baby’s tongue or a history of a previous child with a tongue tie.
Who can assess for a tongue tie?
We have a team of Infant Feeding Champions who can assess for Tongue Tie. If your named midwife is not a Tongue Tie Assessor, we can arrange for you to be seen by one. If your baby is no longer under the care of the midwifery team, your baby can be assessed by a health visitor trained in tongue tie assessment.
Ongoing assessment and feeding support can help to improve feeding in some cases. However, if an assessment identifies a suspected tongue tie and you have ongoing difficulties with feeding, you will be offered a referral to an NHS tongue tie service. The waiting time for assessment and division is usually 2 to 6 weeks. This is free of charge.
Tongue-tie division is also offered by a number of private providers. The wait times are usually shorter than NHS, but you will have to pay for the assessment and procedure yourself. The cost varies but averages at around £180.
If you would like to explore the option of a private service, we recommend that you visit the Association of Tongue Tie Practitioners website: https://www.tongue-tie.org.uk
Tongue tie division procedure
During a tongue tie division, the frenulum (tissue beneath the tongue) is cut using sterile scissors. It is usually very quick, and the pain resolves soon after, therefore anaesthetic is generally not used in younger babies. You will be encouraged to feed your baby immediately following the procedure to sooth them. Around 80% of people notice a significant improvement with feeding in the days and weeks following division of tongue tie.
Tongue tie division should only be considered once all non-surgical options have been tried. The risks of tongue tie division include:
- Ulceration and damage to the salivary ducts under the tongue
- No improvement in feeding
Maternity services will provide ongoing assessment and support to help you and your baby with feeding for as long as you need or until you are ready to be transferred to the care of the Health Visiting team.
If you have a family history of bleeding disorders or your baby has not received Vitamin K following birth, you must inform your care provider as your baby may be at increased risk of bleeding during the procedure.
If my baby is referred to an NHS Specialist Tongue Tie Service, where and when will they be seen?
Your baby will be referred to County Durham & Darlington NHS Trust. Waiting times can very between 2 and 6 weeks depending on demand.
A member of the team at County Durham & Darlington NHS Trust hospital will contact you within 2 weeks to inform you of your appointment time and the clinic location.
If you have not been contacted within two weeks of the referral, please email: [email protected]
Will a tongue tie affect my baby’s speech and language development?
There is no good quality evidence that links tongue tie with speech and language development problems.
Will switching to bottle feeding solve the problem?
Babies with a tongue tie can sometimes have problems with bottle feeding. If you are breastfeeding and your baby is unable to attach at the breast comfortably or effectively, we can support you with cup feeding your baby until they are able to successfully attach at the breast.
Cup feeding can be helpful as it might avoid the need for bottle feeding, which can sometimes interfere with learning to breastfeed. Sometimes you may need, or choose to feed your baby expressed milk or formula through a bottle until the problems improve.
Will using nipple shields help?
Nipple shields can sometimes help a baby with a tongue tie as a temporary measure whilst you are awaiting division of tongue tie. We will support you to stop using the nipple shields as soon as is possible, as they can sometimes affect your milk supply. This in turn may cause blocked ducts which can lead to mastitis. Your baby may also become used to them and prefer to use them in the longer term.
Will a Tongue Tie affect my milk supply?
If your baby has a tongue tie they may be unable to remove milk from your breasts effectively, which can sometimes cause problems with setting up your milk supply. Your Midwife or Health Visitor will work with you to develop a plan to protect your milk supply. Please ask your Midwife or Health Visitor if you are concerned that you are not producing enough milk for your baby.
If you have any further questions, please do not hesitate to ask your Midwife or Health Visitor.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.