Tongue Tie Assessment & Treatment
Areas we cover
£100 for assessment if no Frenulotomy performed
During the visit we will run through a full history, discuss any symptoms and complete an oral exam. A comprehensive functional assessment of the tongue will assess the mobility, appearance and specifically how your baby is using it.
We can observe a feed and can help identify why you or your baby are struggling.
If a tongue tie is identified and you would like the option of treatment, our experienced practitioner will explain the treatment and the small risks involved.
We will discuss what to expect after the procedure, healing, feeding and aftercare. We will support you with a feed immediately afterwards. An appropriate care plan can be put in place if necessary.
Our fully comprehensive aftercare package, included as standard, means you can contact us via phone, text or email if you have any questions or concerns. We will happily re-assess in person if needed.
Appointments last approx 45mins.
We are fully insured and CQC registered.
What makes Cheshire Baby Support different from other tongue-tie division practitioners?
·- We firmly believe that tongue-tie division should not be done in isolation from feeding support. For this reason every tongue-tie division appointment will be attended by Jennifer, a tongue-tie practitioner and Amanda, a lactation consultant (IBCLC). This ensures that a full and holistic assessment is made for each individual baby and family. This is then followed up by expert and ongoing feeding support.
- Amanda will gently and firmly hold your baby’s head during the cut. This means that parents do not have to do this job. It also increases the safety of the procedure.
- Jennifer is qualified to Master’s level in the tongue-tie division procedure and has received the highest recognisable qualification in the country. Amanda holds the highest qualification in clinical infant feeding support, recognised across the world.
- We will visit you in home or at our clinic.
- Appointments typically available at short notice.
- We offer ongoing support at our breastfeeding support groups for as long as you need it and will re-assess a tongue-tie free of charge, in our clinic.
- We pride ourselves on looking at your whole picture and not just relying on a tick box exercise. Feeding issues can also affect sleep, digestive issues and mental health. This is why we have a multidisciplinary team which includes feeding support, tongue tie assessment/division and bodywork. This helps us give you the best care possible.
Tongue Tie Information
What is a tongue-tie?
A tongue-tie (also known as Ankyloglossia) is caused by a short or tight membrane under the tongue (the lingual frenulum).
Where the membrane is attached at, or close to the tongue tip, the tongue tip may look blunt, forked or have a heart shaped appearance. However, where the membrane is attached further back the tongue may look normal.
Research suggests that approximately 1 in 10 babies may be born with some membrane under the tongue. But only about half of those babies display significantly reduced tongue function, making breast or bottle feeding difficult.
These babies are likely to benefit from treatment to release the restriction that the membrane is having on the tongue and enable to baby to feed effectively.
Tongue-tie practitioners often talk to parents who have had conflicting advice around whether or not their baby has a tongue-tie so it may be helpful for parents, and professionals who do not assess and divide tongue-ties, to have an understanding of what an assessment for tongue tie involves.
The decision on whether or not a tongue-tie is impacting on feeding and whether it is appropriate to offer to divide it should be made after a detailed feeding history has been taken. This will usually include information about the pregnancy and birth and the medical history of both mum and baby. The baby is usually observed at the breast. This may be done by the person who divides tongue-ties or by someone who has been supporting you with feeding, prior to you being referred for division, such as a MW, HV or breastfeeding counsellor/lactation consultant. The function of the tongue will also be assessed to establish if the baby is tongue-tied and if this is impacting on feeding.
Assessment for tongue-tie requires training and skill and involves placing a finger in the baby’s mouth. It cannot be done by just taking a look. Assessment is usually carried out with the baby on the assessor’s lap or a flat surface such as a table or couch. It involves observing how the baby uses their tongue.
Professionals assessing babies for tongue-ties should assess elevation, lateralisation and extension. Elevation can most easily be assessed when baby cries. With the mouth wide open, the tongue tip should lift up to at least the mid mouth. In tongue-tied babies the tongue often stays quite flat in the floor of the mouth or the edges curl up to form a bowl shape or ‘v’ shape. Babies should be able to poke their tongue tip out well over the bottom lip when the bottom lip is stimulated. When the assessor runs their finger along the top ridge of the bottom gum the tip of the baby’s tongue should follow the finger so the tongue sweeps side to side (lateralisation).
Some assessors perform a suck assessment by placing their finger in the baby’s mouth (pad side up, nail side down) and feeling how the baby is cupping and using their tongue. Assessors sweep their finger under the baby’s tongue so they can feel the extent of the tongue tie and the tongue will also be lifted to visualise the frenulum. The appearance of the frenulum is also documented including the shape of the tongue tip, where it attaches to the floor of the mouth and the underside of the tongue and how long and stretchy it is.
Problems which may be due to a tongue-tie:
Nipples which look misshapen or blanched after feeds
Low milk supply
Exhaustion from frequent/constant feeding
Distress from failing to establish breastfeeding
Restricted tongue movement
Small gape resulting in biting/grinding behaviour
Unsettled behaviour during feeds
Difficulty staying attached to the breast or bottle
Frequent or very long feeds
Excessive early weight loss/ poor weight gain/faltering growth
Clicking noises and/ or dribbling during feeds
Colic, wind, hiccoughs
Reflux (vomiting after feeds)
Your baby may not display all of these signs and there can be other causes for these symptoms so thorough assessment by a practitioner skilled in breastfeeding is essential.
Information from https://www.tongue-tie.org.uk/
What will happen during the tongue-tie division consultation?
Whether at home, or at clinic, we will introduce ourselves and ask you about any feeding difficulties you are having. If your baby is hungry and wishes to feed it may be useful to observe a feed and assess any difficulties that the tongue-tie may be causing your baby.
We will discuss assessing your baby’s tongue-tie using the Hazelbaker scoring system. With your permission we will proceed to use this to assess how your baby’s tongue functions and appears, giving it a score. Once we have fully checked your baby’s tongue-tie we will discuss the findings with you.
If your baby is found to have a significant tongue-tie based on the Hazelbaker scoring system and the symptoms that you and/or baby are experiencing, we will discuss the small risks involved in doing the tongue-tie division procedure. We will also answer all of your questions.
If you wish to continue then we will perform the tongue tie division procedure. Following the procedure your baby will be returned straight to you for comfort and feeding. You may choose to breast or bottle feed your baby.
We will assess the feed after the procedure and offer any help or advice that we can to ensure optimal positioning and attachment. Before leaving, we will ensure that you are happy with everything and that the wound is not actively bleeding.
You can receive free follow-up support by contacting us by telephone. In person visits are also available - please click here for more information.
What is the Hazelbaker scoring system?
The Hazelbaker scoring system is considered to be the best tool available for assessing a tongue tie using a quantitative measure. It not only takes into account how a tongue tie appears but how the babies tongue can function. This is very important as occasionally a tongue-tie can look very severe but the baby’s tongue actually functions very well, parents of these baby’s may wish not to proceed with the division.
More concerning however, are the baby’s that have relatively ‘normal’ looking tongue, but very poor tongue function. Often these tongue-ties go undiagnosed for weeks or months despite symptoms in the mother and/or baby. The Hazelbaker score helps parents and health care professionals understand why they are experiencing feeding difficulties.
A score is given out of 14 for function and out of 10 for appearance. The lower the score, the worse that the baby is affected, by the tongue-tie. A score of less than 11/14 and 8/10 indicates a tongue-tie that may benefit from a tongue-tie division procedure.
What is a posterior tongue tie?
A posterior tongue-tie sits at the back of the tongue. It is often much more difficult to see than the widely recognised anterior tongue-tie, that is accepted as membrane extending to the tip of the tongue. Often posterior tongue-ties are not diagnosed by healthcare professionals, many of whom receive little to no training on tongue-tie. If you suspect that your baby has a posterior tongue-tie it is important to find a tongue-tie practitioner who is confident in the diagnosis and treatment of posterior tongue-tie. Posterior tongue-ties can impact on your baby’s tongue function just as significantly as an anterior tongue-tie and it should be treated if it is causing feeding difficulties for you or your baby.
We acknowledge the significance of posterior tongue-ties and are fully qualified to diagnose and treat this type of tongue restriction.
What does the tongue-tie division procedure involve?
During the procedure the baby’s head is held gently but firmly by Amanda. Jenny will then gently open the baby’s mouth and lift up its tongue to see the tongue tie. Scissors are then carefully placed either side of the tongue-tie and it is cut. The procedure is very quick lasting only a few seconds. The baby is returned back to its parents as soon as the division is completed for comfort and a feed.
I have been told by several health professionals that my baby doesn't have a tongue tie but I am still experiencing problems, why is this?
Unfortunately the majority of health care professionals, including midwives, health visitors and doctors receive little to no training on tongue tie. This is not their fault, their roles are highly skilled to their particular area and tongue tie is not a part of this. Tongue tie training is a specialist area that can take years of study and training alone. Both Amanda and Jenny have received specialist training on identifying oral restrictions. If you still experiencing problems we can help.
Of course not all feeding problems are related to tongue tie and this is why we offer specialist infant feeding support at each appointment. We are passionate about not only treating the symptoms but looking for the underlying cause of the problem. Amanda offers specialist, individualised care for feeding problems and one to one consultations, click here for more information.
Does the procedure hurt the baby?
The procedure does not seem to hurt babies. This is because there are very few nerve endings in the area around the floor of the mouth. Some babies sleep through the procedure, while others cry for a few seconds.
Are there any risks associated with the procedure?
Bleeding: Most babies do experience some bleeding as the tongue-tie is divided. Although this may initially appear heavy to the parents, it is actually only a few drops of blood mixed with the baby’s saliva. The best way to stop bleeding is by keeping your baby as calm as possible and then offering a breast or bottle feed. As the baby feeds the tongue will be pressed down onto the wound creating pressure that will help to stop the bleeding.
Occasionally bleeding can be slightly heavier (1:400). In this situation the tongue-tie practitioner will apply continuous pressure onto the wound for 10 minutes, whilst rocking and comforting your baby at the same time. This can be repeated again. If excessive bleeding continues beyond this, medical assistance will be called to perform additional measures to stop the bleeding, this will require a transfer into hospital via ambulance. More information can be found here;
Re-learning to feed: Following the tongue-tie division procedure the baby can react in 1 of 3 different ways.
1) The baby has an instant feeding improvement.
2) The baby continues to feed as it did before the procedure and gradually improves over the next few days or weeks.
3) The baby takes a step back and struggles to feed immediately following the procedure, but then gradually improves over the next few days or weeks. Please note this is the least likely thing to happen and is temporary. If this does happen we will support you through this.
The tongue is a muscle and needs to rebuild its strength to correct the "current state" of muscle weakness, this takes time.
Following a successful tongue-tie division parents usually report that there is an overall improvement in the baby’s feeding after 2 weeks.
Reattachment: The risk of reattachment is about 4% and has 3 possible causes:
1) The tongue-tie was never fully released at the time the procedure was performed. In this situation little to no improvement would occur following the procedure.
2) As the wound heals, the edges fuse together causing the tongue to be restricted by scar tissue. If this happens an improvement is usually seen with the baby’s feeding but then the original symptoms start to reoccur again.
3) When the tongue-tie is divided, it creates space which more tongue-tie, that was hidden in the muscle, can move forward into. This is very rare. If this happened an improvement is usually seen with the baby’s feeding but then the original symptoms reoccur again.
If you are concerned that re-attachment has happened, then please contact contact us. We are happy to reassess the baby’s tongue function and offer further treatment if it is considered to be in the baby’s best interests on an individual basis. This will be done at our clinic in Chester.
Damage to surrounding structures: A baby’s mouth is a relatively small place and the tongue-tie division procedure involves placing scissors into this space. There is an extremely small risk that other structures within the mouth could be damaged during the procedure. To minimise this risk blunt ended scissors are used by a fully trained tongue-tie practitioner and an IBCLC will gently but firmly holds the baby’s head in position.
Infection: The risk of infection is very rare. Sterilise any bottles, dummies or nipple shields carefully before use. If infection occurs your baby is likely to be generally unwell/very unsettled/lethargic with a fever. If your baby has any of these symptoms please see your GP urgently.
The tongue tie procedure is not an 'instant fix' or a 'stand alone' treatment. Parents may see an improvement immediately following the division but typically the full benefits may not be seen for a while. Feeding support following a division is crucial. We will offer feeding support via phone for as long as is needed after the procedure. There are also a variety of peer support groups and national helplines that can assist.
When your baby has a tongue tie there is likely to be tension in the surrounding oral structures, which will need to relax in order to achieve a wide open gape to feed. Bodywork has been shown to support with this. Babies that have been born with interventions (induction, epidural, narcotic use in labour, breech or transverse presentation, c section or instrumental deliveries) will find this therapy particularly useful.
Feeding support, combined with body work appears to yield the greatest results. We offer a full package that includes bodywork, please contact us for more details.
What if I’m unsure about if I want the procedure to be done?
Once your baby has had its tongue function and appearance assessed the scores will be discussed with you. The tongue-tie practitioner will also discuss alternative approaches to managing your baby’s tongue-tie with you, for example modifying your breast or bottle feeding technique. You are under no obligation to continue to have the tongue-tie divided if you do not wish to.
Do I have to stay in the room during the procedure?
Parents are free to choose if they wish to remain in the room with their baby or be in another room whilst the procedure is carried out.
Is it safe to perform a tongue-tie division in a home environment?
Yes! We have been fully inspected by the CQC, who also agree that the home environment is an ideal and safe environment for the tongue-tie division procedure. The main advantages to performing the procedure at home are:
It lowers the risk of infection-doing the procedure at home means that your baby will not be exposed to any bacteria that it is not used to during the procedure. Your baby is used to the bacteria in your home; therefore it is much less likely to cause an infection.
You do not have to travel, babies often don’t like travelling in cars. Doing the procedure at home is much less stressful for you and your baby. You do not have to worry about feeding your baby in time to leave for an appointment or arriving late. Likewise you do not have to worry about the journey home again.
You and your baby will feel more relaxed and in control. Your home environment is a much more comfortable and private space. You are both more likely to feel at ease at home, this makes feeding baby after the procedure much easier.
There are no time restraints. A typical appointment takes around 45 minutes, however, if you are experiencing complex issues or simply feel like you need more time during the consultation then this is easily accommodated during a home visit.
What qualifications are required to perform a tongue-tie division procedure?
Worryingly no official qualification is required for an appropriate health care professional e.g. doctor, dentist, midwife, nurse etc. to perform a tongue-tie division at present. It is possible that the person performing the procedure has not done any formal qualification and may have simply been taught by a colleague. This can lead to problems, if the person teaching the procedure was not doing it correctly themselves.
Currently health care professionals can complete a tongue-tie division course at Southampton hospital or Wolverhampton University.
We are very proud that Jennifer completed her Masters’ level qualification at Wolverhampton University. This course involved studying the theory of tongue tie and learning the practical procedure to the highest educational standard.
Do you think every baby has a tongue tie?
Absolutely not! This is why we use a scoring system to quantify our findings. This can then help us to shape your care appropriately.
What is the Care Quality Commission (CQC) and why is it important?
The CQC are the independent regulator of health and adult social care in England. They make sure health and social care services provide people with safe, effective, compassionate and high-quality care.
To achieve a CQC accreditation a tongue-tie practitioner must show that they provide the following:
- Person-centred care. You must have care or treatment that is tailored to you and meets your needs and preferences.
- Dignity and respect. You must be treated with dignity and respect at all times while you're receiving care and treatment.
- Consent. You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you.
- Safety. You must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Providers must assess the risks to your health and safety during any care or treatment and make sure their staff has the qualifications, competence, skills and experience to keep you safe.
- Safeguarding from abuse. You must not suffer any form of abuse or improper treatment while receiving care.
- Premises and equipment. The places where you receive care and treatment and the equipment used in it must be clean, suitable and looked after properly.
- Good governance. The provider of your care must have plans that ensure they can meet these standards. They must have effective governance and systems to check on the quality and safety of care. These must help the service improve and reduce any risks to your health, safety and welfare.
- Duty of candour. The provider of your care must be open and transparent with you about your care and treatment. Should something go wrong, they must tell you what has happened, provide support and apologise.
Do all tongue-tie division services have to be registered with the CQC?
Sadly no! Doctors with GMC registration and those practitioners not working in England do not have to register with the CQC. This means that they are not accountable to the CQC’s high standards of care.
We are very proud to be regulated by the CQC and to have satisfied all of their high expectations for the care that we provide.
Where can I find additional information?
Association of tongue tie practitioners:
UNICEF and baby friendly: