Tongue Tie Division Procedure: Frequently Asked Questions
Yes. I’ll always take a history and perform a thorough (but gentle!) oral examination, before talking you through my findings and discussing where you’d like to go from there.
It’s thought that the frenulum does not have many nerve endings until babies are older, and so we believe that the procedure is not very painful for babies. However they can feel that something has been done and will often cry very briefly (as with a heel prick procedure, vaccinations etc). The procedure itself takes around 2-3 seconds, and we will aim to feed immediately afterwards for baby’s comfort and to minimise any bleeding.
Some babies can be unsettled or fussy in the hours after the procedure. They may wish to feed more frequently, or not feed as much for a while. Skin to skin, lots of cuddles, calming measures, and relaxed feeding will all help if this is the case. Babies over 8 weeks can have paracetamol if needed, but this is often not required.
Yes. NICE Guidance (2005) & The Cochrane Systematic Review (2017) have deemed tongue tie release to be a safe and effective procedure. This can be performed safely in a clinic setting or as a home visit. Tongue tie practitioners are regulated by the Care Quality Commission.
There are often a few drops of blood collecting under the tongue after the release. This generally stops very quickly with feeding. Very occasionally, some babies may need a few minutes of pressure applied under the tongue if bleeding is not stopping with feeding. Heavy bleeding is a recognised risk, although this is extremely rare.
Anterior tongue tie describes a prominent restrictive frenulum which can be seen more easily towards the front of the tongue. Posterior tongue tie describes a restrictive frenulum that is further back underneath the tongue (although the exact definition of where can vary). When assessing for any restriction, it is important to fully assess tongue movement and function, rather than judging on appearance alone. The first three images below show more anterior tongue ties, and the last two pictures show more posterior types.
After tongue tie release, you will often see a diamond shape underneath baby’s tongue. After a day or two, this will usually become a small white or yellowish ulcer, which is part of normal healing and nothing to be concerned about (and doesn’t appear to bother babies).
Although complications are extremely rare, I will always talk through potential risks of the procedure before taking consent, and will discuss ways to minimise these risks.
Bleeding:
There are often a few drops of blood collecting under the tongue after the release. This generally stops very quickly with feeding. Very occasionally, some babies may need a few minutes of pressure applied under the tongue if bleeding is not stopping with feeding. Heavy bleeding is a recognised risk, although this is extremely rare.
Infection:
Cases of infection are extremely rare (especially if giving breast milk as this has many protective factors), but it is good practice after the procedure to ensure that any bottles, dummies etc. are sterilised before use, and that infant formula is prepared safely (as per instructions on the tin) to ensure that there is no bacterial contamination.
Reattachment:
Reattachment is uncommon but can occur, although not all babies with some reattachment will require a second division. I will show you some very gentle exercises to encourage tongue mobility and reduce this risk.
I use sterile frenulotomy scissors to perform the procedure. These are designed to curve away from the tongue, and are blunt ended to avoid causing damage to surrounding structures. Most nurses and midwives use scissors for the procedure, and this method is generally used within the NHS. Some private oral surgeons and dentists use lasers. Regardless of method, the most important factor is the skill of the user.
Here is a useful article explaining the differences between scissor and laser tongue tie division.
I will assess your baby’s tongue function, and give you my opinion as to whether or not there is a restriction present. I will also offer suggestions to help with any feeding issues you are having. There is never any pressure or obligation to go ahead with the procedure. Some parents wish to proceed, some decide not to, and some may come back to division at a later date if problems are ongoing. It is important that you are able to take your time and make the right decision for your family.
Yes, if you choose to proceed then the tongue tie can be treated during the same appointment, and any required feeding support will always be included alongside this.