What’s tongue-tie and how do I get help for my baby?

After the birth of baby Ezra in March 2020, Pura founders Abi and Guy Fennell experienced months of feeding problems before discovering that Ezra had a mild “tongue-tie”.

Tongue-tie is a common condition where the skin connecting the tongue to the bottom of your baby’s mouth is shorter than usual.

With the normal schedule of postnatal face-to-face visits from healthcare staff pared back due to Covid 19, some women are finding a delay in tongue-tie diagnosis - meaning they, and their babies, suffer unnecessarily.   

We outline the signs and symptoms of tongue-tie and explain how you can get help.

What is tongue-tie?

While tongue-tie can sometimes be diagnosed at birth, it’s not always easy to spot – depending on the type of tongue-tie. The first indication that your baby has tongue-tie is often trouble with feeding.

Tongue-tie can inhibit movement, meaning your baby has problems latching onto the breast, which can make breastfeeding very painful. 

Abi shares her story. “Ez has never been a good feeder,” she explains. “Because he was a premature baby, we were encouraged to breastfeed him - but we were also advised to bottle feed him as well.

“I was expressing breast milk into a bottle, so every feed involved 30 minutes of breastfeeding and 30 minutes of bottle feeding to ensure Ezra’s weight didn’t drop. At about four months, he fell out of love with breastfeeding and so we switched solely to formula.

“Each feed was taking an hour and a half. Ez would push the bottle away in the daytime but feed better at nighttime, so we decided to see if there was an oral issue.

“A feeding specialist diagnosed a tongue-tie problem, but she wasn’t entirely sure if it was a big enough issue to cause the feeding problems.”

Treatment for tongue-tie

Treatment for tongue-tie is not always needed. In Ezra’s case, his tongue was revealed to be just 25% tight, so Abi and Guy decided to opt for cranial therapy to help relieve the tension around Ezra’s jaw and upper body.

Paediatric craniosacral therapy is a light-touch treatment that helps release restrictions, allowing improved motion for the tongue and the entire body.

Yet if a baby’s feeding is more severely affected, tongue-tie treatment involves a simple procedure called a tongue-tie division.

Performed by doctors, nurses or midwives, tongue-tie division involves cutting the piece of skin connecting the underside of the tongue to the bottom of the mouth.

In babies a few months old, the division can normally be done without anaesthetic or with a tongue numbing local anaesthetic. A general anaesthetic is usually needed for older babies.

You can also have laser treatment - a frenectomy – but this is not typically offered on the NHS.

Experiencing tongue-tie division

New mum Charlene Hughes suffered months of pain when breastfeeding before her daughter Thea was finally diagnosed with tongue-tie and had a division at 12 weeks old.

“We experienced lots of challenges feeding in the early days and support was scaled back massively due to the Covid 19 pandemic,” says Charlene.

“I was on the community midwife books for 30 days because breastfeeding was very challenging for me. I had severe nipple trauma and had to feed with nipple shields for three months because the pain was so excruciating.

“When I relayed this to the healthcare workers, they asked questions such as: ‘does she have a heart-shaped tongue’? ‘Can she stick her tongue out’.  She could in my eyes, but I didn’t really have a good idea of what to look for as a first-time mum.”

 Charlene continued to experience extreme pain when breastfeeding. At Thea’s eight-week check-up, the GP was concerned that Thea wasn’t putting on weight.

“It was then that they started to identify that there might be an issue,” says Charlene.

“I was sent to a lactating consultant, through the healthcare clinic, and it wasn’t until Thea was 12 weeks old that it was confirmed that she actually had a tongue-tie.

 “I was told it was a small one, but it was recommended that we proceed with a division.”

Significant improvement

Charlene says there has been a significant improvement in breastfeeding since the division.

“For me, the pain continued for a while, but this didn’t bother me too much as Thea started to put on weight again.

“I’m sure that pre-Covid, the tongue-tie would have been caught a lot sooner. Within five seconds of the physical check, it was diagnosed.

“So, for us, the biggest issue we had is the lack of support, which is a direct result of Covid. People’s priorities are elsewhere - and rightly so. But face-to-face contact with healthcare staff is so important in this instance.

“Thea is now doing much better, still exclusively breastfeeding at five months, so it’s going well and it was worth having the division done.” 

 Signs of Tongue-tie

According to NHS advice, signs of tongue-tie in babies include:

• Difficulty lifting the tongue up or moving it from side to side

• Difficulty sticking the tongue out

• The tongue looks heart-shaped when they stick it out

Babies may also:

•Have difficulty attaching to the breast or staying attached for a full feed

• Feed for a long time, have a short break, then feed again

• Be unsettled and seem to be hungry all the time

• Not gain weight as quickly as they should

• Make a "clicking" sound as they feed

If you're concerned about your baby's feeding and think they may have a tongue-tie, see a health visitor, midwife or GP as soon as possible.