Tongue Tie

Tongue tie, or ankyloglossia, is present from birth. The thin band of tissue that connects the underside of the tongue to the floor of the mouth (the frenulum) is shorter, thicker or attached closer to the tip than usual, so the tongue cannot move as freely.

Many children with a visible frenulum have no problems at all and need no treatment. In others the restriction can make it difficult for a baby to latch and feed effectively, or may later affect the ability to lift the tongue, lick the lips or make certain speech sounds. The tip of the tongue may look heart-shaped when your child tries to poke it out.

• Treatment is considered only when the tongue tie is actually causing a problem, not simply because it is present. Common reasons include:
• Difficulty breastfeeding or bottle feeding in a baby, such as poor latch, prolonged feeds, clicking, or nipple pain for the mother
• Difficulty with speech sounds in an older child, after assessment by a speech pathologist
• Trouble with eating, licking or oral hygieneYour child's surgeon will examine the tongue, ask about feeding or speech, and discuss whether release is likely to help. Working alongside a lactation consultant or speech pathologist is often part of the plan.

The procedure is called a frenotomy or tongue tie release. In young babies it is a very quick procedure in which the tight band is divided with a small pair of sterile scissors. It is over in moments and the baby can feed straight away, which also comforts them.

In older babies and children, where the band is thicker or the child cannot keep still, the release is performed under a brief general anaesthetic as day surgery. The band is divided and a few dissolving stitches may be placed to shape the wound and reduce the chance of it re-forming.

Bleeding is minimal and usually stops within a minute or two. A small white or yellow patch forms under the tongue in the first day or so; this is normal healing tissue, not infection, and disappears within a week or two.

Babies can feed immediately and often show improvement over the following days as they learn to use their freer tongue. Older children may have a sore mouth for a day or two and can eat soft foods and take simple pain relief. Gentle tongue exercises may be suggested to encourage movement and prevent the band from reattaching. Contact the team if there is ongoing bleeding, fever or refusal to feed.