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The Dudley Group NHS Foundation Trust Logo

Maternity

Tongue-tie

Patient Information Leaflet

 

What is tongue-tie? 

This leaflet explains what tongue tie is, the possible implications for you and your baby and the available treatment options. The underside of the tongue can be connected to the floor of the mouth by a piece of tissue called the lingual frenulum. If this piece of tissue is near the tip of the tongue, is thicker or shorter than normal it can restrict and affect tongue movement 

 See pictures below for examples of tongue-tie. 

 

How may tongue-tie affect my baby? 

The presence of a tongue-tie may not affect your baby at all; however, some babies may have difficulty feeding. 

If your baby has a tongue-tie that is causing a feeding problem, a health professional may refer your baby to the Tongue Tie Assessment clinic at The Dudley Group NHS Foundation Trust. You will be seen in clinic by a midwife who has specialist training in tongue-tie assessment and division. 

 

How may my baby’s feeding be affected? 

Tongue-tie can affect both breastfeeding and bottle feeding. If this happens, midwives, health visitors and feeding support workers are available to help you with feeding support.  

 

Possible effects on breastfeeding 

To breastfeed successfully, the baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage. A tongue-tie can prevent the baby’s tongue from moving properly during this process, which can cause a range of breastfeeding problems. 

If your baby is breastfeeding and has a tongue-tie they may:  

 

If the tongue-tie is affecting breastfeeding, you may have: 

These problems may be due to the way your baby is feeding and not just because a tongue-tie is present. Your midwife, health visitor or breastfeeding support worker can advise you on breastfeeding and on the way your baby is positioned during feeds. 

 

Possible effects on bottle feeding 

Tongue-tie may also affect your baby’s feeding if they are bottle-fed. They may: 

In addition, they may not be able to keep a dummy in (if you are using one). 

 

What are the treatment options for tongue-tie? 

If your baby has been diagnosed with a tongue-tie that is affecting their feeding, you will need to decide how it should be treated. 

To help you make this decision, you may be referred to the tongue-tie assessment clinic. When the tongue tie team have received your referral, they will book an appointment for a telephone call to arrange an appointment for you and your baby in the tongue tie clinic. Details of the call will come as a text on your mobile phone. At the clinic appointment the tongue tie practitioner will assess your baby and discuss the following with you: 

You then have some options;  

In either case, we will give you information about how you can get support in your area with feeding your baby. 

What happens if my baby does not have their tongue-tie divided? 

Part of the tongue-tie may separate on its own, either in childhood or in adulthood. It may be beneficial to seek feeding support in your local area to ensure feeding continues to go well. You may decide to wait until your baby is older to see if the issues you are having resolve with time or as the baby grows. An older baby or child can be referred to an Ear, Nose and Throat (ENT) consultant by your GP. 

 

What if I change my mind? 

If at a later date you decide you would like your baby to be assessed and considered for a frenulotomy, you can organise this as follows: 

For babies up to 10 weeks old  

You will have been given a ‘Patient Initiated Follow up’ leaflet during your appointment. A follow up telephone call with a tongue tie practitioner can be arranged by calling our Outpatient Centre on 01384 365100.  

For babies over 10 weeks old (from your expected date of delivery) 

You can either: 

 

What happens during a tongue-tie division?  

A tongue-tie division is a simple and quick procedure. Your baby will be wrapped in a towel to keep them still. They will then be placed on a bed, a member of staff will support your baby’s head, and a light will be used to look into your baby’s mouth. Sterile, curved scissors are used to cut the tongue-tie. You will be able to be with your baby at all times. 

Your baby may cry during the procedure and afterwards for a short time and there will be a small amount of bleeding when the tongue-tie is cut.  

 

What happens after the procedure? 

When the tongue-tie has been cut, it can open into a diamond shape at the base of the tongue. This seals over quickly and then becomes a white patch which looks a bit like an ulcer. This gradually gets smaller and heals over a period of one to two weeks. If your baby is jaundiced, it can be yellow. 

After the frenulotomy, you can offer your baby a feed straight away. For most babies, there is an immediate improvement in feeding although it may take longer in some babies.  

 

What are the risks of a frenulotomy? 

Pain

This may be an uncomfortable procedure for you baby. Immediately after the procedure, babies should be offered a feed. This is a way you can give comfort to your baby. Babies can be unsettled for 24 to 48 hours after the frenulotomy. In some cases, your baby may need pain relief. 

Pain relief options available: 

For babies under eight weeks: Paracetamol medicine may be used if prescribed by a GP.  

For babies over eight weeks: Paracetamol (e.g. Calpol) can be given without a prescription (always read the label and do not exceed the recommended dose). 

 

Risk of damage to other structures 

There is a small risk of accidental damage to the structures surrounding the frenulum. However, this is an extremely rare complication. Babies are wrapped in a towel with their head supported to prevent movement during the procedure. 

Bleeding  

There is usually only a little bleeding following a frenulotomy. Feeding your baby as soon as possible after the procedure helps to stop this by calming your baby and the action of feeding puts pressure on the frenulotomy wound site. The tongue tie practitioner will take your baby’s medical history and discuss any possible risk factors relating to bleeding. 

Before you leave the clinic, the tongue-tie practitioner will check that the bleeding has stopped and give you a link to an information leaflet on caring for your baby after a tongue-tie division This will include information about what to do if your baby’s frenulotomy site starts to bleed when you are at home. You will also be signposted to the ATP guidance on bleeding. 

Infection   

As with any operation, there is a small risk of infection. After the procedure, if your baby shows any signs of infection such as a high temperature, not feeding well and they are unsettled, it is important to contact your GP for advice. 

Reformation                                                                                      

In some babies, the tongue-tie may reform. When this happens, parents report that the improvements in feeding symptoms shown after the frenulotomy start to get worse again.  If you are concerned about this, you should book a PIFU follow up appointment.  

 

Potential relearning of how to feed 

Most parents report an immediate improvement in feeding problems after a frenulotomy has been performed. However, some babies do take a period of time to relearn how to latch to the nipple or teat more effectively. It is important to access local feeding support to ensure your baby is learning to attach well to the breast after a frenulotomy. 

 

How do I care for my baby after a frenulotomy? 

You should care for your baby as normal. Some research suggests that it may help your baby’s tongue movement and reduce the risk of reformation if you encourage your baby to poke its tongue out and they regularly move their tongue such as regular feeding. The midwife who performs the frenulotomy will discuss this with you after the procedure. 

 

Can I find out more? 

You can find out more from the following web links: 

 

Contact Information 

If you have any queries, or there is anything you do not understand about this leaflet please contact: 

Infant feeding team by calling 01384 456111 ext 3887, Monday- Friday 09.00am-12.00pm or email dgft.tonguetie.assessment@nhs.net 

 

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet. If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

 

Originator: Maternity Documentation Group. Date reviewed: July 2025. Next review due: August 2028. Version: 7. DGH ref: DGH/PIL/00865.