FAQ

• We will ask you to avoid feeding baby for an hour before the appointment so he or she will be interested in feeding during the consultation.
• We will discuss and review your consent form and health history and answer any questions you may have. We will observe your baby feeding.
• We will assess tongue function and then discuss our findings with you.
• We will go through strategies, which may be more appropriate than tongue-tie division, or which may be needed alongside division, to improve feeding such as positioning and attachment, boosting milk supply, suck training, etc. If you are bottle feeding you'll be supported with different bottle feeding techniques.
• Your follow up appointment will be scheduled, we prefer to do this face to face.

• If tongue-tie division is appropriate we will go through the potential outcomes and risks of the procedure with you so you can make an informed decision on whether to go ahead or not.
• We will discuss consent again with you. There is no obligation to go ahead and we are quite happy for parents to go away and spend time researching and thinking more about the procedure if they wish to.
• Your baby will be swaddled in a muslin and placed on the treatment couch. You can choose to stay with your baby or to briefly leave the room. In the home they will be placed on a changing mat on your table or other flat, clean surface. We use a bright head torch to ensure adequate lighting.
• If we are working together then one of us will hold your baby’s head. However, if one of us is working alone then a parent will need to hold baby’s head.
• Using an index finger to lift the tongue, the frenulum (tongue-tie) will be visualised then snipped using a pair of single use, sterile, curved, blunt tipped scissors.
• Once the frenulum has been divided a piece of gauze will be placed under baby’s tongue and baby then passed to parents to feed. Babies usually latch on within a minute and bleeding is usually very light and stops quickly once baby is feeding.
• Baby’s feeding will be observed and support provided with this.
• We will explain to you what to expect and give you an aftercare leaflet.
• A feeding plan will be agreed with you to manage any ongoing feeding issues.
• We will stay with you until any bleeding has settled.

International Board Certified  Lactation Consultants (IBCLC) are professionals with extensive experience and in depth knowledge in supporting breastfeeding mothers.  IBCLC is the highest recognised qualification in breastfeeding, it is recognised internationally and once qualified IBCLCs are required to prove they have kept up to date every 5 years by submitting evidence of 75 hours of continuing professional development.

Lactation Consultants have specialist skills to support mothers and babies with the more complex issues such as prematurity, twins and multiples, sick babies and those with special needs, poor weight gain and low milk supply, sucking problems, tongue-tie and cleft palate.

Some IBCLCs work within the NHS and voluntary sector but the majority work privately as we do.  This is due to the fact that are very few opportunities in the NHS and the value of IBCLCs and breastfeeding expertise in the UK health system is still not held in as high regard it is in some other countries. Many people within the NHS and private sectors call themselves breastfeeding consultants or specialists but do not have the IBCLC credential. IBCLCs are regulated by the International Board of Lactation Consultant Examiners (IBLCE) and have to follow a strict code of conduct. You can check that the person supporting you is an IBCLC on the IBLCE register at this link https://iblce.org/public-registry/

As an IBCLC we can offer parents antenatal consultations to prepare for breastfeeding and early parenthood as well as support with feeding after the birth. Please get in touch to discuss an individualised package of antenatal education.

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 feeding at the breast or with the bottle. 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 of a Tongue Tie video courtesy of Sarah Oakley

https://youtu.be/hZCQhr6Csos

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.

The video clip shows part of an assessment for tongue-tie.

• Sore/damaged nipples
• Nipples which look misshapen or blanched after feeds
• Mastitis
• 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)

CQC