Frequently Asked Questions
What is a Lactation consultant?
International Board-Certified Lactation Consultants (IBCLC) are professionals with extensive experience and in-depth knowledge in supporting breastfeeding families. It is the highest recognised qualification in breastfeeding.
To be eligible to enter the exam, practitioners must have completed a set number of breastfeeding support hours.
Qualification is via a 4-hour degree level examination. IBCLCs are required to re-certify every 5 years and to re-sit the exam every 10 years. This is to ensure knowledge is kept up to date. IBCLC’s come from a variety of backgrounds in medicine, nursing, midwifery and breastfeeding counselling.
The exam includes the following areas related to lactation: anatomy and physiology, endocrinology, biochemistry, nutrition, immunology and infectious disease, pathology, pharmacology, psychology, sociology, anthropology, research and ethics.
Lactation Consultants have specialist skills to support families with the more complex issues such as sucking problems, poor weight gain and low milk supply, tongue-tie, prematurity, twins and multiples, sick babies and those with special needs and cleft palate.
What is tongue-tie?
Tongue-Tie is a condition which presents itself at birth and can restrict the tongue’s range of motion. Underneath the tongue you can see a string of tissue that attaches the tongue to the floor of the mouth, this piece of tissue is called the lingual frenulum. If the lingual frenulum is too short, it can cause restricted movement or mean that your baby may have problems feeding.
Some tongue-ties are easily visible and easy to diagnose as you can see the frenulum joined to the tip of the tongue, which looks heart-shaped when the baby tries to extend their tongue, but the frenulum can be joined anywhere along the underside of the tongue which can be difficult to see without a careful examination from a trained professional.
If you and your baby are finding breastfeeding difficult, you can ask your midwife to check for tongue-tie.
Breastfeeding is not always easy. So, difficulties may have nothing to do with tongue-tie, in which case your midwife or lactation consultant should still be able to help you and your baby with feeding.
How does a tongue-tie affect feeding?
Babies with tongue tie struggle to open their mouths wide enough to latch onto the breast effectively. Once on the breast the tongue needs to perform several important functions to effectively remove milk. The tongue cups the breast and stabilizes it in the mouth, forming a vacuum. It then moves in a wave like motion to create the negative pressure that is needed to extract milk efficiently. The baby needs to be able to maintain this action throughout the feed. A baby with a restrictive tongue tie can experience a variety of symptoms since they are unable to use their tongue in this efficient manner when breastfeeding.
Bottle feed babies can also struggle to effectively feed. The tongue needs to be able to create a vacuum around the teat. Although many tongue tied babies find it easier to bottle feed, some however, still experience difficulties.
Not all babies with a tongue tie struggle to feed. If the frenulum is stretchy then the tongue may be able to move in the normal way. Feeding problems can occur for a variety of reasons and therefore oral and feeding assessment by a trained healthcare professional is useful to establish if tongue tie division may be useful.
What are the main signs and symptoms of tongue-tie?
- Persistent very sore or damaged nipples
- Compressed nipples and/or blanching after feeding
- Low milk supply
- Milk blisters on nipples
- Needing to use a nipple shield
- Discomfort while feeding
- Plugged ducts
- Sleep deprivation (Because baby is not able to feed efficiently, they compensate by feeding more often, leading to frequent night feedings.)
- Difficulty establishing breastfeeding or baby refuses to latch.
- Difficulty maintaining attachment at the breast.
- Frequent or constant feeding.
- Baby doesn’t seem satisfied after a breastfeed
- Excessive weight loss, static weight or slow weight gain
- Baby falling asleep before feed complete.
- Cannot maintain a seal at the breast or bottle and dribbling milk.
- Clicking sound when feeding.
- Frequent hiccups
- Baby rarely or never settles to a deep restful sleep
- Sucking blister on upper lip
- Disorganised suck/swallow pattern
- Weak suck
- Oral aversion
- Unable to open mouth widely
- Unable to stick out tongue
- Excessive drooling
- Doesn’t lift tongue when crying.
How do I know if my baby has a tongue-tie?
- Your baby may have been seen by a health care professional who has diagnosed the tongue tie.
- You may be able to see a frenulum under your baby’s tongue when the baby lifts its tongue up.
- You and your baby may be experiencing symptoms of tongue-tie, but health professionals have said that the baby does not have a tongue tie. This can be very confusing. Often in this situation the baby has a posterior tongue tie. This means that the frenulum is right at the back of the tongue. Posterior tongue ties can be just as troublesome as the easier to spot anterior tongue ties, that come right to the tip of the tongue. Finding a practitioner with specific knowledge on posterior tongue ties is essential in getting the correct diagnosis and treatment in this situation. Not all health care professionals and tongue tie practitioners are trained to diagnose and understand the impact of posterior tongue ties, hence why you have received conflicting advice.
- Your baby has already had a tongue tie division, despite an initial improvement in symptoms, symptoms have returned. No one knows why this happens sometimes. It is thought that rarely the tongue tie can re-attach or that once the tie is released more tongue tie comes forward. Occasionally the tongue tie is not fully released at the time of division.
How is tongue-tie treated?
When you arrive at the clinic we will listen carefully to your concerns and assess the difficulties that are causing the feeding problems. With your consent we will assess the way that your baby moves its tongue, the appearance of the baby’s tongue and the way that your baby is feeding. Once these assessments are complete, we will thoroughly discuss the findings with you, so that you can make an informed decision regarding the best course of treatment for your baby.
We may find that the baby’s tongue tie is not causing the feeding difficulties, likewise there may not be a tongue tie or you may not wish to have the tongue tie to be cut. In these situations, we will provide you further feeding assistance and support to help you overcome the challenges that you are experiencing in alternative ways.
If a tongue tie division is indicated, then we can continue to do the procedure at your consultation. It is a very quick procedure and you can choose if you wish to stay with your baby or step out of the room for a few moments. The baby will be wrapped in a blanket or towel to keep them still. They are placed on a bed and a light will be used to look inside the baby’s mouth. Blunt ended scissors are used to cut the tongue tie. Most babies cry for less than one minute after the procedure and baby will be returned to you straight away for a breast or bottle feed.
What are the risks of a Frenulotomy (Division of the tongue-tie)?
Frenulotomy is a very effective treatment for tongue-tie related feeding problems and the occurrence of risks are minimal. Below are the known potential risks. Please keep in mind that all of these risks are unlikely to occur, and the majority almost never occur.
Pain during the procedure:
It is difficult to assess how much pain, if any is felt during the procedure. Studies have shown that babies usually cry for less than a minute after the procedure. Adults that have undergone frenulotomy without anaesthetic report a ‘pinching’ sensation but no pain. Other studies have shown that there is no difference in crying when local anaesthetic is used compared to when no local anaesthetic is used.
Pain after the procedure:
The majority of babies don’t display any signs of pain or discomfort after the procedure. Some babies are more unsettled than usual for 24-48 hours. Paracetamol can be given if needed. If the baby is under 8 weeks old this will need to be prescribed by the GP.
There is usually only a small amount of bleeding following frenulotomy, which settles quickly when the baby feeds following the procedure. If bleeding is heavier the tongue-tie practitioner will apply pressure on the wound until it stops bleeding. In extremely rare situations transfer to hospital may be needed to stop the bleeding.
A wound is created so there is a small risk of infection. Fortunately, saliva and breastmilk contain antibacterial properties which minimise the infection risk. Less than 1:10,000 babies undergoing frenulotomy will develop an infection. It is important that if your baby becomes unwell after frenulotomy that you contact your GP.
The risk of reformation is thought to be less than 5% You may notice that your baby’s feeding improves, then troublesome symptoms reappear. If you are concerned that the tongue-tie has reformed, then please contact us for a reassessment appointment.
Potential relearning of positioning and attachment:
Some babies show an immediate improvement when feeding following frenulotomy. Other babies don’t show any improvement at first then gradually improve as they get used to using their tongue effectively. A small minority of babies find it difficult to feed at first with their new tongue moving abilities, they have to re-learn how to feed. This requires patience and practice, lots of feeding opportunities and skin-to-skin contact will help.
Damage to the surrounding structures:
This is a very rare complication. A cut will be made under the tongue by a trained tongue tie practitioner. Other structures are in close proximity to the area of the cut. Every effort is made to ensure that these structures are avoided, however, for you to give your informed consent to the procedure we have a duty to make you aware that this is a risk, even though it is very unlikely to occur.
How much does an appointment cost?
Lactation Consultation with Tongue Tie Division Visit:
Lactation Consultation Only Visit:
£150 – up to an hour
£75 for a follow up consultation
If Tongue Tie division is booked following on from a lactation consultation:
NB: Travel costs may apply dependent on geographical areas covered. These costs will be agreed with the Practitioner in advance.
What is your cancellation process?
Please see our cancellation policy here.
What if I want to make a complaint?
Please see our complaints procedure here.
If you wish to talk to someone outside of the organisation who is not directly involved in your care, or if you are dissatisfied with the response from My Midwife & Me there are a number of options available. These include:
Health Service Ombudsman:
Health Watch, England:
Telephone: 03000 683 000