Checking for tongue tie?

[ItsAllGoingToBeFine]

I was going to ask in my birth plan for the baby to be checked for tongue tie, with the implication that if it was the frenulum was to be snipped.

I asked in my antenatal class today to find out if this was something that they routinely did anyway (hence could maybe leave it out of birth plan).

The midwife first of all (after looking vaguely stunned) said that the consultant would check for cleft palate/lip (is this related?), but wouldn't check for tongue tie as there were different opinions on it.

I thought the different opinions were

1. tongue tie doesn't cause any real issues, either with breastfeeding or speech development. The baby will grow out of it.

2. tongue tie can cause issues with breastfeeding and speech development, but that fixing it straight after birth is an incredibly minor operation with minimal (no?) risk to child.

If this is the case I can see no reason not to have it checked and fixed if necessary - worse case scenario seems to be that your baby would have an unnecessary operation because it would have grown out of the tongue tie anyway. Seems to be a win win to me?

Opinions please?

My son was born last January - away from home and early so I was completely unprepared. I had no hospital bag or notes with me and didn't expect things to move so quickly.

Anyway - he came along happy and healthy, but wouldn't feed in the hospital. Normal procedure is to let Mum and baby go home after seeing the baby feed well so I had to really work hard to let us go home - as he wasn't feeding but I was desperate to get nearer home.

I knew breast feeding was hard work and was sure it would happen in the next few )more relaxed hours) at home). Anyway - he lost a lot of weight and it wasn't until about day 3 when a new (and wonderful!) midwife came out and immediately realised he was severely tongue tied. Which explained why he couldn't feed at all and why I was getting such bad blood blisters.

Anyway - we had to wait 15 days to get a referral to Southampton hospital who performed what is a relatively minor procedure and did allow him to breastfeed finally. But not after a lot more heartache teaching him how to do it at 2 weeks old.

Still, I don't regret having it done - he happily breastfed until 9 months old and can now poke his tongue out at Mummy.

The procedure itself is relatively minor - a very quick snip with some scissors - I think DS1 was away from me for a total of about 90 seconds. Its also still quite upsetting for all concerned - such a tiny baby, there was blood in our case, and a lot of crying and at least 48 hours of a very sad baby afterwards. Which they don't tell you about at the hospital - only the 'positives'. Its also not something they would correct at birth - most midwives aren't legally allowed to perform the procedure (even if they're qualified to do it) and so you would have to get the hospital referral. My doctor was sceptical as to whether or not it was something that would correct itself or not, but she was wrong - he lost 12% of his body weight and we were desperate. It sorted things for us.

We were also told that its not necessarily something they grow out of. And it could affect speech in later life but they couldn't confirm this so it became a gamble.

I guess what I am saying is that I saw 4 BF specialists in the hospital before they let me go home - none of whom picked up on his very severe tongue tie. Neither did the doctor who did our day home visit or the next 2 midwifes.

It is something I would recognise again immediately - a very white scar like tissue under the tongue. Its actually quite easy to tell because a small baby when they cry (loudly) would usually life their tongue up - and he didn't. It stayed stuck flat to the base of his mouth. He also couldn't breastfeed at all, had a VERY stiff jaw, and you could feel it if you massaged under his tongue.

I don't think its something people routinely check for, in fact it is something that some professionals didn't recognise. So - I would check yourself. If you have no problems breastfeeding them chances are its not an issue, but it would be something to raise at day 3/4 if things aren't getting any better.

Oh, and he wouldn't take a bottle or a dummy either - his tongue was so rigid it just pushed them out - so they're more signs to check for.

Hope this helps?
Have you had experience of tongue-ties before or are you just being extra-cautious?

P.S. I'm due no2 in May and won't be relying on any 'specialists' to help me diagnose if this one has a tongue tie - I'll check myself and then arranged the referral to Southampton.

The problem is that some babies feed beautifully with it, and there's a 1:1000 risk of infection. So it makes more sense to wait for a day or so to see if there's a problem, rather than routinely snip, because if your baby got an infection and didn't need the op at all, you'd have every right to be mightily peeved.

But you aren't supposed to leave hospital if a bf mum unless and until the baby has latched, so if yours IS tt and can't feed, it's as well to insist they follow the NICE guidelines and perform the procedure BEFORE you go as your baby is an in-patient, and thus a priority. If you let them discharge you with falsified papers and a handful of syringes to express with, you might find you're at the end of a 6 week outpatients waiting list for the snip, and need to buy a breastpump asap.

Yes, I do speak from bitter experience.

I am a speech and language therapist and it is incredibly rare to have a tongue tie interfere with speech development (it would have to be extremely severe) - however, when ds had a very minor tongue tie I still insisted on having it snipped as feeding really, really hurt me. As soon as it was snipped, I enjoyed feeding a lot more. I read that up to 85% of tongue tied infants have some issues with feeding, often related to poor milk transfer/maternal pain and that it is not necessarily related to the severity of the tie.

And the biggest long term impact of tongue tie? Apparently, being a sloshy kisser. Not something the NHS care about for the average infant, but not something I would want for my poor boy when he's grown either! The snip takes about 5 secs when they are little - my widget slept through his, no anaesthetic or anything.

Huh? Consultant? What consultant? (assuming your are NHS led and not anticipating being high risk?)

DDs2 and 3 both had tongue ties. DD2 very severely but I STILL had to push to have it snipped (went private in the end, not extortion, money well spent) DD3 also had tongue tie (we were very aware of possibility) and we had it done again on the NHS. THat time I was MUCH more assertive to GP and pretty much demanded referral. I'm not taking any more BS from GPs ever again.

my first 2 were tongue tied, so when ds3 was born i just asked the midwives to check him.

Seems reasonable to ask for tongue tie to be checked, but mw or hv can do it.

Well worth having snipped if it is done properly. My 3yo had his snipped at 6 weeks old but it wasn't done properly. He now has to have it done under general anaesthetic which is a much bigger deal. It hasn't affected his language or speech development but he dribbles when he says certain sounds, snores very loudly, and it has affected his eating (can't lick ice cream, can't clear yoghurt from round his mouth, and may well be the reason he is such a dreadfully picky eater).

oh...
not very encouraging to hear that some of you have had more than one experience of this.

i was desperately hoping no.2 might not have this problem, but looks like i may have to consider the possibility...

I had dd in January, and the midwife looking after us noticed Isabelle was having to work quite hard to suck when bf'ing, so she checked her for tongue tie. Turns out she did have a slight tongue tie, and luckily for us the midwife was one of 2 in the area that can perform a frenulotomy. She explained everything to us, told us that they can't perform the frenulotomy on the basis of it may affect speech later in life, they can only do it if it's affecting breastfeeding. Although dd's TT was very slight, we decided to go for it, as we felt we'd rather just get it done while it would be simple than maybe face painful bf'ing, and possibly an operation under GA if it created further problems in the future. DD was less than a day old when the procedure was done, DP held her head while it was done & it took a couple of seconds, and she fed straight away afterwards.
Looks like I was lucky though, having a mw who could do it there & then, she did mention that people had to travel to that hospital to see her/the other mw from quite a distance away.

My son was born and it was spotted immediately that he had tongue tie. He didn't seem to have problems feeding but when we got home after 3 days, I realised how much wind he took in feeding and he cried and cried and in the end I went to the GP and got a referral back to hospital. I held him whilst they snipped it quick. He did cry, there was a little blood but he fed much much better from me after.

I'm not sorry I got it done personally. Wish it was easier to get it done when you first had them though.

Even though DD3's t/t was MUCH less severe than DD2's, I was very surprised at how much easier bf was after it was snipped. Why do they make it so hard to get done?

Completely different - our experience seemed to be a struggle from start to finish.

I ended up having to feed DS every hour and a half with a syringe as it was the only way he could take it before anyone helped us out. He went from 8lbs 1/2oz to 7lbs 2oz in 3 days and still no-one realised what was wrong with him.

The referral to the hospital then got lost, when it was finally diagnosed, (someone left it on the laminator!) and the secretary wouldn't talk to us until it was in front of her. Meanwhile it felt like my son was starving and there was nothing I could do.

I had hoped hoped hoped that there was little chance of no.2 having it but seeing what other people have written on here it seems as if its something I should consider. It reduced me to tears last night - it was the hardest few weeks of my life.

newmomma your story sounds terrible. As you said in your first post though, you'll check yourself and then arrange the referral to Southampton. Have you spoken to your MW about your fears, in case she has an idea on how to make sure you don't experience the same twice and it's easier to get it dealt with?

No, I hadn't but I think that's probably a good idea. The midwife I saw throughout my pregnancy last time was signed off sick when I had DS1 so she didn't know anything about it - perhaps I'll mention it on my next appt in a few weeks, as its the same midwife this time round.

I think I have heard something in the past that suggested different pcts treated in different ways.
DD1 (now 3 weeks old) couldnt latch on/feed - however her tongue tie wasnt spotted until she was 8 days old at home. She is due to have the snip this week. It has caused great problems with feeding (most of the bottle goes down her front not in her!) and she is not making great progress on gaining weight - 1 oz in the last week :-(

I wish it had been spotted sooner and I would then have breastfed by choice. I will be more assertive next time!

Sillysow have you been expressing instead? You may still be able to breast feed after the procedure. Its not too late if there's still milk there.

La Leche have a free helpline and if you called them they could help you. Or dropping into a BF clinic locally. Your HV or MW would know where they are.

Or am I barking up the wrong tree?

Kellymom has such helpful advice too: weblink

"But you aren't supposed to leave hospital if a bf mum unless and until the baby has latched, so if yours IS tt and can't feed, it's as well to insist they follow the NICE guidelines and perform the procedure BEFORE you go as your baby is an in-patient, and thus a priority"

Cnfuzled thats amazing! What a good thing to know! I am tongue tied and my DS is too, although only mildly. I did suffer hideously painful cracks but they went as he got bigger. But what a great thing to be able to say to them. thanks!

I'm a SALT too but with adults.
Sometimes get referrals to see adults with tongue tie.

Main problem is oral hygiene. Can't use the tongue like someone without tongue tie to fish food debris out from around the gums after eating, or wash acid neutralising saliva round the teeth to help prevent decay.

People can end up with gum disease and rotting teeth, can be severe. I've seen it more in males than females and obviously some people are stringent with oral hygiene and won't experience this at all.

SK

my ds1 was tt, bf agony, much better after the snip but again really had to fight for it.

ds2 not tt. newmomma, so it's not inevitable, and it's more common in boys so if you have a dd it is less likely.

i'm now due dc3 soon, and wondering about what strategy to take if he/she is tt. Even wating 2 weeks for an urgent referral is a looong time when you are in that much pain and baby is feeding constantly.

i'm not sure the figure of 1:1000 risk of infection is accurate actually, i haven't read any papers with that statistic. one said 2 babies had an ulcer under the tongue, but i think the procedure has such a low risk and the benefits of continued bf so important that it really should be easier to get sorted out.

The mw noticed my dd was tt at birth, and I had a terrible time establishing bf, 13 weeks of blood, sweat and tears (mostly mine) Yet she still wasn't refered, no-one said it could be her tt?
When ds was born, I noticed right away he was tt, and had same issues with bf, I asked gp to refer and ds had it snipped in outpatients clinic,at 5 weeks old it took approx 10 seconds and he wasn't bothered one bit. Bf improved immediately.
I have since asked to be refered for dd who is now 3, as she couldn't stick her tongue out, spit (hot food,she has has burned her mouth),toothpaste or even lick her lips or an ice cream! She did have to go in as a day patient, more upsetting for me than her it seemed. I wish I had pushed to be refered when she was an infant.
I would definately get a referal, if bub is tt.
Good Luck

my dh is a community dentist trained to do this procedure so will definately ask him to do it on baby 3 if necessary - will just ask midwife to go out room if they won't do it! He sees lots of tiny babies eg 1-3 days old who come in on way home from hospital or within a couple of days of discharge. He claims the babies rarely cry and mums report much better feeding. Thinki it is much better to have it done as early as possible.