Expert Parenting Support for Every Step of Your Journey
Expert Parenting Support for Every Step of Your Journey
At The Natal Network, our approach to tongue tie division goes far beyond a tongue tie division (Frenulotomy). We provide holistic care that looks at your baby’s overall oral function, feeding, and development. This is not a quick cut appointment; the division is part of a broader 90-minute consultation designed to support functional feeding, with access to ongoing follow-up and support.
While tongue ties can impact feeding, they are rarely the only factor. Simply dividing the tongue tie may not resolve all feeding difficulties if other contributing factors are not addressed.
Our holistic assessment helps us see the bigger picture. Based on what we find, your baby’s care plan may include personalised strategies, home exercises, aftercare and referrals to other specialists such as physiotherapists, bodywork practitioners, or your GP.
If a tongue tie division is not clinically appropriate at this appointment, we can reschedule the procedure for a later date based on the reason it needs to be deferred. This rescheduled appointment is charged at the price of a follow-up consultation.
1-1 Tongue Tie and Oral Dysfunction Assessment and Diagnosis (10 minutes)
This appointment includes:
For more intensive and regular support following an Initial Consultation, Follow ups can be booked in blocks of 5 with a saving of £90
The term ‘tongue tie’ is used to describe the lingual frenulum underneath the tongue, when it anchors the tongue to the floor of the mouth, resulting in a restriction of normal tongue movement.
Before birth this piece of tissue is prominent in all babies, fortunately, in most cases this naturally recedes before birth. It is estimated that for 1-2 in 20 babies, this tissue remains prominent and restricting, which can cause it to be difficult for these babies to use their tongues.
True tongue ties are more than just the presence of tissue under the tongue, the diagnosis is based mainly on the function of the tongue. A suitably trained professional can carry out an assessment, this usually involves using a gloved finger to trigger certain tongue movements from the baby.
Tongue ties cannot be diagnosed nor ruled out based on appearance alone, this is only half of the story. There are however some common signs and symptoms that may lead you to access an assessment.
For the infant:
Pushing away breast or bottle.
Colic and reflux.
Unsettled baby.
Biting or chomping whilst feeding.
Feeding constantly.
Long pauses and fatigue between sucks.
Guzzling and choking.
Slow or static weight gain.
Weight loss.
Milk leaking from their mouth.
Clicking during a feed.
Arching of the back during or after feeds.
Open mouth when resting or asleep.
Sucking blisters.
Frequent night waking.
For the breastfeeding or chestfeeding parent:
Nipple Pain and trauma.
Blanching nipples (white- or purple-coloured nipples).
Lipstick-shaped nipples after breastfeeds.
Milk blebs.
Chronic blocked ducts or mastitis.
Low milk supply.
Engorgement.
Anxiety and/or postnatal depression
Oral dysfunction is a term used to describe the restricted movement of the tongue due to a variety of reasons.
Evidence suggests that many unnecessary procedures are conducted due to practitioners’ inability to diagnose and resolve alternative causes of oral dysfunction. There can be numerous reasons for oral dysfunction such as a receding jaw, low tone, high tone, muscle tension, torticollis, plagiocephaly, tension within the fascial system or tongue tie.
Jumping straight to a tongue tie release is not only unethical but may delay the correct course of treatment, for many, this delay could mean the premature end of a breastfeeding journey.
Only the tongue tie practitioner within the frenulotomy clinic is able to diagnose if there is a tongue tie, and whether it is deemed necessary for surgical intervention.
Having the knowledge and training to diagnose and perform a frenulotamy is not a regular occurrence for infant-related medical professionals, such as midwives, health visitors or paediatricians. It requires extensive specialised training to become a tongue tie practitioner.
We would always recommend seeing a practitioner who is a specialist in lactation support (IBCLC).
Some strategies that may help while you are waiting for a tongue tie release, or if you have decided against a tongue tie release can include:
Breast shaping.
‘Flipple’ technique.
Laid-back breastfeeding positioning
Paced bottle feeding.
Frequent smaller feeds for bottle-fed infants.
Sitting babies upright following feeds
Access, reliable advice and support to optimise positioning and attachment.
Soften breasts through hand expressing if engorged, before attempting to latch baby
Encourage tongue movement through exercises and games.
If unable to breastfeed directly maintain your milk supply by expressing at least 8 times in 24 hours, including during the night.
A frenulotomy is a simple and safe procedure usually carried out in a community clinic or your own home. It involves swaddling your baby, before using a pair of blunt-end scissors to release the tissue under the tongue. This is a quick procedure and you will be encouraged to remain with your baby throughout.
As with any surgical procedure you will be asked to review and sign a written consent form, this will be confirmed verbally prior to performing the tongue tie release. You can withdraw consent at any point.
By consenting to the procedure, you are acknowledging the potential risks outlined within the form, these include:
severe bleeding
infection
damage to surrounding structures
ulceration
pain
adapting to new mobility of the tongue
reoccurrence
no improvement or worse feeding outcomes
The chance of experiencing any of these risks is small and frenulotomies are considered a safe procedure with the very rare occurrence of complications.
It is expected that there will be little to no bleeding after your infant’s division and you will be asked to feed them immediately afterwards.
The act of feeding usually applies enough pressure to the wound to stem any bleeding that may have occurred.
In a small number of patients, estimated 1 in 400, It is also required to apply pressure using a sterile gauze for approximately 20 minutes. It is extremely rare for a patient to need any further intervention than this.
Infections are rare, if there is an active infection in your baby’s mouth, then the procedure will be delayed until the underlying infection has been treated. Further to this, there is added protection for breastfed babies, as breastmilk is known to be protective against infection.
There are no cases reported within literature of damage to the surrounding structure, it is however standard to include this risk with any surgical procedure.
Approximately 48 hours following the procedure there will be a white or yellow diamond-shaped wound under the tongue. This resembles an ulcer, as the moisture within the mouth prevents a scab from forming, taking approximately 14 days to heal. It can be easy to mistake this wound for an infection, especially if yellow patches become visible. Be reassured that these yellow patches are usually bilirubin and are a common occurrence within the healing process, it is not an indication of infection.
It is irresponsible to imply that this procedure is pain-free, however, the degree of pain experienced by babies appears to be like other postnatal procedures such as immunisations or heal pricks.
Interestingly, one study reported 18% of babies slept through the procedure, this can be accounted for by the lack of nerve ending located within the frenulum. Anaesthetic is not recommended as even local anaesthetic may impact feeding post-procedure. Babies over 3 months can be given liquid paracetamol, those younger than 3 months can consult with their GP prior to the appointment and obtain a prescription for pain relief, however medical pain relief is not generally necessary.
In rare cases, estimated 1 in 100 procedures, reoccurrence of a restricted frenulum occurs. To limit this risk the tongue must be encouraged to move, this can be done through feeding or the use of non-invasive oral exercises and games.
While many parents see improvements immediately, some babies require more support to use their newly-found tongue freedom. There are 8 muscles in your baby’s mouth, some will have been working hard to compensate for the restriction, which may have caused tension. Others may have been restricted and require time to build strength and tone. Ultimately it may take time and practice for your baby to learn the most effective way to feed, this is usually done before birth but in the case of a tongue-tied baby, this needs to be learnt following the tongue tie release.
We will only perform the procedure if you are able to commit to the recommended aftercare, this involves a mixture of oral exercises, bodywork and massage. This is crucial to optimise wound healing and reduce the risk of reattachment. This also helps to correct dysfunctional suckling skills your infant may be using, due to the potential restriction.
Unfortunately, we are unable to guarantee outcomes, as for many the release of a tongue tie is only the beginning of the solution. It may take time for improvements to be seen, understandably this may be disappointing for parents.
The evidence is clear that the best outcomes are seen when a release is performed alongside skilled infant feeding support. The Natal Network provides comprehensive follow-up care with practitioners, available for an additional fee.
Every tongue tie is anatomically different, we use an assessment tool which will give us the information on whether to offer a surgical division (if a resolution cannot be reached through conservative methods alone, such as positioning and attachment support, and oral exercises).
This is often seen in tongue ties that are made of the same tissue as the webbing between your fingers and as such do not ‘stretch’ over time.
What may happen is that as your baby grows (and there is more space within their mouth), you may not experience the same symptoms. Likewise, your baby may learn other ways of using their oral muscles to compensate for the restriction.
It is understandable that lip ties are a concern for many parents, they are easily visible and mentioned frequently on parenting forums. Within the UK we do not currently support the division on lip ties for the purpose of improving breastfeeding symptoms.
The rationale behind this is that, unlike the bottom lip, the top lip remains in a neutral position during feeds. When a baby’s top lip flanges (often described as fish lips), they may be attempting to cling to the breast, indicating a shallow latch. You may also notice sucking blisters along the top lip as a sign your baby is compensating for a shallow latch.
If we released the frenulum along the top lip, your baby will be able to compensate for a shallow latch better with the ability to cling to the breast. However, this will not treat the primary cause of the shallow latch.
The Association of Tongue Tie Practitioners (ATTP)’s statement on lip ties can be accessed here ATP Position Statements – Lip tie (2014) and Disruptive Wound Management (2021) – Association of Tongue-tie Practitioners
There is no evidence to support releasing tongue ties preventatively for speech or dental issues. If problems arise later, NHS referrals can be made for children over 5, following input from speech therapists.
Some families may experience a recurrence of symptoms between week 1 and 3 post-procedure. There are a couple of reasons for this. Firstly, fibrous tissue will start to form in the wound around this time, this is a natural part of the healing process. However, because this tissue is not as flexible, there can be a relapse in symptoms. Encouraging your baby to lift their tongue through gentle post-procedural exercises or games and regular feeding, will promote the wound to heal vertically. This is the optimal position to maximise tongue function. Over time this tissue will become smoother and softer.
Another common reason for relapse in symptoms is oral muscle fatigue. As with all muscles, we must regularly move them to build strength and tone. For babies who have had their muscle movements restricted by a tongue tie, it will take time for this to happen. Much like going to the gym, the more you commit the stronger you become, a few aches and pains are to be expected along the way. This fatigue should resolve as the muscles build strength and the movement becomes easier.
It can take time to re-educate a muscle to move in a different way than it is used to. Your baby’s oral muscles have learnt compensatory methods of suckling and despite having had a tongue tie release, they will not yet have the muscle memory with how to use the tongue without the restriction. Regular feeding and engagement with post-procedural exercises will help re-educate your baby’s suckling skills. These skills are useful throughout your feeding journey, as any changes within your baby’s mouth, such as teething and colds, may prompt them to use old compensatory methods of suckling.
It is possible that restricted tongue movements (caused by a tongue tie) may impair a child’s ability to move food around their mouth, swallow, and chew. This may become evident once a child has started solids at 6 months of age. Symptoms may include gagging and food refusal.
We advocate the use of regular feeding and gentle oral exercises or games, alongside bodywork and fascial unwinding technique. This is based on scientific knowledge looking at muscle rehabilitation, fascial tension release and wound care. We aim to use your baby’s natural reflexes to encourage tongue movement to build tone, strength and re-educating their neuromuscular pathways.
We encourage parents to be led by their baby and only continue if their baby is enjoying the exercises. We work to resolve tension within the muscular or fascial systems prior to performing a tongue tie division, which gives us the best opportunity to maximise positive outcomes and optimise wound healing.
It may be necessary to rebook an appointment for a tongue tie release at a later date to allow time for any tension to resolve. Whilst we understand that this could be disappointing, it is necessary in some cases as releasing the tongue tie will not improve function if the muscles are constricted.
All our care plans are based on years of expertise, and most families see excellent results. But we can’t guarantee them. Results will mainly rely on your own commitment, but we do offer extensive open-access support to help you. If you’re struggling, consider our optional follow-up appointments (additional fee applies).
For most families we support, acute feeding challenges have become an emergency, and understandably your main concern about delaying surgery is ‘how do I feed my baby?’. We would recommend delaying treatment only if it is in the best interest of you and your infant to have the best chance at positive long-term outcomes.
Thankfully, muscular tension (which is negatively impacting oral function and infant feeding), responds well to the bodywork undertaken in the clinic, so we commonly see improvements in both oral function and infant feeding symptoms during the initial appointment. We also ensure you leave the clinic with a feeding plan that is manageable for your family and options to book follow up appointment (at an additional fee), that doesn’t leave you unsupported for a long period of time.
Feeding will only improve with the correct treatment plan for each individual infant.