What is Tongue-tie?
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Tongue-tie (ankyloglossia) is a condition in which the thin piece of skin under the baby's tongue (the lingual frenulum) is abnormally short and may restrict the movement of the tongue tip. Sometimes tongue-tie causes no problems at all and requires no action. Tongue-tie can interfere with a baby's ability to suckle efficiently at the breast. This may lead to nipple pain and trauma, poor breastmilk intake and a decrease in milk supply over time.
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The decision to release a tongue-tie often depends on a clinician's belief about the possible impact on feeding. Currently, clinicians are divided in opinion, which can lead to confusion for parents. Clinicians who work with breastfeeding mothers and babies will base their decision on management, following assessment of the baby's mouth, breastfeeding and maternal comfort. If breastfeeding is painful, there is poor milk transfer and there is a significant tongue-tie, then release has been found to improve the baby's ability to breastfeed.
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Tongue-tie is more commonly found in boys (60%) and there will often be other family members who have had this problem. The most immediate impact of tongue-tie is on the baby's ability to breastfeed effectively. There may be an affect on ongoing oral hygiene. The effect of tongue-tie on speech development remains controversial.
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Indications of a significant tongue-tie
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- a misshapen nipple after breastfeeding
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- a compression / stripe mark on the nipple after breastfeeding
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- the baby often loses suction whist feeding and sucks in air
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- a clicking sound may be heard whilst the baby is feeding
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- the baby fails to gain weight
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- tongue cannot protrude beyond the baby's lips
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- tongue cannot be moved sideways
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- tongue tip may be notched or heart-shaped
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- when the tongue is extended, the tongue tip may look flat or square instead of pointed.
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Assessment
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A lactation consultant or experienced clinician will conduct a thorough assessment of breastfeeding and infant tongue mobility to determine whether release is required.
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If the frenulum is thin and the baby is less than four months of age, the frenulum can be released as an outpatient procedure without any anaesthesia. A baby who is older than four months of age or one whose frenulum is thick, will usually be referred to a specialist.
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Tongue-tie release
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The release of a tongue-tie involves the clinician placing a finger and thumb under the baby's tongue to gain clear access to the frenulum. The frenulum is released with a small pair of sterile scissors.
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A drop or two of blood at the release site is normal and is rarely a problem. Many babies may actually sleep through the procedure whilst others may be unhappy at being held still and having fingers placed in their mouth. Occasionally an infant will startle when the release is performed but will settle quickly once comforted.
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Following the procedure, the infant will be returned to the mother for feeding. The feed will be assessed by both the mother and the clinician.
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Possible complications of the procedure are bleeding or infection, but the incidence of these occurring are extremely rare. There is no specific aftercare required. Occasionally, during the healing process a small white patch may be seen under the tongue of some infants, this is normal and should resolve within two weeks of the release. If you have any concerns following the procedure, please contact your lactation consultant, maternal and child health nurse, paediatrician or your general practitioner.
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Where to get more information or advice
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Breastfeeding Service
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Royal Women's Hospital
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Level 4, Cnr Grattan St & Flemington Rd
Parkville VIC 3052
Tel: (03) 8345 2400
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Australian Breastfeeding Association
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Tel: 1800 mum 2 mum (1800 686 2 686) Breastfeeding Helpline
Web: http://www.breastfeeding.asn.au
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Maternal & Child Health Line (24 hours)
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Tel: 13 22 29
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Tongue-tie: Information for families (video & DVD)
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Available for purchase from RCH Shop Online
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References
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Academy of Breastfeeding Medicine Clinical Protocol #11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. http://www.bfmed.org/protocols
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Ballard JL et al. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002. 110 (5): e63
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Better Health Channel. http://www.betterhealth.vic.gov.au
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Grif.ths DM. Do tongue ties affect breastfeeding? J. Hum Lact 2004; 20(4): 409 - 414
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Hogan M, Westcott C, Grif.ths DM. A randomised controlled trial of division of tongue-tie in infants with feeding problems. Arch Dis Child 2004; 89 (Suppl 1): A5
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Lalakea ML, Messner AH. Ankyloglossia: does it matter? Pediatr Clin North Am 2003; 50(2):381-97.
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UNICEF UK Baby Friendly Initiative. Tongue tie: Information for parents. http://www.babyfriendly.org.uk/page.asp?page=152
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Last updated Jan 2008
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