Tongue-tie division (Frenulotomy)

I'm shocked & saddened to hear that parents are still occasionally being told by healthcare professionals that their baby's tongue-tie is 'cosmetic' or that it's 'cruel to cut it' ! Often they are simply told that there is 'nothing wrong'... often without so much as their baby being examined.

A really severe tie will definitely and absolutely prevent a baby from latching and breastfeeding (as in the case in the video, below). Less severe ties will make what should be a pleasant, bonding experience in to a toe-curling torture of bleeding nipples, long, frequent feeds with windy/colicky babies that can drop down the weight centiles. The paradox in the NHS is that if a Mum has to abandon breastfeeding due to the severity of her baby's tongue-tie... then they won't offer to divide it... as it's only done for breastfed babies !! The sooner it's done, the better. It's a myth that you should wait a minimum of X days (or weeks) before division. I've done around 4500 of these procedures over c 15 years and the youngest baby I've done was less than 24hrs old. The oldest was an exceptional 22mth old, though generally it becomes unpleasant for a baby over 18mths. I've also done an amazing 11yr old, who had difficulty eating (imagine that, at school!) and several adults.

We all naturally have a frenulum under our tongues and a 'normal' frenulum will be thin and stretchy and extend forwards to between 20 and 40% of the tongue's length. Of course the severity of tie can vary and it's not always a linear relationship - ie, very occasionally a tie right to the front of the tongue (100%) is really thin and stretchy & baby can latch and feed without problems. Much more common are the 'posterior' ties, which can't always be seen just by observation. These are only to, say, 50-60% but are thick, tight and restrictive and prevent the back of the tongue from moving normally when suckling. You can only really see these when gently popping fingers in, either side of the tongue & lifting it.

As part of my assessment of a baby, I will ask about the birth process and stats like gestation, weight, % weight drop (normal is between 0% and c 7%... often badly tied babies will lose 10%+).

I'll ask about the latch and feeding, be it breast, bottle or a combination of both and I'll explain that the risk of bleeding is generally very small, though 1 in 1000 babies in the UK are said to bleed heavily, potentially needing hospital back-up after a frenulotomy. I've never needed anything more than a feed (thankfully) though I do have special gauze (Kaltostat) and cauterising equipment as a back up in Cheltenham, if ever I need it (hopefully not!). I'll explain that I've never had any baby get worse in their feeding and none get infected. I'll also mention that there is a small (c 1 in 100) risk of scar tissue building up at the site ("re-attachment") which is typically noticed by breastfeeding mums at around 4 weeks and if present, can be re-cut.