A frenulum is a piece of tissue in the baby’s mouth attaching the underside of the tongue to the floor of the mouth. They occur elsewhere in the mouth and body, but this one is called the lingual frenulum.
It's usually loose enough to allow the tongue to move freely, but some babies are born with a tight attachment. This can restrict movement of the tongue, and is graded according to severity. This can have a knock-on effect on a good latch and good feeding, and later on with speech, if very tight and left uncorrected. A minor surgical operation is sometimes recommended to release the frenulum and this corrects the tongue-tie.
You may notice that your baby doesn’t bottle feed or breastfeed as well as you would expect. For breastfeeding mums, you may notice a few signs: that baby is refusing the breast or has difficulty latching on to the breast, baby may be coming off the breast or slipping onto the nipple frequently. Baby may appear more unsettled during meal times or make unusual noises while feeding. They may be more colicky, windy or suffer reflux symptoms, if they are swallowing lots of air during each feed. Our paediatrician has some tips.
As a breastfeeding mother you may notice that the whole process is quite difficult and more challenging. They might take much longer on the breast and require more frequent feeds. You may suffer the pain of mastitis, sore nipples and breast pain during feeding or even a reduced milk supply due to ineffective latch.
In bottle fed babies you may notice that baby refuses the bottle, pushing the teat away often. They may struggle with teats with a fast flow, therefore requiring feeds more often but in a smaller volume. They may also dribble a lot or choke on feeds.
All of these may affect your baby’s ability to put on weight or cause them to lose weight quickly.
Tongue-tie can be noticed in older babies too, finding solids difficult when it comes to weaning or difficulty articulating certain speech sounds.
Check to see if your baby can pull out their tongue fully. If they can’t, or the end has a heart-shaped fold, or they look like they are unable to move their tongue freely from side to side, then tongue-tie might be present.
It’s not always the easiest thing to diagnose. So if you’re experiencing feeding difficulties and can’t see anything obviously wrong in the mouth, do seek expert help from a tongue-tie specialist. Your health visitor or GP may be able to refer you to them, but you can also contact them privately.
The decision to treat your baby's tongue-tie depends mainly on how well you and your baby are coping. If you decide to go ahead with treatment, your baby can have a releasing procedure, which cuts the frenulum, allowing free movement of the tongue.
The procedure is very quick and easy and relatively painless, it’s done within minutes and baby is awake throughout. Most people find the procedure improves their babies' feeding difficulties straight away, but there are no absolute guarantees and it doesn’t work for everyone.
If you don't want to undertake a procedure, then addressing other areas such as baby’s latch, positioning, as well as utilising breastfeeding supports like nipple shields, can all be tried first.
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