Sharon Trotter is well known for her work on breastfeeding and neonatal skin care. She has a website (TIPS®) that involves parents in evaluating a range of commercial products for use with babies, and as part of this, she has also developed some information leaflets for parents. Over my time as editor of the Digest, one area that has really moved on in terms of clinical recognition and positive outcomes for breastfeeding is the management of a tongue-tie (Finigan 2009). Therefore, when I saw Sharon’s leaflet on this, I felt that it was important to make midwives aware of the accessibility of this for parents. The leaflet has been slightly adapted for reproduction in the Digest and the content is subject to copyright laws. It is written with parents in mind and therefore the style is based on plain English for a lay readership. In reproducing it here, in this format, it is hoped that this will raise awareness in health care professionals and advisors of what information appears to be needed by and will be of most use to parents. There is more information about Sharon and her website, following her advice on tongue-tie.
Finigan V (2009). ‘It’s on the tip of my tongue’: evaluation of a new frenulotomy service in Northern England. MIDIRS Midwifery Digest 19(3):395–400.
TIPS Ltd (2009). Available at: www.tipslimited.com
[back to top]
‘TIPS’ Toolkit for tongue-tie
Ankyloglossia (better known as tongue-tie) could be more common than you think.
Having personally referred three babies for treatment of their tongue-tie I am surprised at the lack of coordinated support and advice. In a bid to help parents who visit the TIPS website I have pulled together a short but informative toolkit which I hope will be equally useful for professionals. It will help to point you in the right direction regarding the best resources available.
The toolkit covers the following:
- What is tongue-tie?
- How will I know if my baby has tongue-tie?
- How is tongue-tie treated?
- Where can I go for treatment?
- How can I find out more?
[back to top]
What is tongue-tie?
Tongue-tie is also called ankyloglossia. When a baby has tongue-tie, the membrane which holds the tongue in place at the floor of the mouth (the frenulum) is thicker or shorter than normal. This condition is graded from 1 to 4 (grade 1 being the most severe). Tongue-tie is thought to affect around 5% of babies and may or may not cause problems, but it can interfere with the successful establishment of breastfeeding. It can also sometimes affect speech, development of the mouth and jaw and even kissing in the long term.
[back to top]
How will I know if my baby has tongue-tie?
You may notice that your baby’s tongue remains fixed or low at the bottom of their mouth. This is especially noticeable when your baby is crying. Their tongue may not move very much. You can see an example of tongue-tie in the pretreatment photograph.
There are other signs to look out for. Your baby may feed frequently, be unsettled, or not put on enough weight gain (despite constant feeding). You may get sore nipples (for no apparent reason) or notice a reduction in your milk supply (all due to poor attachment as a result of the tongue-tie). If this happens, you should speak to a health professional. They will be able to diagnose tongue-tie and arrange for treatment, if necessary.
[back to top]
How is tongue-tie treated?
Treatment is relatively simple: the tongue-tie is simply snipped (also known as a frenotomy). Your midwife, lactation consultant or health care professional will arrange treatment for you locally. This should only be carried out by a trained professional. Snipping the tongue-tie solves the problem instantly with few, if any, side-effects. Occasionally, the initial snip fails to cure the problem, and sometimes scar tissue can grow back making a second snip necessary.
[back to top
Where can I go for treatment?
(featuring examples of national and local centres of excellence)
Locations where tongue tie can be divided in the UK: (18 August 2008)www.babyfriendly.org.uk
List of private lactation consultants in the UK: www.lcgb.org
Chiltern BF partnership. Luci Lishman and Addy Henderson are both International Board Certified Lactation Consultants who also specialise in division of tongue-tie. For more information or to book a consultation call: 01844 273 416 (Phone and fax). www.chilternbreastfeeding.co.uk
[back to top]
How can I find out more?
The following websites give excellent information on tongue-tie:
National Institute for Health & Clinical Evidence Division of ankyloglossia (tongue-tie) for breastfeeding (December 2005). http://www.nice.org.uk/nicemedia/pdf/ip/1PG149guidance.pdf
[Accessed 2 February 2010].
UNICEF Baby Friendly Initiative guidance. (April 2006). Helping a baby with tongue-tie – information for parents.www.babyfriendly.org.uk
Tonguetie.net: The purpose of this website is to inform those with tongue-tie, as well as their families and professional helpers, about the condition and how best to deal with it. www.tonguetie.net
Lactation Consultants of Great Britain (LCGB): Tongue-tie and infant feeding leaflet available on the LCGB website containing updated information based on the original leaflet Breastfeeding and Tongue Tie, by Mary O’Shea (IBCLC) 1969–2008.
Kellymom.com : This website offers a great selection of resources on breastfeeding a baby with tongue-tie
Book - Tongue tie – from confusion to clarity: ankyloglossia. 88 pages. £39.95 (pbk). ISBN: 0646352547, Bollarong Press, Fernando C (1998). — This is the first book to
explore tongue-tie comprehensively. It explains that tongue-tie is real and proceeds to recommend an assessment method to judge the severity of the condition and to determine whether surgical intervention is warranted.
The book includes:
- a history of attitudes to the condition
- an explanation of the largely unrecognised effects of the condition
- an outline of the practical skills of diagnosis and management of the condition.
This book provides very helpful information for those with a tongue-tie, the parents of children with a tongue-tie and the many health professionals involved in the treatment of this condition.
Power-point presentation: Breastfeeding and frenulums by Brian Palmer DDS
— Internationally recognised researcher, has done extensive research on the cause and treatment involved with tongue-tie. He states:
‘It is falsely assumed that tight frenulums will go away by themselves and do not have consequences. There are NO MEDICAL OR DENTAL BENEFITS of having a tight lingual (under the tongue) or labial (lip side) frenulum. There are many major medical and dental consequences that result from tight frenulums. One of the first consequences is the impact on breastfeeding.’
For more information visit Brian Palmer’s website
Podcast: MIDIRS podcast by Rachel Hillan, infant feeding advisor at North Bristol Trust. In this podcast, Rachel Hillan talks mainly about the effects of tongue-tie in relation to breastfeeding. She also talks about how tongue-tie is treated, and how the condition can also affect cup feeding and weaning. To listen or download go to:
[back to top]
About Sharon and TIPS
I have worked with MIDIRS for a number of years. I am a midwife who is passionate about breastfeeding, alongside my other interest of looking into baby skin care and cord care. To this end I have spent years researching and writing about these subjects and have been published in professional journals. My proposed new guidelines on skin care are now policy in my local maternity unit with many other units following this lead. TIPS Ltd is now a stakeholder with the National Institute of Clinical Excellence whose recent postnatal care guidelines (NICE 2006) now recommend that cleansers and baby wipes no longer be used on newborn skin. My goal is to continue to spread the word to parents and health care professionals throughout the UK and beyond. In November 2008, I won the Dermatology award at the Nursing in Practice Inaugural Awards Ceremony in recognition for my work on baby skin care and especially the Baby care — back to basics™ leaflet which is now in its 6th edition. It was very encouraging to have such recognition as at the outset, getting attention for my work was not easy. My intention is to explore other subjects in the future with the aim that the outcomes from this will be easily accessible to parents and professionals. All my work is evidence-based and where possible fully referenced and I have a range of experts to call on when needed.
All my work is available to read online at www.tipslimited.com and here, on my professional website www.sharontrotter.org.uk
I decided something original and objective was needed to help parents find their way in the mass of commercial products available for baby care and infant feeding. I set up the TIPS Awards Scheme to mark out those products that parents considered met a high standard of ‘fitness-for-purpose’ as a product. The scheme was launched in 2007 to carry out independent market research into carefully sourced products within the baby and toddler market. While at first glance, it would seem such information is quite widely available, it is important to try to evaluate use and effectiveness based on independence of thought. The products are tested by highly motivated parent testers who have signed up voluntarily on the TIPS website.
The trials so far include:
Aquasolari bed pad, baby wipes, breast pads and treatments, baby skin care products, Bentley organic toy sanitizer, Dribblebuster bib, Ella’s Kitchen baby food, Miracle toys, TENS machines, open top cups, nursing bras and tops, Shampoo Rinse Cup, baby baths, cuddle towels, decongestants and thermometer soother.
Currently underway is the largest trial of baby skin care products (within eight categories) and the results will be published in the spring and will replace the 2007 trial. It is hoped to retest each standard trial every 2–3 years interspersed with one-off trials of products or services we believe offer something unique in the mother and baby market.
To find out more about how TIPS can enhance the information you offer women and parents in your care, please visit the websites, or email me
National Institute for Health and Clinical Excellence (2006). Routine postnatal care of women and their babies. London: NICE.
Trotter S (2010). TIPS Toolkit for Tongue tie. TIPS Ltd, Scotland
Trotter S. MIDIRS Midwifery Digest, vol 20, no 1, March 2010, pp 83-5
[back to top
Original article. © MIDIRS 2010.