Tongue Tie/Restriction Information

Tips for When Tongue Tie Is Suspected or Identified

The below information aims to help you improve latch, or find alternative ways to manage feeding your baby whilst protecting and building your breastmilk supply.

The information here is written for a generic audience, and all information may not be appropriate for you - please refer to your personalised plan and contact Heidi Hembry IBCLC if further clarification is needed.

Tongue Tie and Division Options

Not all babies with a tongue tie/restriction need a division, focus on good position and attachment is sometimes enough.
For those where a division may be helpful, there are NHS and Private options.
If you can wait, then NHS is a good, free option, with a clinical care environment and usually good follow-up support at the time of division and in the following weeks, and continuity of care and communication amongst your usual health care providers.
You can usually request an NHS referral through your Midwife, Health Visitor or GP. There is often a waiting list for NHS practice, however, this can give you time to practice and develop your latch and/or build your supply.
Private Practitioners obviously come with a fee, usually around £200+, but will often come to your home within 48 hours. This can be an excellent option if you have insurance or a budget to cover the fee and if feeding is too painful/challenging to wait.
There is great information for parents in the link below, and you can search for NHS and Private Practitioners by postcode too.
I never recommend anyone outright as it's important you choose who comes into your home, Samantha Tanak, Paula Herrero, Tara De Mezza, Erinn Winter, Lauren Wong are names that come up often. I do suggest that you choose someone who will be able to support you with breastfeeding - Tongue Tie Practitioners who are also midwives, nurses or IBCLCs are often better placed to do this than dentists and surgeons.
Tongue tie divisions are more likely to lead to successful breastfeeding when mums are making 75-100% of the milk volume their little one requires, so improving your milk supply ahead of the procedure can be really important if your supply is currently low.
It’s also preferable to be doing some at-breast-feeding, so if you have heavy reliance on bottles, consider using nipple shields as this will make the transition to breastfeeding easier for you and your baby post-division.

Association Of Tongue Tie Practitioners

https://www.tongue-tie.org.uk/

This is a good link that describes some of the tongue exercises, however, any stimulation that encourages baby’s jaw to open wide, tongue to protrude from their mouth, lateralise from side to side or lift up to the upper gum line, will develop a good range of motion

VIDEO: https://youtube.com/watch?v=JhOnRXH146w&feature=share

Encouraging Wider Gape/Tongue Extension/Suck Strength

The below exercises can be helpful both post and pre-division, however if feeding is significantly sub-optimal (pain, nipple damage, excessively frequent or long feeds, slow weight gain, heavy reliance on bottle feeds) and you have had support to improve breastfeeding, then delaying a division may not be adviseable

Babies love to mimic and love to get smiles from their parents
Tell baby what you want him/her to do and then show them yourself e.g. “Big mouth baby, aaaaahhhhh” and reward him/her when s/he does a wider than usual mouth.
Repeat this at every breast/bottle feed and only latch baby when a wider mouth is made
Expect some frustration, especially if baby is unlearning a developed skill of using a small mouth.
Play ‘wide mouth games’ during any restful awake phases. Make “bleurgh” noises with a wide mouth and tongue out.
Massage the lower gum, then encourage it to drop by pushing down firmly but gently, again, with a wide mouth yourself to encourage mimicking.
Reward any attempt at tongue protrusion or wider mouth with a big smile and “well done” - baby is more likely to repeat it again.
Allow baby to suck on your finger, pad side up. Gently turn it over and then stroke the tongue down and out of the mouth, again making that “bleurgh” noise and mouth to show baby what you want him to do.
Release jaw tension by doing some circular massage around the jaw hinge, then ‘smoosh’ cheeks to see kissing/fish lips and a widening jaw.
Repeat any exercise 2-4 or more times if baby is enjoying it and responding well. Games and exercises should be fun for both of you. If baby doesn't like it take a pause this time and try again later.
Repeat games/exercises before feeds and/or 3-4 times a day at awake times. You do not need to do all of them each time - choose the ones that seem a good fit for you and your baby, and mix them up a little for variety.
Please note, whilst I used gloves to demonstrate some of these techniques during the visit, you do not need to use gloves, though practising good hygiene is important.

https://balancedbreastfeeding.com/infant-suck-relearning/

Nipple Shields

Shields can be very helpful when used appropriately as a short-term intervention, though some families are able to use them for many weeks/months with no adverse effect on supply.
Having the right size shield for you and your baby is important. The majority of women will find a small or medium is a good fit. A few may benefit from a large siz, and a minority may need specialist fitting.
If baby is only feeding from a bottle, it can be more helpful to use a shield so that s/he gets used to being fed at the breast.
Shields give babies a similar feeding stimulus to the teat of a bottle, and they can mean it is easier for baby to maintain a latch, especially if s/he has tongue restrictions.
When working to increase supply or weight gain, it is best to offer both breasts at every feed, and even a 3rd and 4th breast (or more) if feeding still appears effective.
It is also a good plan to try to express after feeds if working to improve supply/eliminate formula. You may not get a large volume, but what you do get further increases your milk supply each time, and also makes a great fatty top-up
One shield can be used across both breasts through out a feed. The second shield of your pair can be used at the next feed.
As with expressing, although your shields need to be sterilised before first use, the can then simply be washed with hot soapy water in rinsed in hot water between uses. Many parents like to clean and sterilise once a day, storing the shields in the fridge between uses.