Paediatric (cranial) osteopathy

If a baby has a tongue-tie that restricts their ability to feed effectively, it can cause the following problems: For the mother – painful feeding, damaged nipples, poor drainage of the breast leading to engorgement or mastitis, difficulty establishing and maintaining an adequate milk supply, resulting exhaustion, and early cessation of breastfeeding. For the baby – difficulty getting and sustaining a deep attachment to the breast or bottle, frequent or very long feeds, weight gain concerns, difficulty controlling the flow of the milk leading to dribbling and choking easily, reflux, noisy feeding and wind problems. Please note there may be other causes for these problems such as ineffective feeding positions or other biomechanical issues such as jaw or neck problems. We therefore recommend a thorough assessment from an experienced tongue-tie practitioner, international board certified lactation consultant and physical therapist. There are links between tongue-tie and dental and speech problems in later life however the consensus is that tongue-tie divison should only be carried out in infants when there are significant feeding issues.

Firstly, the tongue-tie practitioner with thoroughly explain the procedure and risks so the parents can make an informed decision. If agreed, the parents will then sign a consent form. The baby is then swaddled and the baby’s head will be supported gently. Sterile gloves are worn and the tongue is elevated with a finger and the lower lip held down to expose and stretch the frenulum. The tongue-tie is then divided using sterile, sharp, round ended scissors without the need for an anaesthetic. This is how the tongue-tie is released. Babies may feel a small amount of pain, if any, and usually settle quickly and are able to feed straight away. There is usually very little bleeding and any oozing is controlled by applying pressure to the area with sterile gauze and encouraging feeding as soon as possible. Support is given afterwards and an agreed plan will be discussed with the mother to help them with their ongoing feeding experience. Aftercare information will be given, including exercises and feeding support.

Tongue-tie release isn't always necessary. Many babies with a tongue-tie can feed effectively with support to optimise their feeding techniques. This is why it is important to seek skilled feeding support before determining if a tongue-tie is causing a problem. Physical therapy such as osteopathy may be helpful if there are additional tensions in the neck or jaw. If feeding problems continue despite this support then you might want to consider surgical release of the tongue-tie. Your tongue-tie practitioner will explain the risks and benefits to you so that you can make a fully informed decision. Please note that surgical tongue-tie release in infants is only recommended where there are signifcant feeding issues and is not carried out to prevent future problems.

An anterior tongue-tie is when the lingual frenulum is inserted anywhere from the mid part of the tongue to the tip of the tongue. This is often easier to see and the tongue can often look heart-shaped. A posterior tongue-tie is inserted further back to towards the floor of the mouth. This can be harder to detect and is identified by feeding difficulties and detailed assessment of tongue function.

Tongue-tie and jaw and neck restrictions are closely related and together can impact feeding. By helping to release all at the same time it is possible that feeding outcomes will be improved more quickly.