Tongue tie is where a baby's tongue is held down by tissue
underneath the tongue which has not separated from the floor of the
mouth and tongue during growth as an embryo.
This can cause problems with breast feeding, bottle feeding,
swallowing and licking. It can even interfere with
development of the bottom jaw and create dental and speech
While a lower lip tongue tie is more common, some babies will
have an upper lip tie which needs to be treated.
I have been treating this condition for 40 plus years, but it
seems to have become more common in recent years. This is
most likely due to midwives and lactation consultants being aware
of it and looking for it when assessing feeding issues with mother
There is a spectrum of severity based on how much of the tongue
is held down, so a minor tongue tie may not cause any issues at
Speech therapists sometimes refer older children to me for
assessment and treatment if needed, but the incidence of this has
not really increased.
Adults also sometimes book an appointment for assessment of
licking problems which they have had all of their lives.
Babies need a mobile tongue so they can effectively latch
on and suck when being fed. The extent of the tie will
determine the degree of the problems arising.
The baby's tongue needs to elevate, collect the nipple and
surrounding breast tissue and push it against the roof of their
mouth. The baby will slip off the nipple easily if their
sucking is impaired. They will make clicking noises and their
tongue may rasp against the mother's nipple and cause her pain.
Feeding this way will take up a lot of energy so the baby will
get tired easily and take longer to feed.
Eventually an impaired suck will result in decreased milk
production, poor weight gains, a hungry, irritable baby and a worn
out tired mother with sore nipples is not a happy situation.
Sometimes the first sign of something not being right happens
after the first few weeks when the mother feels her supply has
decreased and her baby's weight gain slows down.
In past years this situation would almost always result in the
abandoning of breast feeding. Some of these babies still had
problems with teats and much time and effort went in to trials of
various shapes and sizes of teats. However tongue tie is now
When you bring your baby to an appointment I will ask for a
description of the problem and will examine your baby to determine
the extent of the physical problem. If I assess that it would
be helpful to separate the tissue between the tongue and floor of
the mouth to remove the tie, I will then proceed with the
operation. You will not need to book a separate appointment
as the operation can take place there and then.
I use a scalpel to give a quick clean cut and avoid
damaging surrounding tissues, which is especially a risk in the
Type 3 and Type 4 ties, the so-called posterior ties.
Some babies feel very little pain, while some do appear
upset for several minutes. Most babies don't like having
large adult fingers in their mouths or being held during the
procedure, which is quite understandable. There is some
bleeding but this usually stops within five minutes.
The baby can be, and is encouraged to be fed straight away.
Some ties grow back. I encourage mum or dad to put their
index finger under the baby's tongue and lift it up to the roof of
the mouth after every feed for three to four weeks afterwards,
starting two days after the operation, however this is not a
guarantee the tie will not grow back. I have seen
ties grow back in a week. Some babies need the procedure
repeated, sometimes several times if they heal quickly.
Bleeding some hours after the operation is very rare but should
this occur, apply pressure to the floor of the baby's mouth with a
gauze swab. This is all that is needed, but the baby understandably
For additional information on after-care: http://vimeo.com/55658345 or
Lots of babies have this condition and it is rarely an
issue. An upper lip-tie is where a piece of skin under
the baby's upper lip (the labial frenulum) is very short or thick
and is pinned too tightly to the upper gum. This can restrict
movement of the upper lip preventing it from being able to flange
or 'pull out'. This can make it difficult for babies to attach to
the breast correctly as it is harder for them to maintain a good
seal. In older children and adolescents, an upper lip-tie can
be associated with a gap between the front teeth. Generally
this is only a cosmetic issue. However, it can make it difficult
for a baby to breastfeed.
The upper lip tie is cut with a scalpel. It bleeds for a short
time so pressure is applied to the upper lip, pushed against the
I have never needed to do anything else to treat a baby with
upper lip tie. A review of overseas studies suggest that
ongoing bleeding requiring treatment has not been needed. If
it was, treatment would involve applying silver nitrate to the
The cost of the consultation is $10* for New Zealand
Citizens. You will need to provide us with a copy of either
of the baby's parents elligible Passport, Birth Certificate or
Community Services Card. Please check with reception when
making an appointment. If we do not have the correct
documents on the day of the procedure the cost is $45*.
* Older children and adults will incur a higher
fee. Fees are subject to change. Please check
with reception when booking.
Please phone reception at Broadway Medical Centre to enquire about
Phone: 03 477 4335
Fax: 03 477 4337