"I was very anxious leading up to the appointment, due to a terrible experience previously. I’m not sure how feasible it would be, but personally, I think I would have benefitted from reading some success stories or “what to expect on the day” stories from previous parents who have had the procedure with Vicky."
I regularly seek feedback form the parents I work with to help make my service family centred. I received the feedback quoted above recently and this post has been created with the help of the family in question. I would like to thank Nicola France for providing her personal account of what she experienced, to help other parents to know what to expect on the day that I visit (and beyond)
From the moment I suspected that my second baby might have a tongue tie, I was instantly nervous about the whole process. My first baby had an undiagnosed tongue tie for 5 months and we unfortunately had a difficult experience having the procedure performed. This time, I knew I would opt to take a different route and started to research private tongue tie practitioners. I came across Vicky’s website and asked my husband to arrange an appointment as I was too nervous after last time. I was worried that I would accidentally agree to something I did not fully understand, or everything would happen too quickly for us and we’d be left in the same state we were last time. However, the exact opposite was true.
Vicky arrived on the day and after expecting her to whip my daughter out of my hands and start setting up a load of scary equipment, we instead sat on the sofa for a informal chat. I have never before been asked about my breastfeeding journey and been allowed to say every word I needed to say. It’s a very emotive subject, and often those who are there to provide support in the early days, simply do not have the time to hear you. The first part of Vicky’s visit was everything I needed it to be and I no longer felt like a failure for my inability to grow a functioning tongue in utero. Myself and my husband also learned things about breastfeeding that we had no idea about - which was a surprise as I had previously breastfed my son for 2 years so we thought we knew a fair amount! Throughout this I also fed my daughter and shared my concerns, then when we were both ready, Vicky asked to check her tongue. She did so and let us know that she thought she would benefit from the procedure but that it was entirely our decision whether we wanted to go ahead or not.
We were given plenty of time to decide after having the ins and outs of the procedure and risks fully explained to us. Then my husband helped Vicky find an appropriate space for the procedure to take place - they chose my dining room table as it had the most natural light over it. Vicky asked us for something for our daughter to lay on and something to swaddle her in to make her feel safe and keep her hands away from her face - we chose our (clean) changing mat and a cellular blanket. As I was nervous, I returned to the sofa while my husband helped by supporting my daughter’s head,
but before I had enough time to become worried, it was over. My daughter cried a little, and there was a small amount of blood on the dressing that Vicky had used to apply pressure to the wound, but that was it. It took a couple of minutes for me and my daughter to relax a bit, and then she fed until asleep. Once Vicky was happy that we were comfortable and that the wound had stopped bleeding, she let us know that we could call or email her with any concerns. The follow up call(s) we’re so valuable and Vicky did not sign us off until we were all confident enough to fly solo! I’d honestly recommend Vicky to anyone. I have had total confidence restored and I have a very happy, very chubby baby as a result. Thank you!
Following your baby's tongue tie division I will have shown you some exercises. This information is to help you to remember them.
It is important to start when your baby is most likely to be receptive to the exercises, during a quiet, alert state or early in an active, alert state. By making the sequence of events predictable, the exercises can be turned into a game for you both to enjoy. It is very important to respect your baby's wishes. If your baby turns their head away, clamps their mouth shut or puts their hands up as if to block you, stop the exercises and try again at another time. Face your baby, making eye contact and talk to them throughout letting them know what is coming next and giving gentle encouragement.
To encourage your baby to open their mouth the following sequence can be employed:
Touch their chin, then their nose and lastly touch the philtrum (the space between the nose and the top lip)
To help with tongue extension.
Ask "can you poke your tongue out?" and then poke YOUR tongue out. Waiting, smiling and then repeating.
These help the side to side (lateral) movement of the tongue.
Verbal cue: "Do you want to play gummys?"
Once their mouth is open, place your finger in front of the lower gum. Slowly slide your finger along the gum to the right and then back to the centre, pause and then repeat 3 times. Then repeat sliding your finger along the gum to the left.
Verbal cue: say "down" during the down and forward action.
Place your smallest finger against your baby's lips with the nail facing away from you. This will encourage your baby to open their mouth wide. Allow them to draw your finger tip into their mouth, your nail will be against their tongue. As they start sucking, gently press down and forward (towards their lips) drawing their tongue forward over their lower gum.
Desensitising the gag reflex
Some babies with a tongue-tie or a high palette can have a very active gag reflex. This can make them slip down the nipple or choose a shallow latch to avoid activating the gag. To help desensitise this overactive gag the following exercise can help. Encourage your baby to open their mouth wide with the sequence described above. Then place your finger (nail down) on the roof of the mouth (hard palate) close to the gums. Slide the finger back, applying firm pressure along the hard palate, stopping just before the gag is stimulated. Over time your baby will learn to tolerate normal touch to the palate. It is important to take this exercise very slowly to avoid reinforcing the discomfort.
I hope you are able to enjoy these exercises with your baby
Watson- Genna, C. (2013) Supporting Sucking Skills in Breastfeeding Infants, 2nd Ed. Jones and Bartlett Learning: MA
Laura Spitzfaden IBCLC, Sucking Skills, http://feedthebabyllc.com/suckling-exercises/ accessed 11.01.2015
You have waited months and months to meet your new baby and finally they have arrived. Then one day you are told your small bundle of perfect joy has an ‘imperfection’, a tongue-tie (anklyoglossia). This may be just days into their life or sometimes weeks or months (or years) later. It may have been suggested by a healthcare professional, a breastfeeding specialist, another mother or you may have discovered it yourself following an inter-web search.
So what do you do? Let me help take away some of the confusion.
What is tongue-tie?
Tongue-tie is diagnosed when there is a short or tight lingual frenulum. This is the piece of skin that anchors the tongue down and prevents good mobility (i.e prevents the tongue moving around the mouth too much). There are many different degrees of tongue-tie. When assessing tongue-tie the practitioner will take the function of the tongue into account as well as the visual appearance.
What problems can it cause?
What is the procedure to have it divided / snipped?
In babies under 6 months the procedure, frenulotomy / frenulectomy is very simple; a sharp pair of scissors are used to release the tightening. This can be performed in a hospital clinic or at home if you chose a private practitioner. The risks are minimal but may include bleeding, formation of scar tissue, damage to other parts of the mouth and nursing strike (refusing to breastfeed).
In older babies and children a general anaesthetic is normally used, to facilitate cooperation but the procedure is the same. Laser dentistry is also available.
So should it be divided?
There are a lot of opinions out there so I shall add my own.
The decision is yours and only yours as your baby’s parent. It is a very personal decision to be made with the information available to you and by using your own instinct. Every baby and every tongue-tie is different.
There is simply no SHOULD about it.
Vicky Jordan is a Tongue-tie practitioner, Breastfeeding counsellor and Registered Nurse based in Kent, England. Her wish is to empower and support women and their families towards achieving their own personal breastfeeding goals.