Releasing a Tongue-Tie
at the Mothers’ Milk Breasfeeding Clinic (HalavM) with Dr. Gina Weissman
Before releasing the tongue:
Why would it be necessary to release the tongue:
We all have a connection between our tongues and the floor of our mouth, but there are instances wherein a baby is born with a connecting membrane that is too tight, too short, too thick, or too close to the opening of the mouth (for instance, connected to the line of the gums). There are instances where it cannot be seen with the naked eye.
During breastfeeding the tongue plays a crucial role. The tongue pulls forward in order to compress the breast. The breast tissue and the nipple are held in the mouth while the tongue covers the lower gums and carries out a circular motion. A tied tongue sometimes prevents the tongue from covering the lower gums during suckling and thus preventing the complete motion. Therefore, it may cause problems with latching on; nipple pain; extended nursing sessions; inadequate amount of milk transferred to the baby, and thus the reduction of the mother’s milk and more.
In a position paper from the Israeli association of pediatricians, the signs that require releasing of a tongue tie mainly include severe pain while nursing, with or without nipple sores or cracks, and frequently repeated disengagement of the nipple from the baby’s mouth while nursing, and in the situation that the breastfeeding baby is not gaining weight.
It is advised to give breastfeeding advice prior to treatment of the tongue, to guide the mother in changing breastfeeding positioning thus preventing the need for surgical intervention. If intervention is necessary it is recommended to do it as early as possible so that nursing is not disturbed. It is their recommendation that releasing the tongue should not be carried out solely to prevent pronunciation or aesthetic problems.
A number of research studies show that releasing the tongue reduces breastfeeding pain for most of the mothers, and they report better milk transfer to the baby and overall extended time of breastfeeding as the baby grows. There is not enough solid scientific evidence to support the influence of a tongue-tie on problems of future pronunciation.
How do we know that we need to release the tongue?
Possible signs for recognition (not all of which need to appear):
Raising of only the sides of the tongue, and not the raising of the whole tongue
Clicking noises while nursing, the sound of a broken vacuum while nursing
Extended nursing sessions, a discontented baby following nursing
Pain while breastfeeding ;Sore or injured nipples
Biting while nursing
High and narrow upper palate
Many of these signs appear as part of the trials and challenges of nursing, thus it is important for a professional to diagnose both the tongue and the nursing process.
The release of the tongue:
A recommendation to release the tongue will be carried out only if there is a solid medical indication for it or a clear nursing problem.
The actual procedure:
We apply local anesthetic gel under the tongue (Benzocaine).
A swift cut of the membrane is made, using a sterile tool that has been sterilized in an autoclave.
If there is bleeding gently press with a sterile gauze.
We return the baby to the mother for immediate nursing following the procedure.
If the place is still anesthetized, and the baby might not latch onto the breast, we'll put mother’s milk into the baby’s mouth (which insures closing of the incision and the speedy healing, and soothes the baby).
Bleeding – this can be dealt with medically, and additionally mother’s milk helps immediately
Infection – to prevent this we use sterile instruments that are sterilized to the highest degree
After releasing the tongue
To prevent infection in the future – insure that all hands that touch the baby are thoroughly washed and prevent young siblings from coming in contact with the baby’s mouth.
Recommendations following the tongue release:
Frequent nursing for the first two days at least to insure the baby’s swift adjustment to its “new tongue”. Please let us know that the baby is nursing freely for the first two days.
Exercises to prevent the reattachment of the membrane: These are done for 3 days, three times per day (a total of 9 times). Each time, the parent passes his finger three times under the width of the baby’s tongue, and lifts the baby’s tongue from underneath, at the place of the release, using his finger (3 times).
The healing of the incision – in some cases (posterior tongue tie), following the release a white coating (in the shape of a diamond) will appear under the tongue; this is part of the healing process and is not pus. Do not attempt to remove it, and continue doing the exercises.
Pain – most babies do not show signs of pain following the procedure of tongue release. If it seems there is need, pain medication such as paracetamol may be given according to directions on the packaging of the medication. It is important to prevent pain (if it appears), in order to permit the exercise of the tongue while nursing and thus quickly improve the movement of the tongue following the release.
Fever – there should not be any fever following the procedure, but if there is fever, notify the attending physician.
Bleeding – there should not be bleeding following the procedure, but if there is heavy bleeding, notify the attending physician, who will give instructions. Light bleeding may appear while doing the exercise, or may be noted in spit-ups or in the baby's stools, due to the baby swallowing some blood during the procedure.
Wishing you and your baby a speedy recovery,
Dr. Gina Weissman
And the staff at the Mothers’ Milk breastfeeding Clinic (HalavM)
Written by Ariela Levy Breastfeeding Management Course 2014
Mothers’ Milk breastfeeding Clinic (HalavM)
Translated from Hebrew to English by Judy Ronen
Breastfeeding Management Course 2015
Mothers’ Milk breastfeeding Clinic (HalavM)