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Tongue tie is a term commonly used to refer to a restrictive lingual frenulum (RLF). The lingual frenulum is the thin piece of tissue which joins your tongue to the floor of your mouth. It's normal anatomy to have a lingual frenulum, although in some cases they are positioned too far forward, or are too short or too tight and therefore restrict tongue function. 

In infants we may suspect a lingual frenulum in situation such as:

- mum is experiencing painful feeding, not alleviated by support with attachment. 
- mum has ongoing significant nipple trauma

- baby isn't feeding effectively, and may often have slow or no weight gain. 
- baby is showing symptoms such as excessive wind & reflux
- baby struggles to cope with flow at the breast or bottle, or is a messy feeder
- mum is experiencing recurrent mastitis or consistent engorgement and poor control of milk supply, in the presence of one or more of the above. 
- bottle fed babies may be very messy feeders, dribbling large quantities of milk or struggling to control flow of milk, as well as showing symptoms such as excessive wind and reflux. 

A restrictive lingual frenulum may be visually obvious, or it may require a full functional assessment to diagnose. Many health practitioners including midwives, health visitors and GPs are aware of what the visual obvious anterior tongue ties look like, but do not have any specific training in diagnosing more complex tongue ties based on tongue function. 

If baby's tongue function is deemed to be restricted and it's impacting feeding then a frenotomy may be performed to release the restricted frenulum. This is not always a quick fix, and for many baby's frenotomy alone doesn't correct the issue completely. Follow up support including exercises, positioning and attachment, management of milk supply and referral to allied health practitioners is often helpful. 

If you are experiencing any of the above, even if you have been told that your baby's tongue 'looks fine' it is vital to get a full tongue function assessment by an IBCLC or tongue tie practitioner. Visual assessment is not enough to see whether there is actually a restriction in function which could be impacting your baby's feeding. 

Tongue tie Assessment

I have undergone a formal training course in Tongue Tie Assessment as well as observational clinical practice with private tongue tie practitioners to enable me to more accurately assess your baby's tongue function. 

I will perform a full functional assessment which will involve observing the visual appearance of baby's tongue, frenulum and attachment points, as well as an oral examination using a gloved finger in baby's mouth to determine how well the tongue can extend, elevate and function when sucking/feeding. I use the Hazelbaker assessment tool to assess and document my findings. I am then able to refer either to NHS or private services for division if this is deemed appropriate. 

I also provide support pre and post frenotomy.

I am in close contact with a network of local tongue tie practitioners to discuss cases and provide second opinions when necessary, as well as allied health professionals such as paediatric osteopaths who can assist with muscular restrictions impacting on feeding. 

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