New guidelines to help babies with tongue-tie

Published on Wednesday, 24 March 2021
Last updated on Monday, 22 March 2021

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Tongue-twisters like ‘Red leather, yellow leather’ are a fun game for school children, but tongue-tie at birth can be a more serious matter.

Each year, about five to 10 per cent of Kiwi babies are born with tongue-tie, and although at least half can still breastfeed normally, around two to five per cent may have difficulty.

Surgery can be performed to free up tongue movement, but until recently, there’s been a lack of consistent information about the risks and benefits of this, and concerns around inconsistent and inequitable access to treatment.

In response, the Ministry of Health has released new guidelines which ensure that babies born with tongue-tie will be assessed and treated consistently.

Here, we talk tongue-tie in more detail.

What exactly is tongue-tie?

Tongue-tie (or ‘ankyloglossia’) is a congenital condition where a very short or tight band of tissue (the ‘frenulum’) restricts the normal movement of the tongue.

Although many tongue-tied babies can feed well and avoid treatment, sometimes tongue-tie makes it hard for a bub to latch on, or stayed latched on, to Mum’s nipple; and occasionally, a baby with severe tongue-tie might have problems drinking from a bottle.

Tongue-tie can also contribute to difficulties swallowing and articulating, and lead to orthodontic problems, although most tongue-ties don’t cause any problems with eating or speech.

What signs suggest that tongue-tie is affecting your baby’s breastfeeding?

There is a learning curve when new mums and newborns start breastfeeding, and many tongue-tied babies settle into breastfeeding as easily as others.

If tongue-tie is making things tricky, though, the Ministry of Health says you will notice some of these signs:

  • Breastfeeding is painful for you during the whole feed
  • Your nipples may get sore, blistered, cracked, bleeding or bruised
  • You’re not making enough milk to meet your baby’s changing needs
  • Your baby may have trouble latching onto the nipple, or staying latched for the full feed
  • Your baby’s feeds are too short or too long, and they’re unsatisfied despite being offered at least eight feeds every 24 hours
  • Your baby may gain weight slowly, not at all, or even lose weight
  • Your baby might seem unsettled or fussy during breastfeeds, or make clicking or slurping noises while they feed
  • Your baby may need fewer nappy changes because they’re producing less wee and poo

All of these signs can be caused by things other than tongue-tie, so it’s important to have a breastfeeding assessment to find out what’s going on.

Your midwife and Lead Maternity Carer can refer you for the assessment, and it involves a lactation consultant discussing your baby’s feeding history with you, observing your baby breastfeeding, adjusting your technique if needed, and seeing how your baby’s tongue is moving and attached.

This assessment can happen as soon as two days after birth (if your baby is having severe feeding problems), and a simple scoring tool is used to assess how tongue-tied your baby is, and whether they need treatment. 

How is tongue-tie treated?

KidsHealth says that, ‘For many babies with tongue-tie, it is best to wait and see how feeding goes,’ with the help of skilled lactation support.

However, if the breastfeeding assessment suggests that your baby’s tongue-tie is causing problems feeding, a tongue-tie release (or ‘frenotomy’) can be done by a registered health professional who is trained in the procedure.

This minor surgery involves a quick and simple snip of the tissue band that’s restricting tongue movement, and it’s usually done before a baby is two-months-old (but not always).

The Ministry of Health says a tongue-tie release, ‘May make it easier to breastfeed,’ with some mothers noticing an immediate difference to their baby’s feeding, some mums noticing no difference, and some needing a bit of time to re-learn breastfeeding with their baby’s ‘new’ tongue.

When it comes to other tongue-tie related difficulties, the government says, ‘There is no evidence at the moment that a tongue-tie release in a newborn baby will prevent later speech or dental problems.’

What do the new tongue-tie guidelines mean for health professionals and parents?

Until recently, there were no national guidelines around tongue-tie, reports of increasing numbers of tongue-tie release surgeries, and concern that a possible ‘unnecessary focus on the condition’ might delay the management of other feeding-related issues in babies.

The good news is that the Ministry of Health has listened to ‘urgent calls for action in this area’ and worked with the organisations who are most involved in tongue-tie releases to agree on some national guidelines.

These guidelines provide the health sector with clear, concise and consistent guidance to identify, assess, diagnose and treat tongue-tie in babies, and they’re for:

  • Registered midwives
  • Lactation consultants
  • Registered nurses, including Well Child/Tamariki Ora nurses
  • Registered medical practitioners
  • Registered dentists and dental surgeons

The guidelines also make things clearer for families. Parents now have reassurance that all health professionals are following the same advice to refer, assess and treat their baby’s tongue-tie, regardless of where they live or who’s treating them.

Also, before tongue-tie release surgery can be done, parents must give written informed consent, which means they’ve been told about the tongue-tie condition, the treatment and options available, expected risks, side effects and benefits.

It’s important to remember that tongue-tie doesn’t always cause feeding problems, and breastfeeding is a learnt art for new mums and newborns. However, if you are concerned about your baby’s tongue movement or feeding, it’s important to seek advice and get support.


Beehive: Better care for babies with tongue-tie

Ministry of Health: Tongue-tie


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