Division of a tongue-tie

This is for anyone looking after a baby who undergoes division of a tongue-tie.

This procedure involves the division of the piece of tissue which attaches the underside of the tongue to the floor of the mouth. This piece of tissue is left over from early development in the womb.

What can I expect after my baby’s procedure?

• After the procedure, you will notice a few drops of blood at the wound site under the tongue. This bleeding usually settles down quickly after the procedure and rarely causes concern.
• If your baby has swallowed any blood, you may see some brown staining if they vomit up a small amount of milk during the first 24 hours after the procedure. This is nothing to be worried about.
• Occasionally, a small amount of fresh bleeding can be seen in the wound.  This is easily settled by feeding your baby. The action of suckling compresses the small blood vessels under the tongue.  
• Most babies settle quickly after the procedure and some even sleep through it.
• Older babies (more than 3 to 4 weeks of age) can be more unsettled. They may need more comforting and extra feeds in the first few days after the procedure.

How will I know my baby is healing well?

A diamond shaped wound will be visible under your baby’s tongue immediately after the procedure. This will look like a yellow ulcer within the first 24 hours. Over the next 14 to 21 days, this will change colour from yellow to white, as the tissue heals. This change is normal.

The incision made to divide the tongue tie should heal over quickly with no problems. This is because of the antiseptic quality of saliva. If your baby is breastfeeding, this will also aid healing due to the large number of protective and healing properties of breastmilk.

How do I care for my baby after the procedure?

When do I seek help about my baby’s progress?

Most babies recover quickly.

Make an urgent GP appointment or go to your nearest Emergency Department (A&E) if you notice any of the following:

• Your baby has a high temperature (more than 37.6 degrees centigrade).
• Your baby is excessively irritable or is making a high-pitched crying sound.
• Yellow or green fluid (pus) is oozing from their tongue-tie wound.
• Your baby is excessively sleepy or is difficult to wake for feeds.
• Your baby is not settling after a feed.
• Your baby has bleeding at the wound site that does not stop after feeding or sucking on a clean finger for 2 minutes.

Feeding after the procedure

If you breastfeed

For the first 72 hours after procedure, offer a breastfeed at least every three hours.

If you formula feed

Offer your baby a feed when they show signs of being hungry. You will see feeding cues such as moving their head around looking for food, or sucking on their fingers or hands.

Reestablishing your baby’s feeding technique

Some babies establish a poor sucking pattern when they first breastfeed, to compensate for their tongue tie. After the procedure, these babies must learn to suck with a tongue that is fully mobile.

You can help them establish a good sucking pattern by following this advice:

• If your baby becomes uncomfortable, unlatch them and reposition them.
• Do not pull them away from the nipple. (If you breastfeed, this can be painful and damage your nipple.)
• Use a clean little finger and gently place it between your baby’s gums to release their latch.
• Reposition and latch again.

Signs of effective feeding

Signs of effective feeding are:

• regular wet nappies
• regular bowel movements
• your baby settles well after feeds
• your baby gains weight.

Ask your midwife or health visitor about local feeding drop-ins if you are worried. These are a good place to meet other mums and access specialist feeding support.

More information

Further information on tongue-tie www.nhs.uk/conditions/tongue-tie/
Further information on infant feeding, including local clinics www.kingstonhospital.nhs.uk/following-birth/infant-feeding/
National Breastfeeding Helpline (9:30 am to 9:30 pm) www.nationalbreastfeedinghelpline.org.uk	Telephone: 0300 100 0212
La Leche League (8 am to 10 pm) www.laleche.org.uk	Telephone: 0345 1202918
The Breastfeeding Network (Bfn), (9.30 am to 9.30 pm) www.breastfeedingnetwork.org.uk	Telephone: 0300 100 0212

_{Images courtesy of Freepik}

Contacts

Kingston Hospital Infant Feeding Team	020 8934 2848 khft.infantfeedingteam@nhs.net
Kingston Hospital Tongue-Tie Team	khft.ttcmaternity@nhs.net