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Trust Core Policy
Tongue tie division (frenulotomy)
by authorised health professionals to assist Infant Feeding Policy
APPROVING COMMITTEE(S)
Date approved:
EFFECTIVE FROM
2013
April 2013
All staff working in maternity, neonatal, paediatrics ,
A&E and Tower Hamlets Community staff
Infant Feeding Policy
Neonatal Expressed Breastmilk Guidelines
Neonatal Hypoglycaemia policy
Babies slow to initiate breastfeeding policy
Weighing newborn infants in all care settings
Maternity Training Needs Analysis
Parents’ Guide to the Infant Feeding Policy
Immediate care of the newborn guideline
Neonatal jaundice policy
DISTRIBUTION
RELATED DOCUMENTS
National Institute for Health and Clinical
Excellence, 2005. Division of ankyloglossia
(tongue tie) for breastfeeding.
STANDARDS
OWNER
AUTHOR/FURTHER INFORMATION
Women and Children’s
Infant Feeding Coordinator, Whipps Cross
Breastfeeding Project Coordinator, Royal London
SUPERCEDED DOCUMENTS
2016
Infant feeding, Ankyloglossia, Frenulotomy
INTRANET LOCATION(S)
http:// [file location]
CONSULTATION
REVIEW DUE
KEYWORDS
Barts Health
SCOPE OF
APPLICATION
AND
EXEMPTIONS
External Partner(s)
Page 1 of 20
Midwives
Paediatricians
ENT Paediatric surgeons
Supervisors of Midwives
Baby Friendly coordinators
Tower Hamlets community staff
Tower Hamlets CCG
Included in policy:
For the groups listed below, failure to follow the policy may result in investigation and
management action which may include formal action in line with the Trust's
disciplinary or capability procedures for Trust employees, and other action in relation
to organisations contracted to the Trust, which may result in the termination of a
contract, assignment, placement, secondment or honorary arrangement.
Trust staff working in maternity departments, neonatal departments,
paediatrics, the Health Visiting service, the Breastfeeding Project and
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the Family Nurse Partnership. Tower Hamlets General Practitioners.
Exempted from policy:
The following groups are exempt from this policy
No staff groups are exempt from this policy
TABLE OF CONTENTS
1
DOCUMENT DEFINITION
3
1.1
Introduction ........................................................................................................................... 3
1.2
References, further reading and links to other policies .......................................................... 3
Error! Bookmark not defined.
2
COMMUNICATING THE TONGUE TIE POLICY………………………………………4
3
MAIN POLICY CONTENT DETAILS
4
3.1
Client Group .......................................................................................................................... 4
3.2
Identification of tongue tie ..................................................................................................... 5
3.3
Referral Process ................................................................................................................... 5
3.4
Treatment ............................................................................................................................. 5
3.5
Contraindications .................................................................................................................. 6
3.6
Follow up ............................................................................... Error! Bookmark not defined.
4
DUTIES AND RESPONSIBILITIES OF INDIVIDUALS AND GROUPS
6
4.1
All Staff ................................................................................................................................. 6
4.2
Clinical Midwifery Managers/Clinical Midwife Leads .............................................................. 6
4.3
Frenulotomy Authorised Health Professionals ....................................................................... 6
5
TRAINING STAFF…………………………………………………………………………7
6 MONITORING THE EFFECTIVENESS OF THIS
POLICY……………………………7ERROR! BOOKMARK NOT DEFINED.
7 APPENDIX 1 - TONGUE TIE AND FEEDING ASSESSMENT REFERRAL FORM.... 8
8 APPENDIX 2 – TONGUE-TIE INFORMATION FOR PARENTS………………………10
9 APPENDIX 3 - INFORMATION FOR HEALTH PROFESSIONAL ON THE
FRENULOTOMY PROCEDURE……………………………………………………………..13
10 APPENDIX 4 - HISTORY SHEET AND RECORD OF FRENULOTOMY TO
SUPPORT BREASTFEEDING……………………………………………………………….15
11 APPENDIX 5 - DIVISION OF TONGUE TIE FEEDBACK QUESTIONNAIRE………17
12
APPENDIX 6 - LETTER TO GP FOLLOWING PROCEDURE …………………….19
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INTRODUCTION AND AIMS OF POLICY
1
DOCUMENT DEFINITION
1.1 Introduction
Breastfeeding is the optimal way for a baby to feed. The UK government and the World Health
Organisation recommend a minimum of six months exclusive breastfeeding. Full tongue
movement is essential for effective breastfeeding. Approximately 10% of babies are born with
some degree of ankyloglossia, also known as tongue tie which is characterised by an abnormally
short band of tissue (lingual frenulum) which can tether the bottom of the tongue to the floor of the
mouth. The tip of the tongue cannot be protruded beyond the lower gum ridge. It varies in degree,
from a mild form in which the tongue is bound only by a thin mucous membrane to a severe form
in which the tongue is completely fused to the floor of the mouth.
The National Institute of Health and Clinical Excellence (NICE 2005) has looked at the current
evidence and decided that it is adequate to support the use of the procedure provided that normal
arrangements are in place for consent, audit and clinical governance. The procedure may also be
used to help when a baby experiences difficulty with bottle feeding.
1.2 References, further reading and links to other policies
The following is a list of other policies, procedural documents or guidance documents (internal or
external) which staff should refer to for further details:
Ref. No. Document Title
1
Document Location
Breastfeeding Policy
Intranet
Postnatal Care guidelines
Intranet
Ballard JL, Auer CE, Khoury JC. 2002. Ankyloglossia: Pediatrics, 110:e63
assessment, incidence, and effect of frenuloplasty on
the breastfeeding dyad
Dolberg S, Botzer E, Grunis E et al. 2003. A
Pediatric Research. 52:822
randomised, prospective, blinded clinical trial with
cross over frenotomy in ankyloglossia: effect on
breastfeeding
2
3
Fitz-Desorgher R, 2003. All tied up. Tongue tie and its Practising Midwife, 6 (1): 20-2
implications for breastfeeding
4
Griffiths M, 2004. Do tongue ties affect breastfeeding?
Hall D M B, Renfrew M J, Tongue tie Common
J Hum Lact. 20(4):409-414
problem or old wives’ tale? Arch. Dis. Child. 90;12111215
5
6
Hogan M, Westcott C, Griffiths M, 2005. A Journal of Pediatrics and Child
randomised, controlled trial of division of tonge-tie in Health, Vol 41; issue 5-6; page
infants with feeding problems
246-250
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Ref. No. Document Title
Document Location
7
Masaitis NS, Kaempf JW, 1996. Developing a J Hum Lact, 12:229-32
frenotomy policy at one medical centre: A case study
approach
8
Messner AH, Lalakea MH, Aby J, MacMahon J, Bair Arch Otolaryngol
E. 2000. Ankyloglossia incidence and associated Surg.126:36-39`
feeding difficulties
9
Neck
National Institute for Health and Clinical Excellence,
www.nice.org
2005. Systematic Review Summary – Breastfeeding
for longer – what works?
10
National Institute for Health and Clinical Excellence, www.nice.org
2005. Division of ankyloglossia (tongue tie) for
NICE (NO951/952)
breastfeeding.
11
National Institute for Health and Clinical Excellence www.nice.org
2006 Postnatal care: Routine postnatal care of
NICE CG37
women and their babies.
12
World Health Organization. 2002
2.
Head
Infant and young child feeding
global strategy on infant and young
child feeding.
Communicating the tongue tie policy
2.1 It is important that there is a mechanism to ensure relevant staff are aware of pertinent
documents, policies and associated procedures that affect them in their work.
2.2 This policy is to be communicated to all staff that have any contact with mothers and babies.
All staff will have access to this policy on the intranet.
3
POLICY
To ensure a prompt access to treatment before feeding difficulties lead to the need to supplement
breastfed babies with a breast milk substitute, or cessation of breastfeeding. Some babies will
have no problem feeding but a significant number will experience difficulty with establishing
breastfeeding as a result of the inability to suckle effectively. Babies with restricted tongue
movement due to a tongue tie may require supplementing with expressed milk or a breast milk
substitute (follow Babies slow to initiate breastfeeding policy).
Babies who are bottle feeding can also experience problems including dribbling and inability to
create a seal around the teat so baby takes in air and becomes colicky and windy and feeding
takes a long time.
3.1 Client Group

Babies up to 6 months old whose mothers intend to breastfeed and present with difficulties as
a result of restricted tongue movement due to tongue tie.
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
Babies up to 6 months who are experiencing difficulties bottle feeding.
3.2 Identification of tongue tie
Babies with restricted tongue movement due to tongue tie may present with a range of problems
including:
 Difficulty or inability to attach effectively to the breast
 Constantly slipping off the breast
 Excessive weight loss
 Slow or no weight gain
 Constant or very frequent feeding, which can lead to tiredness in the baby
 Unsettled baby
 Bottle fed babies may take a long time to feed, dribble, take in air or be very windy and colicky
Mothers often complain of:
 Sore nipples
 Pain during feeds
 Engorgement or mastitis
 Poor milk supply
N.B. Not all babies with tongue tie need to have a frenulotomy. Many of the above
problems are commonly found during the early breastfeeding period and associated with
ineffective positioning and attachment, which should be addressed before considering
frenulotomy. When tongue tie is present these problems may persist regardless of skilled
help. Frenulotomy should not be seen as a substitute for skilled breastfeeding support.
3.3 Referral Process
Health professionals should refer to Appendix 3 prior to the referral. The baby can be referred to
the practitioner performing the procedure by a midwife, health visitor, breastfeeding supporter,
GP.
 All referrals to be accompanied by a referral letter or referral form (Appendix 1)
 The referral letter should be securely attached to the baby’s notes
 Parents of referred babies are contacted by telephone as soon as possible to arrange the
appointment to ensure breastfeeding is not compromised.
 Tongue tie information leaflets should be given to parents (Appendix 2)
3.4 Treatment
Frenulotomy is a simple surgical procedure and may be performed as an outpatient. No
anaesthetic, medication or stitching is required in very young babies because the frenulum has a
poor nerve and blood supply. The baby appears to feel only transitory pain and there is little
bleeding. The frenulum is snipped with a pair of sterile, sharp, blunt-ended scissors, which allows
free movement of the tongue. The baby is encouraged to feed immediately after the procedure.
The authorised midwife will document the completion of the procedure on Appendix 4 and attach
this to the health records.
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3.5 Contraindications









Baby is breastfeeding or bottle feeding effectively
Positioning and attachment not optimal and should be corrected prior to considering
frenulotomy
Frenulum is thick and vascular
Other atypical structures existing beneath the tongue
Baby under 1 month old that did not receive vitamin K IM or the full course of Oral Vit K
following birth
Baby more than 6 months old or has teeth
Any signs of infection
Parents withhold consent
Parents who have concerns about future speech or dental problems but whose babies do not
present with feeding difficulties
Should any contraindications to tongue tie division exist, the baby can be referred to
………………………..
3.6 Follow up
Parents will be asked to attend the ‘Tongue Tie’ group at the Royal London (or their local
breastfeeding group) for follow up and on going breastfeeding support.
Please refer to Appendix 5 for information on the frenulotomy procedure including followup and aftercare.
4
DUTIES AND RESPONSIBILITIES OF INDIVIDUALS AND GROUPS
4.1 All Staff
All maternity and neonatal staff have a duty to ensure that they are familiar with this policy. All
staff must ensure that they are familiar with the requirements for caring for mothers and babies
who experience tongue tie, which have been identified in section 3. Responsibility for identification
of tongue tie or feeding issues lies with all health care professionals involved with the care of the
newborn. Referral of babies to the Frenulotomy service lies with the attending midwife or medical
staff.
4.2 Clinical Midwifery Managers/Clinical Midwife Leads
Clinical Midwifery Managers and Clinical Midwife Leads are responsible for ensuring the policy for
referring babies with tongue tie is followed in their area and that the processes are monitored.
They have a responsibility for ensuring access to adequate training for staff.
4.3 Frenulotomy Authorised Health Professionals
Midwives, nurses and health visitors with more than two years experience, trained in
breastfeeding management and who have undertaken training in the procedure and have been
assessed to be competent to perform frenulotomy according to the competency framework for this
expanded practice. No other midwives, nurses or health visitors are authorised to perform this
procedure.
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5
TRAINING STAFF
5.1 Frenulotomy Authorised health professionals must complete the recognised training and have
received a certificate of competency.
5.2 As part of their orientation programme – all staff will be informed about the referral pathway
for babies with restricted tongue movement which is affecting feeding.
6
MONITORING THE EFFECTIVENESS OF THIS POLICY
A patient satisfaction form (Appendix 5) will be given/emailed to the parent to be returned to the
practitioner after 4 weeks following the procedure.
The effectiveness of breastfeeding and method of feeding will be assessed and recorded at the
Tongue Tie/Breastfeeding group for all attendees.
Data collected can then be collated to provide evidence of the effectiveness of the service. This
evidence will be presented in the annual Frenulotomy report presented to the Maternity
Directorate Governance Group.
END
APPENDIX 1 Tongue Tie and Feeding Assessment Referral Form
APPENDIX 2 Tongue-tie information for parents
APPENDIX 3 Information for Health Professional on the Frenulotomy Procedure
APPENDIX 4 History Sheet and Record of Frenulotomy to support breastfeeding
APPENDIX 5 Division of tongue tie feedback questionnaire
APPENDIX 6 Letter to GP following procedure
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APPENDIX 1 - Tongue Tie and Feeding Assessment Referral Form
N.B. Please write clearly or use stickers and complete all fields including postcodes
Date of referral
…………………………
Place of
…
birth………………………………………..
Baby’s name:
Where
DOB:born
Mother’s name……………………………………………
DOB:…………..…
NHS no:………………………
Address………………………………………………
……………………………Postcode…………………
NHS no:
GP:………………………..……..
Surgery………………………………………………………
………………………………………………..
Postcode…………………………………………….
Contact phone no: ………………………………………………………………
Baby Assessment: please tick
Excessive weight loss/ Insufficient weight gain  Appears hungry  Not feeding  Fusses/slips off
breast  Jaundice  Sleepy  Thrush  High palate  Reflux  Tongue tie visible 
Other, please state
Maternal Assessment: please tick
Low milk supply 
Engorgement 
Sore/cracked Nipples 
Mastitis/blocked duct 
Other, please state
Assessment of feeding and milk transfer: please circle
Positioning and attachment is correct
Yes No
Not sure
Mother experiencing pain
Yes No
Not sure
Appropriate sucking pattern with audible swallowing (1 – 2 suck per swallow)
Yes No
Not sure
Baby alert and actively feeding
Yes No
Not sure
Baby is satisfied after feeds
Yes No
Baby weight gain is appropriate
Yes No
Nappies in 24hrswet
stool
Bottle feeding babies: feeding effectively
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Not sure
Not sure
colour of stool
Yes No
Not sure
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Tongue tie Information for Parents sheet given 
Breastfeed observed & help given to improve positioning and attachment
Baby led attachment 

Expressing and supplementing with EBM 
Formula supplements 
Other, please state
Relevant history
Type of birth
Family history of bleeding disorders?
Yes/No details
Vitamin K given?
Yes/No
Newborn Examination done?
Yes/No
Newborn bloodspot screening taken
Yes/No,
excessive bleeding? Yes/No
Other relevant information
Referred by
Job title
Address
Contact no
Email referral to………joy.hastings@bartshealth.nhs.us………………………………………………………………
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APPENDIX 2 – Tongue-tie information for parents
What is a tongue tie?

All babies have a frenulum. It is skin which attaches the tongue to the floor of the
mouth.

Many babies have a visible frenulum. It is only known as a ‘tongue tie’ if movement of
the tongue is restricted – either by being unable to extend over the gum, lift or move
from side to side
Sometimes it is attached to the tip of the tongue, sometimes further back under the
tongue.
Most tongue ties are very thin and long, a few are thicker and chunky.
Tongue tie is more common in boys than girls and tends to run in families.



How does tongue tie affect feeding?
Recent research has suggested that some babies with tongue tie may experience feeding
difficulties. This is because a freely moving tongue is vital to enable baby to attach
effectively onto the breast and to remove an adequate amount of milk during feeding. Babies
who are bottle feeding can also experience problems including dribbling and inability to
create a seal around the teat so baby takes in air and becomes colicky and windy. However
all mums and babies are different and some will be more affected by a tongue tie than
others. Signs that may indicate feeding difficulties include:
For baby:
 Difficulty attaching to the breast and/or difficulty staying attached (seems to keep
slipping off)
 Feeding for very long periods - almost continuously, due to baby being unable to obtain a
good feed.
 Baby may be very unsettled and seem hungry most of the time.
 Weight gain may be poor.
For mother:
 Pain and sore/damaged nipples due to baby clamping down on nipple to keep it in the
mouth.
 Milk supply may dwindle due to baby not being able to remove milk from the breast
adequately.
 Mastitis - often reoccurring due to milk being left in the breast.
Some mothers’ and babies may have only one of these problems, others may experience more
of them and some may feed without any problems.
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What other potential problems are associated with tongue tie?
It is impossible to predict whether a baby with a tongue tie will go on to experience speech
or other problems as a result of tongue tie. Certainly some will have difficulty with speech
but the aim of this service is to help resolve feeding problems and there is no evidence to
support dividing a tongue tie of a young baby, if the baby is feeding well.
How is tongue tie divided?
Tongue tie division is a very simple procedure in young babies. It takes only a minute or so,
the baby is simply wrapped up to prevent wriggling and the tongue tie divided with bluntended scissors. Babies don’t like being wrapped up and some will cry at that point. The baby
does not require any anaesthetic or medication because the frenulum is poorly supplied with
nerves and blood vessels. Some babies are asleep when the procedure is carried out and
remain asleep.
Tongue tie clinic at Royal London Hospital –
Breastfeeding Room, 8F. Use Lift 9
You will be given an appointment to attend the clinic. It is helpful if mum can be accompanied
by partner or friend. Please allow up to 2 hours for the appointment. If you do not intend to
keep the appointment, please let us know on 07961 609 626 asap.
The baby needs to be fed immediately after the procedure so please do not feed the baby
too much beforehand. If the baby is too sleepy and uninterested in feeding – the procedure
may be done.
If your baby is not breastfeeding – please bring her/his usual milk and method of feeding
with you.
On arrival, the information will be discussed with you and the baby examined. You will then
be asked to complete an information form and sign a consent form. It is absolutely fine to
decide not to go ahead with the tongue tie division.
You may accompany your baby during the procedure or wait in the Breastfeeding Room for
the baby to be brought back to you.
Following division of baby’s tongue tie:
The baby is promptly unwrapped and returned to mother for a feed. The average length of
crying is 15 seconds. A few drops of blood are normal, but this stops quickly. Feeding the
baby immediately after division is the best way to calm the baby and stop any bleeding. The
mouth heals very quickly. There is often a small diamond-shaped white or yellow ulcer on the
underside of the tongue lasting 1 – 7 days, this does not appear to cause any discomfort and
there is no need for any dressing or treatment.
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Occasionally there may be a little bit of further bleeding at the site of the division if baby
puts his/her fingers in the mouth and catches the newly healed site or if baby is being
bottle-fed and the teat inadvertently slips under the tongue and disturbs the healing area.
For this reason it is best to avoid using a dummy for at least 48 hours after the procedure
to reduce the risk of infection.
Frequent feeding at least every 3 hours will ensure the wound heals and helps prevent the
tongue tie recurring.
Older babies may take a while to get used to their newly released tongue. If this is the case
then it will help to play tongue-stretching games with your baby.
 Poke your tongue out at baby and encourage him/her to do the same to you!
Place a clean finger, pad side up into baby’s mouth, once he/she starts sucking on the finger,
turn the finger slowly around and gently press down on baby’s tongue as you slowly withdraw
the finger. This will encourage the baby to follow your finger out with his tongue & thus give
the tongue a stretch
 Tease baby’s mouth with your nipple before latching onto breast, this will encourage lots
of rooting behaviours which include protruding and stretching the tongue.
Feedback
We are very keen to know whether the procedure improved the feeding of your baby. We
encourage you to attend local support groups and will also ask you to complete a feedback
form which we will email to you. Please make sure we have your email address.
If you have any concerns or questions following this procedure, please contact:
Breastfeeding Project
07961 609 626 or 02035942591
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APPENDIX 3 - Information for Health Professional on the Frenulotomy Procedure
Taking a History
 Read the letter from the referring professional and any notes available from other health
professionals.
 Take a full history using the history sheet of feeding ability and difficulties experienced.
 Enquire about any other medical problems especially bleeding disorders.
 Any relevant family history should be noted. Determine whether any exclusion criteria exist.
Pre-Division Discussion
 Ensure mother/parents have received the tongue tie information leaflet.
 The parents are given time to ask any questions and are then asked to decide whether they
want to proceed to tongue tie division.
 Obtain written consent from the baby’s parent using the parental agreement to investigation or
treatment where consciousness is not impaired (see GWH consent policy).
 If parents decide not to proceed they are advised to return to their midwife, health visitor, or
breastfeeding supporter with the option to be re-referred should they change their minds.
 Explain fully to the mother/parents what the procedure involves.
Inspection of the mouth
The mouth should be inspected to exclude any other oral pathology e.g. cleft palate or ranulae.
The diagnosis of tongue tie is confirmed.
Frenulotomy Process
 An area with sufficient privacy to allow the mother to breastfeed after division will be used.
 Take the baby from the parents and assure them that you will return within a few minutes.
Parents may be present if they so wish.
 All those involved in the procedure should wash their hands and apply alcohol hand rub.
 The practitioner undertaking the procedure should follow universal precautions and wear
sterile gloves.
 In a ward treatment room wrap the baby carefully, but firmly, in a towel or thin blanket.
 Position one of your assistant’s hands on each shoulder so that the baby’s head is held firmly
between their wrists.
 Using the left index finger, the practitioner lifts the tongue to place the frenulum ‘on the stretch’
and holds the lower lip down with the left thumb (left-handed practitioners will use the right
hand).
 Assess the degree of tongue tie and ensure the absence of any aberrant physiology under the
tongue.
 Divide the tongue tie as far as the tongue with sterile, sharp blunt-ended scissors usually in
one snip, though sometimes a second snip is necessary.
 Sweep the left index finger tip across the underside of tongue to ensure that the entire tongue
tie is divided.
 Briskly unwrap and pick up baby and cuddle while compressing the floor of the mouth with a
sterile gauze swab - cotton wool should NOT be used.
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




Promptly return the baby to the mother and encourage her to breastfeed immediately, giving
advice and assistance as necessary as she will be wary of the pain of breastfeeding and will
need reassuring that her baby is all right.
Ask if the feeding is better, worse, or the same as before division? Is the attachment better?
Having established that all is well, confirm that there is no bleeding or any other problem.
Write in the parent-held record as well as any hospital notes.
Inform the parents that a small white/yellow discolouration or ulcer at the site of the division is
common for a few days following the procedure. Infection is a rare complication, and parents
should see their family doctor if inflammation is seen.
The tongue tie information sheet has a phone number to ring should any problems that may
be related to the procedure occur.
Follow Up
 Details of the feeding assessment and procedure will be recorded in the baby's notes, this will
be the patient-held maternity record or if the baby has been transferred to the care of the
health visitor, the parent-held Child Health Record.
 Encourage the mother to return to her health visitor/midwife/breastfeeding supporter for
further support as necessary.
Potential Complications/Risk Management
 Very rarely, the site of division becomes infected and the baby requires antibiotics.
 Bleeding usually ceases within minutes. If it persists, the baby should be seen by a
paediatrician/GP before going home.
 Continued support with feeding should take place, usually from the referring professional, but
if necessary from a breastfeeding specialist.
Aftercare
 The practitioner, having completed the frenulotomy will inform the GP by letter (Appendix 6)
 The parents are given the Feedback Questionnaire and asked to complete and return to the
practitioner within a month to ensure that the procedure has been successful in facilitating
effective feeding.
 The mother should be informed who to contact if there are any concerns and about local
breastfeeding support counsellors and groups.
 Ensure tongue tie information leaflet has been given to the mother (Appendix 2).
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APPENDIX 4 - HISTORY SHEET AND RECORD OF FRENULOTOMY
TO SUPPORT BREASTFEEDING
Today’s date:………………………………..
Baby’s Name:…………………………………… DOB ……………………..Age…………………
NHS no:………………………...
MRN:……………………………………………………….
Mother’s name……………………………………………
MRN no…………………………………..
Feeding history
Relevant Medical History
Family History of bleeding problems? Yes/No Details………….…………………………………………….
Vitamin K given? Yes/No
Newborn Examination done? Yes/No
NB Blood spot taken Yes/No
If yes, was there excessive bleeding? Yes/No
Family History of tongue tie? Yes/No.
Details…………………………………………………………………………………………………
Examination
Tongue tie
Anterior
Posterior
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None
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Thickness
Percentage
Tongue shape
Heart shaped
Parents
Discussion
Pointed
Blunt
Dimple
Given information sheet
Consent obtained
Procedure
Done
Blood loss
None
Satisfactory feed
Few drops
Maternal comments
Small
Post procedure
frenulotomy site
Not done
Post procedure
Pressure for more than
>1 min
Notes
Assisted by……………………………………………………………………………………….
Signed…………………………………………………………………………………………..
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Printed name……………………………………………………………………………………
Date………………………………………Time……………………………………………………….
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APPENDIX 5 - DIVISION OF TONGUE TIE FEEDBACK QUESTIONNAIRE
Baby’s Name:
Date
Mother’s name
Baby’s age when tongue tie divided
Baby’s age now
How old was your baby when tongue tie was first noticed?
Were there feeding difficulties prior
to the division of tongue tie
Yes, what difficulties?
no
Following division of tongue tie did
feeding improve
yes
no
If yes, what changes did you notice? Please make any comments you wish
More comfortable breastfeeding
yes
no
Better latch
yes
no
More efficient breastfeeding?
Yes
no
Bottle fed babies feeding better
Yes
no
Baby more settled/satisfied following
feeds
yes
no
Milk supply improved?
yes
no
Baby’s weight gain improved?
yes
no
If you had been unable to breastfeed
were you able to return to
breastfeeding?
yes
no
How long did you continue
breastfeeding for?
If no longer breastfeeding why did you stop?
Family history of tongue tie?
yes
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no
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Would you like to make any further comments?
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Appendix 6 Letter to GP following
Date
Dear Doctor,
Baby name
Hospital No. ………..NHS No. …………
DOB ……………………..
Address
We saw ……………….in the Tongue Tie clinic on …………………..
Feeding difficulties……………………………………………………………………….
On examination today……………………………………………………………………………
We explained to the parent that there is evidence to suggest that tongue tie in babies who struggle to
breastfeed has proven benefit and can be done without the need for anaesthesia. We explained that there
is minor bleeding which stops spontaneously or occasionally with pressure.
They mother asked us to go ahead with division and frenulotomy under direct vision was performed.
Post procedure……………………………………………………………………………………….
An information sheet which includes post procedure information has been given to the mother and she
will receive follow up care from the Breastfeeding Team to support the feeding.
Yours sincerely
Name
Tongue tie practitioner
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