Infant tongue tie and bottle feeding

What is a tongue tie?

The frenulum is a piece of skin which attaches the underside of the tongue to the bottom of the mouth. A tongue tie (also known as ankyloglossia) is where this piece of skin is too short or too tight.

What problems can this cause?

Most babies with a tongue tie will have no problems at all. They can feed well and put on weight easily. Some babies can have problems with breastfeeding, and a few find bottle feeding hard. Many parents worry that tongue ties will cause problems with speech later on in life, but this is very rare.

Should my baby have treatment?

If you are worried about your baby’s feeding, you can ask for information and support from your midwife, health visitor, or infant feeding specialist.

Some tongue ties stretch over time, and some are divided (split) by baby putting things in their mouth, such as toys or spoons.

The National Institute for Health and Clinical Excellence (NICE) guidelines tell us studies have shown that dividing a tongue tie in babies who are having problems with breastfeeding can be helpful for baby, but there is no research to say that a tongue tie division will help babies who are struggling to bottle feed.

Tongue tie division treatment comes with a small risk of a painful ulcer underneath the tongue, and a very small risk of bleeding, which would then need an operation under general anaesthetic. It would be wrong to put a baby through the discomfort and risks of a tongue tie division when we cannot be sure it would help, and this is why we do not divide tongue ties in babies who are bottle fed.

What if my baby seems windy?

If milk leaks out of baby’s mouth while feeding, air gets in and is swallowed. This can make your baby very windy, and they may get more colic, or seem grumpy or irritable. There are lots of different medicines for wind, which you can either buy or get on prescription. There is very little scientific proof that these work, but some parents feel they have made a difference for their baby.

To help with wind and colic, you can try:

• taking a break when feeding, and gently rubbing baby’s back to encourage them to burp
• holding baby upright, in a sitting position or over your shoulder
• gentle massage of the tummy from baby’s right to left side
• holding baby face down over your forearm, supporting their head in your hand, with their legs either side of your elbow (tiger in the tree)

What about bottles and teats?

There are many different kinds of teats, and you will probably need to try a few before you find one which is right for your baby. The size of the hole in the teat changes how much milk can flow through. If the milk is flowing too fast for baby, milk may leak around their mouth, and so a teat with a smaller hole would be better. If the hole is too small, feeding can be hard work and baby will often tire, fall asleep, or become frustrated. A simple, soft, long teat may be easier for baby to use, but try a few kinds of teat, and use the one that seems to suit your baby.

Try holding the bottle horizontal to the ground when feeding. Tip it just enough so that your baby is taking milk through the teat, and not air. This will help to stop the milk flowing too fast. Babies feed in bursts of sucking, with short pauses to rest. With the bottle not tipped up too high, the milk can stop flowing, so baby can have a short rest before sucking again.

How do I help baby bottle feed?

Feed your baby when they show signs of being hungry. Look out for cues like moving their head and mouth around, or sucking on their fingers. Crying is the last sign of being hungry, so try and feed your baby before they cry.

Always hold your baby close to you, and look into their eyes when feeding. This helps your baby feel safe and loved. Try to hold baby fairly upright, with their head supported in a comfortable position. Brush the teat against their lips and, when they open their mouth wide with their tongue down, help them put the teat in their mouth. During a break in feeding, your baby may need to burp. This also gives your baby chance to think about how full they are, so they do not have too much. This will make over feeding less likely, and stop forcing the last bit of a feed, which may not be nice for baby.

What if the problem does not go away?

If your baby is not putting on as much weight as they should be, then please see your GP, as there could be another problem that needs to be looked at. If there are no other problems, and your baby is not putting on weight because of the tongue tie, you can ask for another appointment to think about tongue tie division, but this is very rarely done.

If you have problems when weaning your baby on to solid foods, then a referral to a speech and language therapist may be useful. If you are worried about your child’s speech in the future, referral to a speech and language therapist before dividing the tongue tie is the best idea. This is because it is extremely rare for tongue ties to cause problems with speech, and it is much more likely that there is a different cause of their speech problems.