Tongue tie assessment at home

Now you are home from hospital, the most important thing for baby to develop is efficient feeding. This means that baby can open mouth wide (120 degrees) and attach to the breast and maintain the attachment for 8 -10 minutes, burp (maybe) have some more on the second side (8 -10 minutes), then settled to sleep for 3-4 hours.

Oral motor functional efficiency is a primary goal.

  1. Are you comfortable during the feed?
  2. Do you have sore nipples, blocked ducts or mastitis?
  3. Does the feed seem to go on forever (> 60 minutes)?
  4. Does the feed seem tedious to you?
  5. Is there a family member (more than just baby with current or past tongue tie?
  6. Do you feel you milk supply is dropping?

And for baby:

  1. Does baby seem comfortable during the feed?
  2. Does baby frequently ‘fall off’ the breast‘ (on and off repeatedly)?
  3. Does he only seem to drink well during the milk ejection reflex (gulping, audible swallowing)?
  4. Is baby gaining weight at the expected rate?
  5. Does he gag frequently?
  6. Have you seen the tip of his tongue extend over his gum line as far as his lip?
  7. Does baby gag frequently?
  8. Does he have a dip in the front edge of the tongue (heart shaped)?
  9. When you feel under the tongue with your finger, is the cord tight or very close to the gum line?
  10. Can you roll baby’s top lip up and his bottom lip down?

If you said yes to anything in the first 6 questions, and 2 or more in the next ten questions, a referral is warranted to a paediatric surgeon for assessment correction.

An American paediatrician, interested in tongue tie, has described it like this:

if when you feel under the tongue it seems like there is a barrier you have to ‘get over’ it’s a tongue tie; if it just feels like a road hump, it isn’t.

As a lactation consultant, I would also take the maternal symptoms into account, and as a child health nurse be concerned about the infant who was unable to drain the breast adequately, and was not efficient with feeding, or weight gain was not optimal.

Contrary to the advice in many old medical books ankyglossia does not get better with age. Some 80 year olds still have problems with it.