The lingual frenulum
The lingual frenulum is a piece of tissue that attaches under the tongue to the floor of the mouth. This is a normal structure, so looking or feeling for an 'attachment', 'restriction' or 'bump' under a baby's tongue, is not going to determine if your baby has a tongue tie. The lingual frenulum can be called a tongue tie, if it is overly restrictive and affects feeding. A tongue tie practitioner can assess whether the lingual frenulum is normal, or if it is affecting the way a baby's tongue functions in relation to their feeding. Babies with tongue tie may be able to poke their tongue out, but may not be able to lift it very much at all. The shape of a baby's tongue when crying can be misleading when assessing for tongue tie. An in person assessment is always necessary in order to observe and feel your baby's tongue movement, action, shape and posture. This needs to involve a lactation consultant who can assess a baby's feeding, and provide guidance of how to support breastfeeding.
Mode of birth and gestation
Birth intervention is the biggest factor that I see in my practice, as affecting feeding. Mums are often told that their baby may be tongue tied, when actually the birth interventions and gestation at delivery may be the factors that have really affected feeding. Babies born after 37 weeks by elective section or following a long induction of labour, can often really struggle to establish breastfeeding as they may have been treated as though they were 'full term'. Assumptions may have been made that they would be capable of establishing breastfeeding without the support that would have been put in place had they arrived before 37 weeks ('premature'). It is crucial that these factors are taken into account when assessing a baby's feeding and when assessing a baby for tongue tie.
A piece of the picture
Releasing, or 'dividing', a baby's lingual frenulum may be carried out if the frenulum is tight and impacting a baby's feeding ability. However, I cannot stress enough that this will be a piece of a much bigger picture. In most cases, other factors will also be impacting feeding. These can include a mum and baby's birth history, gestation at birth, feeding delay after birth, a baby's stamina to practise breastfeeding, tension elsewhere in the body, reduced milk intake...the list goes on. An experienced tongue tie practitioner and lactation consultant (IBCLC) can help unpick what may be happening and how to help a baby breastfeed well. The tongue tie procedure alone will not address these issues, and experienced feeding support goes hand in hand with assessing and treating a baby for tongue tie.