Choosing a Tongue Tie Provider for Frenulotomy

Tips for finding a tongue tie provider (UK)

Baby tongue tieWe get asked a lot for recommendations for independent providers that treat tongue tie in other parts of the country, so I thought some discussion around helpful things to ask when deciding who to use may be useful to some.

There isn’t currently an exhaustive list of providers in the UK as UNICEF highlight; those currently available require hospitals to submit their details.  Some organisations like the ATP offer a directory that practitioners can list their details on as part of their paid membership – but there’s no requirement for practitioners to join the ATP.  Some lists only include providers who use a specific tool such as laser as per this page.

The other problem at the moment is that there are wide variations in different services offered, and how satisfied parents are with the quality of both the treatment and care received.  Some providers have a social media presence to enable communication between parents, whilst others don’t – therefore using groups and pages to ask others about their experiences and search for feedback alongside the lists can be invaluable.  Alongside the UK tongue tie group on Facebook (facebook.com/groups/tonguetie) and the Scottish group (https://www.facebook.com/groups/960034197363209) most areas have local bf support groups listed where you will find people knowledgeable about local support and services.

Parents are very often not aware there are significant differences in the service offered and so whilst the lists can give you an idea of what’s available in your area, it pays to do more digging.   Outside of a hospital setting, checking the person is trained, certified and holds adequate appropriate insurance is a given; any HP should be happy to provide copies of their documents as proof upon request.

Some further questions parents may consider asking:

1. How long is the session and what does it include?

Some services are as short as 10 minutes, others are an hour or more – there’s huge differences across the board in what is offered and for what price. For example many private hospital ENT charge £400+ plus for a short consultation and the division; obviously surgeons who haven’t undertaken further training in infant feeding aren’t able to provide feeding support, so this tends to be a very rapid service purely to snip the frenulum. They also tend to charge the bulk of their fee for the consultation, with a smaller additional fee if the tie is treated – yet a lot don’t acknowledge or release the posterior or back section of the tie, so it’s worth asking before you go so you know what to expect. http://www.drghaheri.com/…/rethinking-tongue-tie-anatomy-an…

Some midwives/IBCLCs also offer 20-30 min slots to assess and treat the tie; they may have feeding support linked via local groups or infant feeding teams, or you may be expected to find your own support to go with the treatment. This sort of service typically costs around £90-£120, although some charge significantly more.

Others offer longer one hour + slots that include taking a history, observing a feed, performing an oral assessment, discussing how the tie is impacting on feeding,what to expect afterwards, treating the tie, answering any feeding questions, if necessary tailoring support such as feeding plans to suit the family and keeping in touch as needed for ongoing support. This typically costs £150+ depending on whether clinical rooms are hired and what level of aftercare if offered via phone/email etc. Some work holistically alongside other practitioners, co-ordinate care and send information needed after the session.  As is discussed below, aftercare is the one key thing parents I spoke to felt was important; this link highlights how for some simply snipping a frenulum isn’t going to result in an instant resolution: http://www.happykansasfaces.com/…/tether-berg-or-tether-floe

Some have different options and different prices, but all should be transparent and happy to discuss what is included.

2. Do you perform a thorough functional assessment before treating tongue tie? (NICE Interventional procedures guidance [IPG149] 2.1.2)

NICE state:

“Many tongue-ties are asymptomatic and cause no problems. Some babies with tongue-tie have breastfeeding difficulties. Conservative management includes breastfeeding advice, and careful assessment is important to determine whether the frenulum is interfering with feeding and whether its division is appropriate.”

It seems obvious that someone would check the tie is likely to be the cause of the problem before it’s revised, yet this isn’t always the case.

3. What happens immediately after the procedure?

Some services treat the tongue tie, give it a moment to stop bleeding and then send parents on their way to feed elsewhere. Some provide a space such as a corridor or waiting room where parents can go. Some build in time for parents to calm, feed and get baby settled with the support of the midwife/IBCLC, with further space to continue feeding beyond the appointment if necessary.

4. Do you offer follow up appointments and what’s involved?

Most practitioners will be happy to provide a free follow up to check the wound site if you have any concerns about healing or reattachment – but not all. For some babies snipping the tie is all that’s needed, other times ongoing support and help is needed, as per the happy Kansas faces link above.

Some offer feeding support follow ups where parents can get more in depth help or ongoing help beyond just the tie – this can be really important for some parents.  I asked a few people who had been through the tongue tie journey what they would ask or do differently,  I’ve added a few below but aftercare was mentioned by everyone:

Kat says: I would ask about their experience dealing with posterior tongue ties. We saw two providers (one NHS & one private) who tried to argue against further revision because it would need a general anaesthetic and there was a significant risk of “bleeding out”. My son had insufficient growth requiring hospitalisation as a result of the posterior tie, it was only when it was released (without GA and without heavy bleeding) that he quickly begin to gain weight and catch up. We’ve since learnt others were dissatisfied with the treatment they received at the same clinics and the information given was not evidence based, it was really difficult at the time not knowing who or what to believe.

Sarah says: I’d ask if they were IBCLC, how long they had been treating tongue ties and whether help was on offer in the hours and days after the treatment. My baby was really fussy for the first 24 hours and being able to text and pick up the phone to check what was normal and get extra expert help was invaluable.

Lisa says:  I just wanted the tongue tie treating ASAP as I thought that would be the answer to everything.  I wish I had spent more time looking at different options and not rushing in.  We had no support when it didn’t instantly fix our problems and overall things took much longer to sort out.

Do you agree and what other tips would you share with parents?