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Knowing when your baby wants a feed and responding to them before they get upset and start to cry is a gradual thing, but keeping them close to you will help you with this learning process.

"All babies are different, so it's important parents watch their baby and look for their particular cues," says Inge.

Click through the slideshow for some of the most common cues - these include:

Another one to look out for is babies opening/closing and moving their eyes.

In time, you'll also learn what signals your baby has to say: "I'm full now, thanks!".

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Knowing when your baby wants a feed and responding to them before they get upset and start to cry is a gradual thing, but keeping them close to you will help you with this learning process. "All babies are different, so it's important parents watch their baby and look for their particular cues," says Inge.

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Tongue-tie in Babies:A Guide for Parents

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Tongue-tie in Babies:A Guide for Parents

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Stories of tongue tie in parents own words

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On one fairly routine day for a postnatal doula I found myself ringing the doorbell of a potential client. Her baby was 2 months old and she wanted some support with the baby while she rested. As I greeted her and cast my eyes around the house, I could see with a glance that all was not right.

Usually by 8 weeks in, mothers are getting into the swing of things, feeding is more or less established, baby's sleep and waking patterns becoming slightly more predictable. Generally by now, they are waving goodbye to their postnatal doulas, not calling one in.

It only took me a moment to get an idea of what had been occurring here. One look at the baby and my heart sunk. There was the characteristic heart-shaped tongue. As I looked more closely I saw the flash of frenulum I have become so familiar with. It was attached right at the tip, tethering his tongue cruelly to the floor of his mouth.

As she gently touched the bottle teat to her son's mouth, I watched as he drank greedily but in an uncoordinated fashion, milk dripping from the corners of his mouth. Diplomatically I asked how things were going and listened carefully as the whole, sorry story spilled out.

Many reading this will be all too familiar with her tale. After a worrying start with her newborn not latching, readmission to hospital for weight loss of over 10%, the introduction of formula top ups and finally a diagnosis of tongue-tie at 4 weeks by a Health Visitor at a breastfeeding drop-in, she was now waiting a month for an appointment to have the tie divided on the NHS. Of course, during that month her supply had dipped more and more, with formula becoming an increasingly large part of her son's diet - until I rang her doorbell that day, a few days into exclusive formula feeding.

The largest part of a doula's work is listening. We listen to the stories of mothers and fathers; the narratives of the birth, the emotions of new parenthood, the highs and the lows of life with a baby. But that day I realised I'd listened to one too many tongue tie stories. It was time to give all these women a voice. I came home and announced on facebook that I wanted stories from parents about their tongue-tied babies. Not even I could have predicted the pain and suffering that appeared in my inbox over the next few weeks.

Much has been written about ankyloglossia, commonly known as tongue-tie, in infants. The controversy surrounding this subject has been well documented and, despite NICE guidelines stating that the impact on breastfeeding warrants the tie being released, many health professionals remain ignorant of the obstacle that this small oral anomaly can present to successful breastfeeding.

A quick search of an online medical dictionary returns this simple definition.

tongue-tie Function: noun: a congenital defect characterized by limited mobility of the tongue due to shortness of its frenulum

Here's how the National Institute for Clinical Excellence defines it:

'Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterised by an abnormally short lingual frenulum; the tip of the tongue cannot be protruded beyond the lower incisor teeth. 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. Breastfeeding difficulties may arise as a result of the inability to suck effectively, causing sore nipples and poor infant weight gain.'

Why does this insignificant-looking frenulum cause all this debate? Generations ago it was a well-known routine procedure. These days, it seems, it's very existence is often questioned. Certainly the medical literature seems to suggest that tongue-tie doesn't affect breastfeeding.

Mervyn Griffiths, a pediatric surgeon who practices at Wessex Regional Center for Pediatric Surgery in Southhampton is a leading light in the field. Back in 2007, his prospective double-blind, randomized controlled trial seemed to prove both the critics and the textbooks wrong.

In the trial, two groups of babies were immediately returned to their mothers for breast-feeding, either after division of the tongue tie or without treatment. During interviews, 21 (78%) of 27 women whose infants received treatment said breast-feeding had improved compared with 14 (47%) of 30 mothers whose infants were not treated. The experiences of 3 women were excluded because of a loss of blinding. The results were statistically significant ( P < .03).

Follow-up surveys a day later found that 90% of mothers reported improved feeding, with 3.3% reporting a full resolution of problems. Repeat interviews after 3 months revealed that 90% of the mothers still experienced improved feeding compared with their pre-surgical experiences, but now 55% said that their breast-feeding problems were fully resolved.

Pretty impressive, eh? But it seems that many in the field are not singing from the same hymnsheet, despite NICE Guidance:

'1.1 Current evidence suggests that there are no major safety concerns about division of ankyloglossia (tongue-tie) and limited evidence suggests that this procedure can improve breastfeeding. This evidence is adequate to support the use of the procedure provided that normal arrangements are in place for consent, audit and clinical governance.'

When asked for their stories, mothers bear out the research; tongue-tie is by no means a simple subject. The impact on breastfeeding can range from no impact at all to the complete cessation of breastfeeding. Add to that the fact that problems do not correlate in any neat fashion with the severity of the tongue-tie and it's hardly surprising that many parents find it difficult to find anyone who can help them get to the bottom of their breastfeeding problems.

But all this jargon, all this abstract talking about frenulums, breastfeeding difficulties and 'division' hides the real stories from the trenches. And 'trenches' seems like an adequate image for it appears there's a war going on; between the pro- and anti-snippers. Thing is, it's the parents and babies who are all too frequently stuck in no-man's land, caught in the crossfire.

The following stories are all from ordinary mothers from a variety of backgrounds, all of whom assumed they would be able to breastfeed. All have given permission for their words to be used, many with their own names attached. Many told me how passionately they feel that other mothers should not have to go through what they went through.

Here's the first story I received when I put out a plea for stories through my online networks. A major theme here is how confused this mother felt and how she was blaming herself for the pain that feeding was causing her. It also throws up how a 'lay' supporter is often the sole source of emotional and informational support the mother receives. This lay supporter is an Association Of Breastfeeding Mothers Breastfeeding Counsellor. ABM is a charitable breastfeeding support organisation in the UK. Other Charitable breastfeeding organisations mentioned in this article are Breastfeeding Network, La Leche League and National Childbirth Trust.
"...My baby is 6 months old. I was told she had a tie very soon after birth as she didn't want to feed, which was then checked by the 'expert' on the ward...who said no tie was present. After weeks of pain and strange clicking noises C came out and confirmed a tie. [She] got the baby café person out to confirm who said yes there was one but they may well not do anything about it and I would really have to fight my cause at the hospital but she would get us an appointment. The appointment happened - the consultant took one look said oh yes I can see a tie and snipped it."
When I asked her how she had been feeling at the time, she said,
"Confused!!! ...I thought I trusted the 'expert' as that's how she was sold to me and I was rather knackered as I had a somewhat difficult birth. It wasn't until Charlotte came round and showed me what she could see and put it in a way I could understand that I believed someone else. To be honest I thought it was me.... I didn't know the clicking was a sign. Various midwives had watched me feed and not said anything and I had complained about pain but none of them mentioned it.
Once it was confirmed but I was told they may not do anything I felt rather deflated to be honest. I had gone from struggling to continue with feeding and thinking I was going to have to give it up and after my birth not going anywhere near even my worst case birth plan I really wanted to do this and it was the only thing I had left that I felt I had control of if that makes sense?
After they just snipped it there and then it was relief I guess. We went back to the car and I fed her and she latched on and the pain was gone and the clicking noise disappeared as she got the hang of it again."
Emma Higgins

Here is a mother whose breastfeeding relationship was entirely broken by an undiagnosed tongue-tie. Despite support to fine tune her baby's latch, her pain continued. In a culture plagued by the myth that 'breastfeeding hurts', it seems that no-one took her on-going agony as a sign of anything untoward. Her feelings of depression, impeded bonding with her baby and presumably the knock on effect on her partner and wider family show the wider implications of breastfeeding problems.
"My son was diagnosed with a tongue tie at 4 months old. From the word go breastfeeding him had been agonisingly painful throughout every single feed and my nipples were in shreds from the first day. We had been seen by three midwives, our regular health visitor, and an NCT breastfeeding counsellor, none of whom had spotted the tie (in fact I don't think anyone had looked in his mouth). In hindsight it was blatantly obvious - the classic heart shaped tongue which he never lifted - but as a first time mum I naively thought that was how a newborn baby's tongue looked. He also used to fall asleep and slip off the breast, he would fight and fight when I attempted to latch him on, it was really really difficult. Unfortunately by the time the tongue tie was spotted we were already well down the road of mixed feeding. From the second week I had begun to express milk and was mostly bottle feeding him this and formula, with some breastfeeding when I could stand it. Ironically breastfeeding was becoming easier by the four month mark but of course my milk supply was shot to pieces as I had so little useful support. We gave up breastfeeding shortly afterwards when he went on nursing strike during a cold.
The emotional impact of this was huge. Finding out there was a tongue tie was at once a relief and also a huge frustration. I was told, however, that the policy in the area was not to snip tongue ties so I wonder if it would have been even worse had I known. More important, I would say, was the emotional impact of finding breastfeeding so painful and yet having everyone insist that they could see nothing wrong. I felt so guilty for being unable to do what nature intended, I would be in tears whenever my son wanted feeding because I dreaded it so much and I am sure I developed postnatal depression as a result (having being diagnosed with this after my daughter's birth I recognised the feelings from before). It most definitely affected my ability to bond with my son in the early months, which is something I bitterly regret to this day."
Sylvina Tilbury

This story thankfully has a happy ending, showing that a helpful companion can make all the difference. Doulas are lay companions, or 'peer' supporters, not lactation specialists (although many are also breastfeeding counsellors) so it is not within their boundaries to diagnose anything or advise any particular course of action. This doula provided emotional, practical and informational support.
"When my little girl was born she couldn't feed and all of the doctors and midwives put it down to her being sleepy from labour.
The problem first seemed to arise from my midwife writing in my notes 'baby fed at birth', which she didn't. We had a doula with us who spotted that Mia had a small tongue tie straight away and said that it could be a reason for Mia being unable to feed. The next day we had our follow up and mentioned the tongue tie to the doctor, who said it was so small it shouldn't cause a problem. Mia continued to try and fail to feed, she just couldn't quite seem to open her mouth properly, and only had one 'successful' feed where a midwife forced her on, she fed a little and then my nipples bled straight away. The hospital were going to send me home, but I asked to stay another night because she hadn't really fed. The next afternoon after seeing no improvement, and no one seemed able to help, we checked out, and went home. [After] another night of Mia not feeding, and more doctors saying the tongue tie was insignificant, our doula gave us the number of a private tongue tie consultant who we saw the next day. He snipped the tongue tie, we took Mia into the next room and she fed straight away! Unbelievable. She lost [a significant amount] of her birth weight in those first two days. I breastfed for a year after that, but would not have been able to breastfeed for a day if we'd listened to the doctors... It was really confusing having the two different opinions, because with the doctors being medically trained you'd hope you could have more confidence in what they were saying...On the second night we had to take Mia to A&E because she looked like she was really starting to suffer...the doctors gave her a bottle of formula and said because she had fed from that the tongue tie wasn't problem. I think it was not being able to find one single doctor or midwife out of so many hat would listen to us that really made us feel so frustrated and angry, and to be treated like we had no idea what we were talking about.
My husband just felt the same, frustrated and angry because it seemed they were wrong and just not paying attention to what we were saying. After telling one doctor in A&E about the tongue tie, he told us of course it wouldn't make a difference, and then he came back an hour later with information printed off the internet which discussed how tongue ties did in fact make a difference, but then still did nothing!"
Emma

Here is an assertive mother who experienced what many believe should be routine - the tongue-tie spotted at birth, information provided on the possible implications and options for treatment or 'watch and wait' and counselling though the informed decision-making process.

"My son's tongue tie was picked up the day he was born by a midwife on the high dependency unit...but then I had conflicting information from several other midwives and doctors...I knew it needed to be cut, he couldn't protrude his tongue at all and within a day my nipples were sore. As a second time breastfeeder and being of a medical nature (I'm a vet) I was confident enough to push and push for it to be snipped and got an appointment with the only person in the hospital qualified to snip it (!) on day 3. I chatted to another mum in hospital...who had been told her baby needed an "operation" to correct his tongue-tie and was terrified, she was already at the point of giving up breastfeeding because she was sore and was not prepared to put her baby through an operation in order to rectify the situation.
It can be so simply sorted, it should be something that is checked for in the new baby checks and sorted immediately."
Jenny Rawling

This next comment is from a client of mine - I am a birth and postnatal doula as well as a breastfeeding counsellor. This mother is a medical doctor, so did her research when I suggested that it might be useful to have her daughter's tongue evaluated by an expert. She decided to call the IBCLC (International Board Certified Lactation Consultant) I recommended and the tie was divided privately soon after she came home from hospital.

"What I would like to know, however, is why checking for tongue-tie isn't part of the baby check. I'm still baffled why Martha's hearing had to be tested before she left hospital, but nobody wants to check if there might be a potential feeding problem, it is so much more urgent. If a tongue-tie is identified, extra attention is clearly required!"
Vicky

Perhaps Vicky has identified a vital point here. Maybe it's not breastfeeding that is seen as crucial by some working in the health service, but any feeding? Is the widely accepted belief that 'if the baby can't breastfeed, formula will do no harm' informing practice?

Here is a story of such trauma and suffering that she must be one in a million to have carried on feeding through so many bouts of mastitis. Why do women put themselves through such suffering? I sincerely believe it is because women are 'driven' to breastfeed. It is a biological imperitive; an activity that goes to the heart of how we define ourselves as mothers. For many, failure is just not an option.
"Daughter born in November 2009, was aware immediately of feeding difficulty (I fed my older two children so I knew that it felt all wrong). Wasn't believed, told it was just positioning and attachment blah blah.
By 3 weeks I had suffered all the usual trauma - cracked, bleeding nipples, mastitis and my daughter had disgusting, smelly, frothy green nappies. I can't quite remember the timeline now but the 'short' version is: Asked midwives - told latch looked fine, no problem. Asked health visitors - told no problem. Asked GP - told no problem (had phoned a LLL counsellor and described everything who agreed with me it sounded like tongue tie). Got referral to paed - eventually appt came through - yes there was a tie but it was 'small' and likely to not need anything done. (Daughter was thriving but I was on my second or third bout of mastitis by that point and in a LOT of pain with feeding). Referral to Infant Feeding Advisor specialising in tongue tie - told no tie. Was attending breastfeeding groups left right and centre, one was attended by a HV who used to be a MW. She agreed - posterior tongue tie. Another referral to another infant feeding advisor, YES - there was a tie but 'small' etc etc. Old news by now. Fourth or more bout of mastitis. Told I might as well give up breastfeeding. (Definitely did not want to give up although was really really upset by now). Another referral to paed ENT consultant - yes tongue tie but now she's 6 months old, might as well not operate. I nearly cried. He asked how much longer I was intending to breast-feed. When I said indefinately, he changed his mind and said the op was worth it if I was carrying on but not if I was going to switch in the next few weeks. Op was booked, daughter was ill so I cancelled it. Secretary called back a couple of weeks later with another date (daughter 7 months old by now) which I declined thinking - well we've managed this far on our own, I might as well just carry on now. Promptly got another bout of mastitis, regretted cancelling the operation but left it anyway. Daughter is now 17 months and has just finished feeding from me. It was a huge trauma to me and if I hadn't been so bloody-minded and had such faith in breast-milk and such strong feelings against formula (despite my older 2 both receiving formula milk after a certain point), I would have caved under it all...
My husband was very supportive (he has learned over the years!). But - he thought it was an awful lot of hassle and doesn't really FEEL how I feel about breast-feeding. My older kids were probably reeling anyway from the addition of the baby but it made things difficult having to find a way to get appointments while dragging them around with me. Especially when I was getting nowhere fast. Quite a few appointments left me in tears. I cried a lot."
Debbie Gilmour.

Here is another example of multiple care-givers missing the tie.
"My son is now 11m. He was born at 37+8 by elective caesarian section. He was readmitted to hospital twice after discharge - on day 5 and day 21 due to prolonged jaundice and poor weight gain. I had breastfed two babies previously so wasn't really worried about the whole feeding cycle. From the beginning the community midwife team were pretty much on my back about the... problems, though I wasn't worried. Both times on readmission to the children's ward, we were observed and told that we were feeding correctly. At some point between the 2 readmissions, baby and I developed thrush. Obviously this did not help, and in time we were directed to a breast feeding support midwife...When baby was 7 weeks old we attended her drop in clinic. Within 30 seconds of seeing the baby she diagnosed tongue tie. We returned the following week to have the tie snipped. I noticed improvements to feeding almost immediately, though the thrush did take a while longer to clear up.
I had seen various midwives, the health visitor, the clinical director of paediatrics and other staff on the children's ward, none of whom had noticed the tongue tie. The breatfeeding midwife was excellent throughout. She did say that some paediatricians don't recognise the link between poor feeding/weight gain and tongue tie. 11 months later, I still feel sad and angry that this was missed, and as the rough start we had.
Stacey

Here is a story that shows that tongue-tie doesn't always obstruct successful breastfeeding. This experienced mother and her baby worked together to find what worked for them.
"Ben was born...in a water pool in our back room...
I knew breastfeeding would be a journey again although I had the experience of feeding the others long term... It was [our midwife] who when looking over Ben noticed his tongue. It is attached right to the end so he can't stick it out very far and his tongue makes a heart shape where his frenulum pulls on it. I knew from past experience that because of a partially inverted nipple it was easier to breastfeed on the right hand side but it was possible on the left so we gave it a try. As with anything new it took some time to dance to the same tune. [Our midwife] helped a little with positioning Ben and gently we began our new dance. At that point in my life I had not heard much about La Leche League so I didn't have much support at all but didn't need it too much either. It was really a journey of trial and error... Ben found the right hand breast more satisfying to feed from and so although in the beginning we fed from both sides as time went on he fed less from the more difficult side so I ended up feeding only from the better side for a long time until he was over two and ready to move on to different things.
I think I would have used information to support me like the LLL info on breastfeeding with a
tongue tie...Had it been our first child I think I would have needed much more support and encouragement."
Kirsten

Conversely, this experience exemplifies the many problems that tongue tie can cause - not only with breastfeeding.
"My second son, Jacob, was born with a tongue-tie. At birth he was very sleepy and did not wake in order to initiate breastfeeding, despite skin to skin. He was born at home so the midwives returned early the next morning. He had fed in the night but I knew his attachement was poor as the feeds were already hurting. When the midwife did the newborn check I said he was tongue-tied - my nephew was tongue tied and I knew Jacob's tongue looked strange so I googled it. It was such an obvious tie. Unfortunately because it was the school holidays the breastfeeding clinic that refers to the surgeon for frenulotomy was not on that week. Despite asking midwives for help it was not long before I was dreading every feed, not wanting to hold my new son as I just associated him with pain. I already had the beginnings of post natal depression and dreading every single breastfeed, which were approximately every hour (sometimes just constant feeding!) I did not bond with my baby.
When I was able to get to the breastfeeding clinic the lactation consultant...was fantastic in helping me with my positioning. Feeds were still unbearably painful but at least they were not lasting for an hour at a time. By day nine I had developed mastitis...I contacted the midwives and she suggested antibiotics...
On the Tuesday we got a call to say Jacob's tie could be cut the next day. I knew the procedure was supposed to be quick and relatively painless but I still worried about my poor baby. I remember sitting in the waiting room, thinking I would feed him after it was cut. He was desperately hungry but I did not want to feed him in the waiting room as there was no way I could do so discreetly...
The surgeon explained the procedure fully, I consented and left the room whilst my husband held our 12 day old baby. In seconds they were out the room, leading me to think it hadn't been done. The cry did not change from a hungry to a pained cry. I took Jacob into a little room, removed the swab that had a smear of blood on it and fed. I was expecting an immediate change to his feeding, but after two weeks of poor attachment it took a further four weeks for us to learn to breastfeed effectively and for my nipples to fully heal."
I have often heard that the breastfeeding problems that many mothers put down to tongue-tie are merely ignorance of how to latch a baby on. A story of twins exemplifies how a mother can feed one baby perfectly and have trouble with the other.
"I had twins by planned section at 38 weeks. Both were good sizes...I planned to breast feed them as I had fed my daughter. In recovery, I fed Max who latched straight away, he was a natural. Tom though was a different story, he kept falling off my breast and they put it down to him being 38 weeks and a bit sleepy. For the next 3 days this happened again and again, I managed to feed him once for 20 minutes at which point I was allowed to go home... When I got home, I spent the next 24 hours feeding or trying to feed constantly. By this point my nipples were cut to shreds and I was bleeding from Tom's attempts to feed. I couldn't physically latch either boy any more without being in howling pain and distraught. Exhausted at 11pm, I got out my breast pump and bottles and started expressing. The midwife that visited me at home just smiled and put my abandonment of breast feeding down to having twins.
Two weeks later, the health visitor came to see me, she spotted Tom's tongue tie and offered to relatch both of the boys onto me. By then I had an expressing routine that was working so I declined. She did tell me that the tie could be cut but only if I went back to breast feeding. Emotionally I was a wreck and felt that it was one too many things for me to take on board. That said, I felt I had failed..."
Natalie

The follow story is a reminder of how undermining and hurtful comments from well-meaning helpers and care-givers can be. This mother remembers these comments still, even months later. I met this mother in person at a mother and baby group and I was truely moved by her story - and in awe of her expressing milk in such quantities for such a long time.
"My baby Harry was born in October 2010 and I was desperate to breast feed him. I had been along to an NCT breastfeeding evening a couple of weeks previously where breast feeding had been presented as natural and easy so I was also excited about the prospect of feeding my new baby. To my dismay the reality of breastfeeding was not an exciting or bonding experience for me and my baby. I found that I was not able to satisfy Harry's hunger at all despite my best efforts...I was feeding for 7-8 hours- till at least 4am until both baby and I fell asleep exhausted. I would then start feeding again shortly after for a similar amount of time. I couldn't go out because once he started to feed I knew we would be there for many hours to come. Harry was never full. He screamed constantly. I was exhausted, drained, confused and emotional. I called out a few midwives to my home and was told I had a lazy baby or just a hungry baby. One midwife even joked that I had a bad one and should send him back! I was advised to 'top him up' with formula but I found that as the weeks continued I was having to give him more and more formula when I really wanted to feed him myself. Finally I went along to the Breastfeeding drop-in where Harry was immediately diagnosed with tongue-tie by a lovely and supportive lady. I had the tongue tie cut almost immediately. Unfortunately at this stage Harry was 3 months old. Once his tongue-tie was cut I was eager to continue breast feeding however my milk was in short supply since Harry had not been able to suck effectively and keep up the demand for milk. I hired an electric [pump] to try to boost my milk supply and only had 10ml when I first expressed. I had to continue to give him formula to feed him. Emotionally and practically I couldn't go back to feeding him for hours without a break and I didn't think it was fair on him who, at 3 months old, was starting to be more aware of the world and wanting to exlplore. Sadly, by the time I had increased my milk to a stage where Harry could gain some satisfaction he had lost his latch and wouldn't accept the breast. This caused much upset. Harry is now 7 months old. I am still expressing milk 5-6 times a day and then feeding him through a bottle. It is frustrating but I am determined to give him all the breast milk I can. The struggle to feed my baby affected my initial relationship...and has left me feeling guily and inadequate as a mother...Tongue-tie is something that is so simple to treat and I hope and pray that no other mothers have to go through what I have been through."
This mother is a Breastfeeding Network Helper and feels perhaps she had less support from staff because of her 'qualification'.
"Because I have breastfed before, the midwives didn't stay to check that Tansy was latching on. Having spoken to other mums about this I don't think they realise sometimes that every baby is different and it's not just a first time mum that may need assistance! So, the girl wouldn't latch on. I managed to get her to comfort suck one night (day 4), but only when she was really sleepy. The rest of the time I could only get her to latch on if I jiggled her constantly... It was as if whenever she got close to my nipples she was screaming 'no! not those!' ...I was lucky enough to see my BfN supervisor on day 3...Come day 5 and I was wishing that I'd asked the midwives to come back before, as I was convinced that she had lost too much weight but had no way of knowing. And everyone I spoke to about it told me not to worry, that she was doing just fine. But I didn't think she was - she was alert when those reassuring me saw her, but sleeping so much more than I expected, not very with it most of the time that she was awake. I just felt that things weren't right. Thankfully the midwife that came to get her weighed had worked in SCBU so was used to seeing very poorly babies, and she could see that we had realised what was going on and had begun addressing the problem - I had started hand expressing a larger amount and cup feeding the previous day. So she wasn't too concerned about the 14% weight drop, and felt it wasn't necessary to take her in to hospital to get her checked out. But then she was overruled by the hospital. She reassured us that we didn't *have* to go in, but the doctors would like it if we did, and that it would only take an hour or so. Then when we got in they took forever to get round to getting the test done and off to be processed - I felt like screaming at them when they said the tests were going to the lab...They wanted to see her drink 2oz before they'd let her go, and I had to point blank refuse a bottle...before they gave me a feeding cup. They wanted me to give her formula, until I expressed 4oz and then they backed down. I'd just managed to get her to have 2oz before we left to take her into hospital, so there was no way she'd be doing that again any time soon. They demanded that I wake her up, not hanging round long enough to realise that it wasn't working, and it felt like they were accusing me of being too soft, not doing it right, that sort of thing. The registrar on duty was Indian, and his use of the English language, while perfectly fluent, was very much 'you must' and 'you will'. He insisted that we admit her overnight and I point blank refused. I think it was only because I knew he was going off in a couple of hours and someone else was taking over that I was coping with the idea of hanging around and getting another opinion. My husband was being supportive to a certain extent, but even he wasn't letting me trust my own instincts fully. Anyway, we saw a consultant when the shift change happened...we were able to talk to him...which was good. But after he'd gone he realised that he wanted to check whether she had a cleft palate, and my baby blues was getting the better of me big time, we'd been there 5 hours by this point. So I went home and left hubbie with the girl to get the oral stuff checked out. So I wasn't there when it happened, but I somehow presumed that because he'd given the all clear on the cleft palate then he'd also checked for tongue tie, and that stuck with me. Checking my forum writings at the time, on day 8 I have written 'Oh, and tongue tie has been checked by several different people, it's not that.' Also I note that I talked about getting an SNS feeder at this point too, and by day 13 I have suspected a high palate. ...Tansy begins to feed properly. And then we have painful latch issues beginning to emerge. Creases on nipples and blisters. Taking forever to feed. Considering nipple shields but when I finally give in then I find she's worse. I go back to using SNS, but this time as a finger feeder. Day 19, I write that the GP says she doesn't have a high palate.
I write ' The problem I seem to be having now is that I am struggling to find a balance between everything that is being expected of me...What I'm doing right now is expressing everything, and using the SNS as a finger feeder, to give my nipples a break. I've been expressing while I've been finger feeding...realistically I need to face the thought that I might not be able to feed her myself. It may be that she and I will never learn to nurse together. I think that is what is worrying me most. If she continues to not be able to self regulate then she may always need to be 'told what to eat'. I figure that the more relaxed I am the easier my milk will come, and there's def something blocking it atm...
Day 22 I have someone tell me that it all points towards tongue tie, and that I should get a further opinion, and to google posterior tt, if there's nothing obvious. She is LLL [La Leche League] and training to be a Lactation Consultant, I later find out. HV (not my normal one ) admitted that she wouldn't have the knowledge to know whether it was posterior tongue-tie, so didn't even bother looking, but instead recommended I make an appt with my GP. Huge frustrations then when I speak to GP - she says that she has less experience than HVs in this area, and made me an appt with a senior female GP who she thinks is more likely to know. But she doesn't know who to refer to if that is the conclusion that is arrived at. Hubbie looks into it online and reports that if there are no issues with weight gain then they are unlikely to do anything - I translate this as meaning they won't do anything for us and start to feel angry and frustrated. Now that tongue-tie is mentioned on the forum, I get reassuring stories from other people too, about getting second opinions and it gives me hope. Day 26 - I finally manage to take and put some photos up for the LLL lady to see...I don't know if I've managed to capture anything useful, but she detects a tight frenulum...so this gives me more hope that this is indeed a problem that can be fixed. And then that night I completely lose the plot. I can't face the thought of the GP appt in a few days time, her telling me that there isn't a problem. What do I do if that's the case? I am exhausted and my pump starts to play up, my hubbie is out drinking with some friends and I have to go pick up him up coz I feel like I can't cope, just being in the house alone with Tansy and my emotions. Somehow it felt better having him there, snoring his drunken head off next to me! I calm down but in the morning we talk... In amongst all of this I have had some wonderful support from someone who had very similar experiences - she suggested it might be tongue-tie early on but I said no to her as well, as I had had several Health Professionals tell me otherwise. Went I finally concede that it might be tongue-tie she tells me her story and points me in the direction of the LCGB site; she couldn't wait 3 weeks for a referral and went private, and suggests that I might find someone local to me that might be able to help. So, day 27, hubbie convinces me to contact local tongue-tie divider and the Cambridge lady replies saying she's in australia right now, but refers me to [an LC] in London. I emailed...and next thing I know, she is visiting someone in Cambridge the following day and can come see us too. Day 28 and she arrives. Here's what I put on the forum about her visit: 'So she arrived on Sunday morning, asked lots of questions, and did lots of assessing of different reasons why T might be having problems. She gave me a long list of symptoms to check against what I was experiencing, and I think I ticked about 80% of them, including several symptoms I hadn't really been aware of (or wasn't aware they were feeding issue symptoms) before thinking about them then! So, additional symptoms that I can remember were - nipple goes white and cold after a feed, bruises on the areola, small mouth gape. She also advised that T's lopsided yawn is an indication of why she feeds better on one side than the other (and recommended an osteopath to resolve), and confirmed my suspicions of a high palate (even though gp said was normal). The kind of tongue tie that she has is submucosal, which I have since googled and found that the common name for this kind is 'hidden tt', and it's the most likely to grow back. The procedure itself was very quick and simple, and she instantly latched on afterwards with a much improved gape, and it felt so much better. The LC lady showed me how to get more breast into the mouth...She was more like 'okay you don't have a perfect baby here, so you're going to have to make these adjustments to help out' kind of an attitude. Very refreshing. She fully appreciated that the 'nose to nipple' thing just wasn't working for us, as T wasn't trying very hard to latch on, so talked more about how to get that position after managing to get her settled on the breast, instead. So... feelings at this point? Feeling very let down by the NHS system - and just because I'm not completely falling apart when they see me doesn't mean that I'm not in need of more help from HVs who just keep telling me that I'm doing really well. If I didn't have my huge network of support online and through texts from BfN colleagues then I don't think I could have gotten this far. I can really see how some women don't. When I see my HV the next week and she rather flippantly says 'oh yes we refer people to the norfolk and norwich all of the time' I feel angry that she had this information but her colleague didn't, the GP didn't, etc. At our 6 week checkup we spend a lot of time talking about the tt - she admits that they are taught tt doesn't cause a problem for bf, and is really keen to hear what I have to say about it. Which is nice...
[Tansy's submucosal tie needed re-snipping a month later] Since then her weight chart says it all - a noticeable leap not just back to where she was (just under 50th line) but slightly over (between 50th and 75th)..."
Kirstine

Here is another story of a doula providing the gift of signposting to an expert.
"Day 1: Our doula, S, put Sasha on the breast immediately after being born and she was feeding well. She also made sure that she got a good few feeds after the birth and before we all went to sleep. The hospital midwife checked breastfeeding before we left the hospital... Day 2: On going home things seemed to be OK and having S around helped give confidence that things were fine.
Day 3: I realised that something wasn't right as I was having problems latching Sasha on and my nipples were getting very sore. S came around and we tried different positions. She suggested that Sasha might have a posterior/sub-mucosal Tongue tie and suggested we have a lactation consultant look at Sasha.
Day 4: An NHS breasfeeding [support worker]...came out and said that Sasha didn't have a tongue-tie and was feeding fine. We tried some other positions but nothing improved. S kept in touch and since things weren't improving [we] contacted the lactation consultant. Day 5: [The Lactation Consultant] came out, diagnosed aposterior/sub-mucosal tongue tie and carried out the procedure. After feeding Sasha after the tongue-tie my nipples were so sore that I had to give them a rest so started expressing around the clock until they healed before trying again. I couldn't face breastfeeding with the pain but didn't want to go on to formula so kept up with the expressing every 3 hours - a 24 hour dairy operation for about a week.....all this while boobs were out and smothered with lanolin to heal. After about a week, started breastfeeding again. It wasn't easy but it did improve. I waited until I had a post-natal doula, K, come and help me. For the first week things seemed to be going OK and by the end of that week I thought that we had a turned a corner. The following week however, Sasha started bobbing on and off the breast alot and I was struggling and in pain again. K noticed a change from the feeding she saw during the first week and recommended I go to a breastfeeding support group in Queens Park...We tried all sorts of different positions and by the end of the session [it was] thought that Sasha's tongue tie had come back. I was so upset I burst into tears. Hormonal and sleep deprived aside, the thought that Sasha would have to be snipped again, and the whole episode of expressing and nipple trauma would be repeated again was just too much. I called [the Lactation Consultant] immediately and she came out the next morning and snipped Sasha a bit deeper. She spent some time with positioning during feeding and told me to go out that day and breastfeed Sasha somewhere in public. Between the tears, I laughed as this was something i had never even contemplated before as I was not confident and needed so many pillows that it would be embarrassing. My mother-in-law was around that day so we went together...I did it which made me feel so positive! I have to say that as determined as I was to breastfeed, without the support of privately paid helpers, I don't think I would have been able to persist with breastfeeding...The NHS talks about supporting mothers to breastfeed but they don't seem to have the expertise and/or resources to do this...
Sasha was breastfed exclusively until she was about 8/9 months old. She is now almost 1 and getting better with solids. I have dropped the night feed as she started sleeping through the night at about 10/11 months and am still breastfeeding her now....once again thank [you] S, K and all the others I have mentioned above for their help support during that difficult time.
Helen Stanwell

It seems that parents are attempting to negotiate the maze of tongue-tie advice and treatment (or lack of it) on a regular basis. The twists and turns, dead ends and set backs that beset many of them can cause great emotional suffering, made worse by wondering why on earth they are being told such different things by different people.

It seems that parents and breastfeeding supporters may need to understand where a great many health professionals stand on the subject of tongue-tie. Here's what one doctor has to say on the subject:
"[I have] no idea what med students are taught now about tongue-tie but present received wisdom is that it doesn't exist.
I have to say I was of that opinion until I saw a mum...who had had a previous babe who breastfed well and the next didn't and had tongue tie. I think mum also had v sore nipples. I discussed her with T. L a paed surgeon...who was of the same sceptical outlook as me but was persuaded to snip the frenulum. This transformed the babe who suckled well. Mum no longer had sore nipples and both he and I are now converts, but I think we are in the minority."
Dr Steve Rose (Peadiatrician)

So why this "sceptical outlook"? Quite an extensive online search of medics and student medic forums yielded me no evidence of any discussion of the topic at all. I found just one study quoted on a website for doctors:

'a review has been undertaken to review the presenting features of tongue-tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature

the review concluded that there is no place for division of tongue-tie without anaesthesia in the newborn. Speech difficulties related to tongue-tie are over-rated and mechanical problems are underestimated

the indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument

there may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal

operation requires general anaesthesia except in older, co-operative teenagers in whom local anaesthetic is appropriate

Reference:

1. J Paediatr Child Health. 1995 Aug;31(4):276-8
http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20030617101312840010

However, the message parents get from other NHS sources is quite different:

'Tongue-tie

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. This is known as tongue-tie and it can affect feeding by making it hard for your baby to attach effectively at your breast.

Tongue-tie is easily treated. If you have any concerns, talk to your midwife, health visitor or GP. "

http://www.nhs.uk/Planners/breastfeeding/Pages/breastfeeding-problems.aspx

A quick search of www.evidence.nhs.uk reveals many studies, including the Randomised Controlled Trail by Mervyn Griffiths mentioned earlier in this article and the NICE guidelines quoted above.

So what effect can this conflicting advice have on parents ? I asked a clincal psycologist:

"When faced with conflicting messages, parents can often find themselves paralysed by indecision. It is easy to become overwhelmed by all the different advice, which can confuse a parent and cause them to stop trusting their own instincts. When confronted with differing advice, and particularily when this advice is contrary to the path the parents instinctively feel is right, this can lead to "cognitive dissonance" which causes emotional confusion and great distress (note cognitive dissonance - first named and described by Leon Festinger . Tavris and Aronson (2007) defined it as: Cognitive dissonance is a state of tension that occurs whenever a person holds two cognitions (ideas, attitudes, beliefs, opinions) that are psychologically inconsistent, such as "Smoking is a dumb thing to do because it could kill me" and "I smoke two packs a day." Dissonance produces mental discomfort, ranging from minor pangs to deep anguish; people don't rest easy until they find a way to reduce it (p. 13).) Not knowing which way to turn, parents may stop completely, their external inaction reflecting their internal conflict."
Dr Kathryn Newns, Registered Clinical Psychologist. BA, DClinPsy.

My latest story is from a mother who has suffered from mastitis almost constantly for the 12 weeks of her child's life. She certainly seems to be suffering from the 'cognitive dissonance' defined above since the peadiatric surgeon refused to divide her child's submucosal tongue tie, saying there was 'nothing there to snip'. She is feeling the angish of not knowing which way to turn and who to trust. Meanwhile, her breasts plague her.

This article is not designed to persuade health professionals to divide tongue ties, or even to persude care givers to learn more about the subject but to call for a better understanding of the emotional impact of breastfeeding problems on parents, their families and the wider community.

The stories here, in their unedited entirety will form the basis for a place online where parents can share their stories. I hope by giving them a voice I can promote empathy and greater understanding on all sides. So if you have a tongue-tie story you would like to share, please feel free to contact me.

I give the last word to Alison Blenkinsop, breastfeeding expert extraordinaire, hitherto International Board Certified Lactation Consultant and famous writer of breastfeeding songs! This song can be found in her book 'Fit to Bust' which is sold in support of Baby Milk Action. More information about Alison and her wonderful book can be found here.

It's a snip! (Tune: How do you solve a problem like Maria from The sound of music)
How do you solve a problem like a tongue-tie when it prevents a babe from feeding well? Many's the time I've seen a nursing mum cry; the latch is poor, her nipples are sore, it's hell! How can the baby get a proper mouthful if the wee tongue is tethered at the tip? We need to ask the paed to watch the baby feed, the hedge of ignorance we have to clip; so how do you solve a problem like a tongue-tie? It's very safe and easy, just a snip!
©Alison Blenkinsop 2004

Please feel free to leave your story below. If you provide a service for tongue tied families, please leave your details over on the Resources page

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The kindest Cut? The Emotional Impact of the Tongue-Tie Maze On one fairly routine day for a postnatal doula I found myself ringing the doorbell of a potential client. Her baby was 2 months old and she wanted some support with the baby while she rested.

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The BSACI’s Paediatric Allergy Group information sheets

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The BSACI’s Paediatric Allergy Group information sheets

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The BSACI/FASG document is guidance rather than a guideline. It is designed to provide useful background and practical advice in implementing the available evidence from the EAT, LEAP and other studies to support individualised care.

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The BSACI's Paediatric Allergy Group (PAG) and the Food Allergy Specialist Group (FASG) of the British Dietetic Association (BDA) have developed guidance for UK Healthcare Professionals on preventing food allergy in higher risk infants. This includes advice on the earlier introduction of potential allergenic foods into the infant diet to reduce the risk of food allergy.

For Healthcare Professionals:

There is an accompanying information sheet for parents including practical advice:

The BSACI/FASG document is guidance rather than a guideline. It is designed to provide useful background and practical advice in implementing the available evidence from the EAT, LEAP and other studies to support individualised care.

The guidance is designed to complement a recent review by a joint specialist committee of the UK Food Standards Agency and Public Health England, which acknowledged that targeted advice may be appropriate for infants at a higher risk of developing food allergy.

Should anyone wish to send in any comments regarding the guidance, please email info@bsaci.org.

Become a BSACI Member...

GPs, Nurses, Allergy Specialists, Dieticians, Generalists

Join BSACI to receive the regular BSACI Allergy Update, have online access to the monthly journal 'Clinical & Experimental Allergy', download our popular guidelines and a discount to the BSACI Annual Meeting.

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The BSACI's Paediatric Allergy Group (PAG) and the Food Allergy Specialist Group (FASG) of the British Dietetic Association (BDA) have developed guidance for UK Healthcare Professionals on preventing food allergy in higher risk infants. This includes advice on the earlier introduction of potential allergenic foods into the infant diet to reduce the risk of food allergy.

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LEAP (Learning Early About Peanut allergy)

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LEAP (Learning Early About Peanut allergy)

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LEAP is a clinical trial investigating how to best prevent Peanut Allergy in young children

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RECRUITMENT IS NOW COMPLETE! WE WISH TO THANK THE THOUSANDS OF FAMILIES WHO CONTACTED THE STUDY TEAM AND THE 1303 ELIGIBLE FAMILIES WHO CHOSE TO ENROLL ON THIS GROUND-BREAKING STUDY.
Welcome to the EAT Study website

The EAT (Enquiring About Tolerance) Study aims to find out how to best prevent food allergy in young children.

It aims to find out whether introducing certain foods early in a child's diet along with continued breastfeeding could stop infants developing food allergy.

The response of mothers throughout England and Wales has been phenomenal and we have now achieved our target of 1302 participants.

In the United Kingdom (UK) approximately 6% of children will develop food allergies. These can vary in severity, from mild to life-threatening.The World Health Organization (WHO) Global Strategy for Infant and Young Child Feeding, endorsed by the UK Government, recommends exclusive breastfeeding for the first 6 months. The UK Government infant feeding information leaflet for parents advises around 6 months exclusive breastfeeding. It also states that if a mother decides to introduce complementary foods before six months there are some foods that should be avoided as they may cause allergies including: "wheat-based foods and other foods containing gluten (e.g. bread, rusks, some breakfast cereals), eggs, fish, shellfish, nuts (and) seeds."

There is little evidence that this prevents allergy. Research studies that set out to find out if avoiding early introduction of allergenic foods reduces food allergy show conflicting results. Moreover, there is some emerging evidence that suggests that the early introduction of allergenic foods may actually protect against the development of food allergy, but this has yet to be confirmed. The theory is that repeated exposure of the immune system at an early age to an allergenic food via the oral route (in other words, eating the food), teaches the body to tolerate the food so it will not cause an allergy when the child grows older.

Since the 1970s allergy has increased significantly in the UK: a study in South Wales showed that asthma rates doubled and eczema rates tripled between 1973 and 1988. Two successive studies from the Isle of Wight undertaken in 1989 and then 1994-1996 suggested that peanut allergy had doubled. These increases have coincided with a two-thirds reduction in early introduction of complementary foods. Therefore, it is possible that later introduction could promote food allergies. So the question is - is early introduction an effective approach or not to prevent food allergy in young children?
With the help of our 1303 participants, the EAT Study aims to provide an answer to this question in order to help decrease the enormous burden that food allergy has on our children.

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RECRUITMENT IS NOW COMPLETE! WE WISH TO THANK THE THOUSANDS OF FAMILIES WHO CONTACTED THE STUDY TEAM AND THE 1303 ELIGIBLE FAMILIES WHO CHOSE TO ENROLL ON THIS GROUND-BREAKING STUDY. Welcome to the EAT Study website The EAT (Enquiring About Tolerance) Study aims to find out how to best prevent food allergy in young children.

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A range of information to help people who live with allergies, as well as for organisations who want to find out more about the issues that people with allergic disease face in their daily lives.

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Allergy Help | Allergy Relief & Advice | Allergy UK

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We are continually seeking ways to improve the quality of life for people with allergy, intolerances and sensitivities. Get allergy help and access our services now.

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In the early weeks, it is normal for a baby to "spit-up" and around half of all newborns do, at least once a day. As a baby's digestive system matures, this usually decreases and for most mothers it is just a short-term inconvenience. ¹

However, in some babies the valve between the stomach and oesophagus does not close properly. The stomach contents flow back into the oesophagus and can cause vomiting. There are several reasons a baby may vomit and a doctor will need to rule out other causes, but one possible diagnosis is GERD (gastroesophageal reflux disease), also referred to as GOR (gastro-oesophageal reflux).

Not all reflux is noticeable and it doesn't always make a baby uncomfortable, but when it's severe it can be painful and cause distress to mother and baby. ²

What are the signs to look out for?

A baby may choke and cough, or seem to have a sore throat. Some babies have bad breath.

A mother may notice back arching and head turning. The baby may stretch out flat as this reduces pain, instead of snuggling close to his mother.

A baby may cry for long periods and be irritable during and after feeds. His cries may sound hoarse. This sometimes leads to a misdiagnosis of colic.

A baby may seem to fight feeding or even refuse to feed. There may be poor weight gain.

What might help?

A few things may help lessen pain. Keeping the baby's head higher than his bottom during feeding can be more comfortable for him/her. Being at a 30 to 40 degree angle with the baby's bottom in the mother's lap and his torso supported on the mother's crossed leg may be one way for the baby to feed more comfortably. If the baby is feeding in a side-lying position then s/he may feed better on the left side; moving the baby over instead of turning him round if changing sides. It's preferable to move the baby to a more upright position as soon as possible. ³

It can be useful to consider "head above bottom" at all times. A baby sling can be helpful for this purpose. A baby with reflux may find it uncomfortable to lay down flat and might cry or spit up when laid in a cot.Some parents choose to keep their baby in their arms or a sling for naps.Others find it helps to keep their baby upright for a period of time after feeds before they lay them down.

Changing the baby on his side may be preferable to avoid putting pressure on his stomach when lifting his legs. A lay-back bouncy seat can be useful. Babies with reflux can find travelling in a car seat uncomfortable due to the pressure on their stomachs and some mothers choose to use the car less while it distresses the baby and instead use public transport while carrying the baby in a sling.

As the opening from the stomach to the oesophagus is usually on the right side, keeping the right side higher than the left may also help.

Short, frequent feeds ease the incidence and discomfort of reflux. ⁴ If a mother has a copious milk supply then feeding one side only at each feed may ease discomfort. However, it is worth looking at what seems to suit your baby.

What causes reflux?

There are several suggestions as to why reflux happens. It's sometimes suggested that it's caused by an immature sphincter muscle 5 and that this will strengthen as the baby grows.

Other studies have shown a link between reflux and allergies, or an intolerance to cows' milk protein. ⁶ A mother could try to remove dairy products from her diet, in consultation with a medical professional, to see if that improves things.

One of the biggest causes can be fast-flowing milk or oversupply. If a baby seems to be choking or gasping because of a fast flow, there are several things to try. You can take him off the breast for a moment until the flow slows, or feed in a more upright position.

Making sure a baby has a deep latch and good tongue function can also make a difference. Tongue-tie can affect a baby's sucking action and can lead to a baby swallowing too much air. You can find further suggestions here:
https://www.laleche.org.uk/too-much-milk-and-oversupply/
https://www.laleche.org.uk/tongue-tie/
https://www.laleche.org.uk/unhappy-baby/
Adding solids to "thicken feeds" has significant drawbacks

It is sometimes suggested that babies with reflux will be helped by adding solids to their diet to thicken feeds. In 2018, a study in the British Medical Journal reported that "Feed thickeners are commonly used for managing infants with GOR despite the lack of strong supporting evidence". 7 As most existing studies assessing the efficacy of thickened feeds on reflux symptoms mainly include formula-fed infants, there is limited information available on the potential reduction of regurgitation in breastfed babies. ⁸

Aside from the lack of strong evidence, this treatment has some significant drawbacks. Introducing solid food too early replaces human milk, which is nutritionally ideal for babies, with a food of less nutritional value. It will also lower a mother's milk supply. Regurgitating solids can add to the baby's distress and discomfort, and introducing solids too early might also trigger allergies in an already sensitive baby.

Switching to formula may not be the answer

Although it is sometimes suggested that breastfeeding mothers change to formula, this may well worsen symptoms. While both breastfed and formula fed babies can experience reflux, research has shown that formula fed infants have episodes of reflux more often than breastfed babies and they last longer. ⁹

As one cause of reflux can be a delayed emptying of the stomach, the fact that human milk leaves the stomach twice as quickly as formula means that breastmilk lessens the possibility of reflux. ¹⁰

If nothing seems to work

If a baby continues to be distressed, then a doctor may refer you to a gastroenterologist who may prescribe medications which can help.

Something positive?

In his Guide to Breastfeeding, ¹¹ Dr. Jack Newman, a member of La Leche League International's Panel of Professional Advisors, explains how breastmilk is full of immune factors that interact with each other and protect the baby from bacteria, viruses and other micro-organisms.
They work by forming a protective layer on a baby's mucous membranes which line the gut, respiratory tract and other areas. This stops micro-organisms from invading the body through these mucous membranes. Dr. Newman explains that a baby who spits up gets double protection, first when the milk goes down to the stomach, and again when he spits it up.
If you would like further help and support look for your nearest LLL group or Leader.

You can find further information here:

www.llli.org/why-infant-reflux-matters/
breastfeeding.support/reflux-in-newborns/

Written by Anna Burbidge, LLLGB 2019

1 Nancy Mohrbacher, "Breastfeeding Answers Made Simple. A Pocket Guide for Helping Mothers", (Jon Dorling: "Feed thickeners in gastro-oesophageal reflux in infants", http://www.lllgbbooks.co.uk/store/p94/Breastfeeding_Answers_Made_Simple%3A_A_Pocket_Guide_for_Helping_Mothers.html)
2 La Leche League International, "The Womanly Art of Breastfeeding", 8 th Edition, 2010, p. 417. ( http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html)
3 Boekel, S. "Gastro-esophageal reflux disease (GERD) and the breastfeeding baby", ILCA Independent Study Module. Raleigh, North Carolina: International Lactation Consultant Association, 2000.
4 La Leche League International, "The Womanly Art of Breastfeeding", 8 th Edition, 2010, p. 417. ( http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html) 5 http://www.nhs.uk/Conditions/reflux-babies/Pages/Introduction.aspx
6 Nancy Mohrbacher, "Breastfeeding Answers Made Simple", 2010, pp. 517-520. ( http://www.lllgbbooks.co.uk/store/p93/Breastfeeding_Answers_Made_Simple.html)
7 T'ng Chang Kwok, Shalini Ojha and
8 Kwok TC, Ojha S, Dorling J.: "Feed thickener for infants up to six months of age with gastro‐oesophageal reflux." Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD003211. ( BMJ Paediatrics Open 2018 ( https://bmjpaedsopen.bmj.com/content/2/1/e000262) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003211.pub2/full)
9 Hegar B. et al: "Natural evolution of regurgitation in healthy infant.s" Acta Paediatrica 2009; 98(7): 1189-1193 ( https://doi.org/10.1111/j.1651-2227.2009.01306.x)
10 Ewer, A. et al: "Gastric emptying in preterm infants", Arch Dis Child 1994; 71:F24-F27.
11 Dr. Jack Newman and Teresa Pitman: "Dr. Jack Newman's Guide to Breastfeeding", Revised Edition 2014 ( https://www.amazon.co.uk/dp/1780662300/?tag=breastfsuppor-21)

Further reading:

Trikha, A.,Baillargeon, J. G.,Kuo, Y. F.,Tan, A.,Pierson, K.,Sharma, G.,Wilkinson, G.,Bonds, R. S. "Development of food allergies in patients with Gastroesophageal Reflux Disease treated with gastric acid suppressive medications.." Pediatr Allergy Immunol 2013 Sep; 24 (6): 582-8

Smyth C, Why Infant Reflux Matters, Pinter and Martin 2021

https://www.ncbi.nlm.nih.gov/m/pubmed/6746107/

https://www.ncbi.nlm.nih.gov/m/pubmed/26022877/

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I Think My Baby's Got Reflux - La Leche League GB

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In the early weeks, it is normal for a baby to "spit-up" and around half of all newborns do, at least once a day. As a baby's digestive system matures, this usually decreases and for most mothers it is just a short-term inconvenience. 1 However, in some babies the valve between the stomach and oesophagus does [...]

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Reflux is when your baby brings milk back up during, or just after a feed. Read about reflux symptoms and how to help your baby

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Read more about common breastfeeding issues such as reflux. If you have any concerns, it’s important to talk to your health visitor.

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By Kelly Bonyata, BS, IBCLC

Babies should be fed when they indicate hunger. Crying is a late indicator of hunger - breastfeeding is much easier for both mom and baby if mom is able to pick up on baby's earlier hunger cues.

Common infant hunger cues include:

Early

Smacking or licking lips

Opening and closing mouth

Sucking on lips, tongue, hands, fingers, toes, toys, or clothing

Active

Rooting around on the chest of whoever is carrying him

Trying to position for nursing, either by lying back or pulling on your clothes

Fidgeting or squirming around a lot

Hitting you on the arm or chest repeatedly

Fussing or breathing fast

Late (calm baby before feeding)

Moving head frantically from side to side

Crying

"My newborn wants to sleep all the time! Should I wake him to nurse?"

Yes, if he doesn't wake on his own. Many newborns are very sleepy in the early days or weeks and may not exhibit hunger cues as often as they actually need to eat. Newborns should be nursed anytime they cue hunger, but at least every 2 hours during the day and at least once during the night. Once your baby has established a good weight gain pattern (at least 4 ounces per week, for babies under 4 months), you can stop waking baby to nurse and let him set his own pattern.

"My baby just started sleeping longer at night. Do I need to wake him to nurse?"

If your baby is younger than 4 weeks, then it is a good idea to wake baby at least every 4-5 hours at night to nurse if he does not wake on his own. If your child is older than 4 weeks, you can allow baby to sleep as long as he wants at night as long as he is peeing, pooping, and gaining weight within normal parameters.

"My baby frequently sucks on his hands. Does this always mean that he's hungry?"

After the newborn period, hand sucking is not as reliable an indicator of hunger. Starting at around 6-8 weeks, baby will begin to gain more control over his hands and will soon begin to explore his hands and everything else using his mouth. It is also common for babies to suck on their hands when their gums become tender in preparation for tooth eruption. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts. More here on teething.

More information:

Signs That Your Baby Is Hungry, a video from baby gooroo's Amy Spangler, RN, MN, IBCLC

Newborn hunger cues video from janellevideo

Baby feeding cues (great photo handout here), from Queensland Health

Infant Hunger Cues, from Lactation Education Resources

Feeding Cues, from the Australian Breastfeeding Association

The Clock and Early Breastfeeding, by Nancy Mohrbacher, IBCLC, FILCA

Nursing your newborn - what to expect in the early weeks @ KellyMom

Should baby be on a schedule? Links @ KellyMom

Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

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Hunger Cues - When do I feed baby? * KellyMom.com

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Babies should be fed when they indicate hunger. Crying is a late indicator of hunger - breastfeeding is much easier for both mom and baby if mom is able to pick up on baby's earlier hunger cues. Common infant hunger cues include:...

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A charity supporting families with children with gastro-oesophageal reflux and reflux Disease

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Supporting Families of Children with Gastro-oesophageal Reflux and Reflux Disease

As parents and carers ourselves, we know only too well how stressful and exhausting it can be living with a child with reflux (GOR) everyday - not just for you but for them also. We do understand the battles you face, which is why Living with Reflux charity is here to help and support you.

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Supporting Families of Children with Gastro-oesophageal Reflux and Reflux Disease As parents and carers ourselves, we know only too well how stressful and exhausting it can be living with a child with reflux (GOR) everyday - not just for you but for them also.

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First Steps Nutrition Trust is an independent public health nutrition charity that provides information and resources to support eating well from pre-conception to five years, including a comprehensive guide for vegetarians and vegains

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Infants & new mums — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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The Many Ways of Burping Baby

Besides the pat on the back, effective burping requires two actions: holding baby in an upright position and applying pressure on baby's tummy (parents often forget this latter step). You seldom see a baby being burped in non-Western, breastfeeding cultures. The need for burping baby after feedings, or help "bringing up the wind," originated with the spread of bottle-feeding. The faster flow of milk from bottle nipples forces babies to gulp air in between closely-spaced swallows.

Breastfeeding infants have fewer problems with air in their tummies. They can control the flow of milk at the breast and so they suck with a slower rhythm that allows them to better coordinate breathing and swallowing. Also, breastfed babies tend to be fed in a more upright position and enjoy smaller, more frequent feedings - other conditions that lessen the swallowing of air. Yet burping baby is still necessary sometimes, even if they are breastfed, especially if they are fast feeders and/or mother has a strong milk ejection reflex.

Sit Baby Up Straight

To lessen the likelihood that baby will swallow air at the breast, feed baby in the upright position (at a 45 degree angle or greater). Help baby comfortably keep a tight seal during latch-on by supporting the weight of your breast and by wrapping baby around you rather than letting baby dangle away from the breast. Watch for signs that baby needs to burp during or after a feeding: she may balk at going to the other breast, she may squirm and grimace when you lay her down, or there may be a painful expression on her face. If baby is content, then burping baby is unnecessary-if she needed to burp at all. Don't feel you have failed if you don't manage to bring up a burp after every feeding. Babies often don't need to burp with snack-type feedings. After a big meal, it's usually worth putting in some patient effort into burping baby. As babies get older and more proficient at feeding, burping becomes less of an issue. Try these burping positions:

Over-the-Hand Burp

Sit baby on your lap and place the heel of your hand against her tummy, with her chin resting on the top of your hand. Lean baby forward, resting most of her weight against the heel of your hand to provide counter pressure on her tummy, and pat her on the back to move up the air bubbles.

Burping Baby Over-the-Shoulder

Drape baby way up over your shoulder so that your shoulder presses against her tummy, then rub or pat her back. Hold baby securely by hooking your thumb under her armpit. If she's on your right shoulder, do this holding with your right hand.

Over-the-Lap Burp

Drape baby over one thigh (legs crossed or spread) so that it presses upward against her tummy. Support baby's head with one hand while you pat or rub her back with the other hand.

Burping Baby With One-Arm

This position is particularly helpful when you're burping baby while you're busy. You can simply stroll around the house and have one hand free. The only drawback is that spit-up may go on the floor or down over your arm and baby's legs.

Sling Burping

If the air just won't come up, place baby upright against your chest and wear her in a sling until the air comes up.

Nighttime Burping

Burping baby is often not necessary during night feedings, since babies feed in a more relaxed manner and therefore swallow less air. If a trapped air bubble seems to be causing nighttime discomfort, you can avoid sitting up and going through the whole burping ritual by draping baby up over your hip as you lie on your side.

Burp and Switch

Some babies are more comfortable if they burp when changing sides. Getting the air up makes room for more milk. This can help avoid large spit-ups when a bubble gets trapped under the milk.

Knee-to-Chest Burp

Sometimes babies need help not only getting air out the top end, but also out the bottom. The knee-chest position (flexing baby's knees up against her chest) helps baby pass excess gas.
If you would like to work with a Certified Health Coach during your pregnancy, or postpartum, you can find a Coach in your area.

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Besides the pat on the back, effective burping requires two actions: holding baby in an upright position and applying pressure on baby's tummy (parents often forget this latter step). You seldom see a baby being burped in non-Western, breastfeeding cultures. The need for burping baby after feedings, or help "bringing up the wind," originated with the spread of bottle-feeding.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual.

Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

Tongue-tie is sometimes diagnosed during a baby's newborn physical examination, but it's not always easy to spot. It may not be obvious until your baby has problems feeding.

See a health visitor, midwife or GP if you're concerned about your baby's feeding and think they may have tongue-tie.

Signs of tongue-tie

To breastfeed successfully, a baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage.

Some babies with tongue-tie are not able to open their mouths wide enough to latch on to the breast properly.

If you're breastfeeding your baby and they have tongue-tie they may:

have difficulty attaching to the breast or staying attached for a full feed

feed for a long time, have a short break, then feed again

be unsettled and seem to be hungry all the time

not gain weight as quickly as they should

make a "clicking" sound as they feed - this can also be a sign you need support with the positioning and attachment of your baby at the breast

Tongue-tie can also sometimes cause problems for a breastfeeding mother. Problems can include:

Most breastfeeding problems, however, are not caused by tongue-tie and can be overcome with the right support.

If you're finding breastfeeding difficult, ask a midwife, health visitor or a breastfeeding specialist for help.

Read more about breastfeeding problems and how to overcome them.

Other signs of tongue-tie

Other signs that may indicate your baby has tongue-tie include:

difficulty lifting their tongue up or moving it from side to side

difficulty sticking their tongue out

their tongue looks heart-shaped when they stick it out

Treating tongue-tie

Treatment is not always needed, if your baby has tongue-tie but can feed without any problems. If their feeding is affected, treatment involves a simple procedure called tongue-tie division.

Tongue-tie division

Tongue-tie division involves cutting the short, tight piece of skin connecting the underside of the tongue to the bottom of the mouth.

It's a quick, simple and almost painless procedure that usually improves feeding straight away.

The procedure

Tongue-tie division is done by doctors, nurses or midwives.

In very young babies (those who are only a few months old), it is usually done without anaesthetic (painkilling medicine), or with a local anaesthetic that numbs the tongue.

The procedure does not seem to hurt babies. This is because there are very few nerve endings in the area around the bottom of the mouth. Some babies sleep through the procedure, while others may cry a bit.

A general anaesthetic is usually needed for older babies with teeth, which means they'll be unconscious throughout the procedure.

The baby's head is held securely while sharp, sterile scissors with blunt ends are used to cut the skin.

It only takes a few seconds, and you can start feeding your baby immediately afterwards.

There should not be much bleeding. Your baby may get a white patch (ulcer) under their tongue, but this should heal in 1 to 2 days. It will not bother your baby.

Research suggests most babies who have treatment for tongue-tie find breastfeeding easier afterwards.

The Association of Tongue-tie Practitioners (ATP) can help you find a tongue-tie practitioner.

Older children and adults

Untreated tongue-tie may not cause any problems as a child gets older, and any tightness may resolve naturally as the mouth develops.

However, tongue-tie can sometimes cause problems such as speech difficulties and difficulty eating certain foods.

Speak to a GP if you think you or your child are having problems caused by tongue-tie.

Tongue-tie division can be carried out in older children and adults, although it's usually done under general anaesthetic.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual. Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

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Blog posts on tongue-tie from Milk Matters

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Blog posts on tongue-tie from Milk Matters

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Last night I posted this picture on our Facebook wall asking "Why does this baby's tongue look like this?"

I see many similar tongues in clinic, and alongside breastfeeding problems like damaged nipples or pain, they're typically diagnosed ...

After tongue tie treatment some babies resolve instantly and spontaneously, we hear about these cases online and it can be easy to think that if this doesn't happen, it hasn't "worked".

Suckling requires the use of lots of different muscles ...

We 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....

It's not always obvious, the tongue can look ENTIRELY normal to the untrained eye... Sometimes it's pulled into a heart shape or the attachment may be visible on the tip of the tongue, but this is just one type; ...

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Last night I posted this picture on our Facebook wall asking "Why does this baby's tongue look like this?" I see many similar tongues in clinic, and alongside breastfeeding problems like damaged nipples or pain, they're typically diagnosed ...

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

The Association of Tongue-tie Practitioners (ATP) was set up in 2012 by a group of tongue-tie practitioners from the NHS and independent sectors with the aims of:

Increasing awareness about the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

Supporting parents of tongue-tied babies to access safe and effective care.

Assisting tongue-tie practitioners to provide safe and effective care through training and sharing knowledge and experience.

Providing resources and education for healthcare providers who refer babies for tongue-tie division.

The Association of Tongue-tie Practitioners (ATP) is also actively working to redress inaccuracies in the reporting and documenting of the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

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Association of Tongue-tie Practitioners | For parents & health care providers, all of the information you need about tongue-tie and the support available.

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

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NCT - Tongue-tie (ankylosglossia) in babies

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NCT - Tongue-tie (ankylosglossia) in babies

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What is a tongue-tie (ankyloglossia)?

Most people have a frenulum - a piece of tissue under their tongue that stretches from the underside of the tongue to the floor of the mouth. Tongue-tie occurs if the frenulum either extends forwards towards the tip of the tongue, is attached close to the lower gum, or is short and tight so it interferes with normal tongue movement (Oakley, 2021).

What problems does tongue-tie cause for babies?

If a baby has a tongue-tie, they may not be able to extend or lift their tongue or move it from side to side. Some will be able to lift the sides, but not the tip (v-shaped tongue). Some will be unable to lift the posterior of the tongue (bowl-shaped tongue). In babies where they frenulum extends all the way to the tip, the tongue may look heart-shaped.

Tongue-tie can affect both breastfeeding and bottle-feeding. For some babies, the effects will be quite mild. For others, tongue-tie can make feeding extremely challenging or even impossible.

In order to breastfeed, a baby needs to be able to open their mouth wide, extend their tongue over their bottom lip and scoop the breast into their mouth. Then the tongue needs to massage the breast in a wave-like motion to remove milk from the breast (Oakley, 2021).

If your baby has a tongue-tie and you are breastfeeding, you might experience one or more of the following in your baby:

difficulty in latching

difficulty in maintaining a latch, with your baby frequently coming off the breast or slipping back to the nipple

a shallow latch

clamping down on the breast

clicking noises while feeding

unsettled behaviour during feeds

frequent or long feeds

poor weight gain or excessive early weight loss

colic/wind/hiccups/reflux.

If you are breastfeeding your baby and they have tongue-tie, you might find your nipples are sore and appear squashed after a feed, often appearing ridged, lipstick-shaped, flattened or blanched. If your baby isn't draining your breasts adequately, this can lead to engorgement, blocked ducts and mastitis. It can also have a negative effect on your milk supply. Feeds which are long or frequent can be very tiring (NHS, 2020; Oakley, 2021).

If you are bottle-feeding your baby, you might notice one or more of the following - your baby:

is very slow to take a bottle

chomps on the teat

needs to be fed very often in order to get enough milk

dribbles a lot during feeds

tends to push the bottle teat out

gags on feeds even when you slow the feed down

can only manage a teat that has a very slow flow.

(Oakley, 2021)

How is tongue-tie diagnosed?

Can I tell if my baby has a tongue-tie?

If you look in your baby's mouth, you might be able to see if they:

are unable to extend their tongue fully

have a tongue with a heart-shaped appearance at the tip

have difficulty lifting their tongue or moving it from side to side.

Tongue-tie is not just about how your baby's tongue looks. A tongue can look completely normal to an untrained eye yet still cause substantial problems with feeding (Young, 2011).

A tongue-tie is diagnosed by the baby's tongue function too - what they can do with their tongue. It can only be diagnosed by a qualified tongue-tie practitioner (NHS, 2020).

Tongue-tie types

Tongue-ties can be described as anterior (where the frenulum extends towards the front of the tongue) or posterior (towards the back of the mouth).

Tongue-ties might also be described using a percentage or a number (type I, II, III and IV). This percentage or number describes how far along the underside of the tongue the frenulum comes. So 100%, or type I, would indicate that the frenulum comes all the way to the front of the tongue.

A posterior tongue-tie, which may be described as a 10% tongue-tie, can restrict tongue function just as much as an anterior one. That means these anatomical descriptions of how the tongue looks don't always relate to how severely a tongue-tie will affect tongue function and your baby's feeding (Oakley, 2021).

Tongue-tie diagnosis

Some babies have a visible frenulum that doesn't cause problems with feeding (UNICEF, no date). Tongue-tie shares many of the symptoms of other breastfeeding problems, so it's not always easy to determine whether these problems are caused by a tongue-tie or something else.

A full feeding assessment should be done before or as part of a tongue-tie assessment (Oakley, 2021). If you and/or your baby are experiencing feeding difficulties, a feeding assessment and some breastfeeding support from a breastfeeding counsellor or trained breastfeeding professional is recommended. Support to improve your baby's attachment to the breast may resolve the problem (UNICEF, no date).

A baby's inability to open their mouth widely and extend their tongue may also be caused by tension around the mouth and neck, resulting from birth tensions or interventions during labour. This might be resolved by manual therapy, such as osteopathy or chiropractic from a registered practitioner (ATP, no date; Oakley, 2021).

If the breastfeeding professional (breastfeeding counsellor, midwife or health visitor) suspects your baby has a tongue-tie, they will refer you to a local tongue-tie practitioner. Tongue-tie practitioners will do a formal assessment of tongue-tie based on how the tongue functions as well as how it looks (e.g. the Hazelbaker Assessment Tool for Lingual Frenulum Function). Most midwives and health visitors are not tongue-tie practitioners so are unable to make a diagnosis of tongue-tie themselves.

Tongue-tie treatment

What is tongue-tie division?

Your baby could have a tongue-tie division, which can release their tongue so it can move more freely. This involves cutting the frenulum (NICE, 2005).

Tongue-tie division is a safe procedure that can improve the breastfeeding problems that tongue-tie causes (NICE, 2005).

Does tongue-tie division hurt?

Tongue-tie division procedures are very quick and simple and are thought to be almost painless (NICE, 2005).

Does tongue-tie division resolve feeding problems?

Most parents say their baby's feeding improves after a tongue-tie division and many find it resolves the problem completely (Buryk et al, 2011; Berry et al, 2012). But a few babies do continue to have feeding difficulties even after a tongue-tie division.

Do I need to get my baby's tongue-tie treated?

The decision on whether to have a tongue-tie divided is a personal one and different parents will make different decisions. Every tongue-tie is different too and the range of issues it causes can vary from very mild to severe. So how much the tongue-tie is affecting feeding and your life with your baby might influence your decision.

You might find it helpful to talk things through with an NCT breastfeeding counsellor too. They can help you explore your thoughts and feelings plus find ways of coping if you decide not to have the procedure done.

What else might help with feeding difficulties due to tongue-tie?

For some babies, it may be possible to improve feeding without having a tongue-tie division.

If babies are fed in a laid back position, they are more relaxed, can open their mouth wider and get a bigger mouthful of breast. But some babies are unable to extend their tongue enough to scoop the breast into their mouth, so this position doesn't make feeding easier. A side-lying position or koala hold might also help.

Babies can also be helped by using an 'exaggerated latch'. This is where you hold your baby close to but below the breast, and use your forefinger to tilt your nipple upwards. That way, when your baby tips their head back and is brought into the breast, your nipple can be flipped towards the back of their mouth (Oakley, 2021).

Babies who are bottle-fed might find feeds easier if paced bottle feeding techniques are used. Occasionally, finger feeding can be a more comfortable option than using a bottle (Genna, 2013). A tongue-tie can make it difficult for babies to form a seal around the bottle teat. A high palate, often associated with a tongue-tie, can trigger the baby's gag reflex. Shorter, wedge-shaped or flatter teats may be easier for babies with a tongue-tie to drink from (Oakley, 2021).

How can I find tongue-tie division services near me?

Only registered healthcare professionals who have received proper training in tongue-tie division should perform this procedure. In many areas, the NHS provides a tongue-tie division service. But provision varies across the country and parents in some areas have to travel long distances to reach a tongue-tie division service.

It can be even harder to find a tongue-tie division service when a baby is having problems bottle-feeding. Unfortunately, some areas might have no service available (Wise, 2015).

The National Institute for Health and Care Excellence - also known as NICE - supports considering tongue-tie division. Yet there is no common agreement among tongue-tie dividers on how to carry out the procedure or how far the membrane should be divided (NICE, 2005). This means the service different health professionals offer varies.

Online, you can see a directory of both NHS and private tongue-tie practitioners on the Association of Tongue-tie Practitioners (ATP) website.

What can I expect after my baby's tongue-tie division?

Babies are often unsettled in the first day or two after a tongue-tie division and might need more cuddles and nurturing. After the procedure, you'll probably see a white patch under your baby's tongue; this takes 24 to 48 hours to heal but it won't bother your baby (UNICEF, no date).

Do I need to do anything after the tongue-tie division?

Some tongue-tie practitioners recommend some tongue exercises or wound massage after a tongue-tie division. The exercises involve encouraging the baby to move their tongue through finger sucking and tongue-poking games. Massaging the wound with a clean finger may help prevent the tongue division knitting together and re-forming but there is no evidence to suggest that this is safe or effective (Oakley, 2021).

Will my baby's feeding improve after their tongue-tie division?

Parents often expect that feeding will improve immediately after a tongue-tie division.

Feeding can be more difficult for the first day or two after a tongue-tie division because it takes time for your baby to adjust to their new, freely-moving tongue (Oakley, 2021).

Some babies might need further support even after a tongue-tie division. If things have not improved after a few days, you might find it helpful to get extra support to improve feeding - see below.
This page was last reviewed in March 2022.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby

Attending a Baby Cafe or other breastfeeding support drop-in can be a good way to access support with feeding your baby. You may also find other parents there whose babies have had a tongue-tie.

Pictures of babies with tongue-tie can be found on Catherine Genna's website.

The Association of Tongue Tie Practitioners has a list of locations where tongue tie can be divided.

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Tongue-tie in babies | Baby & toddler, Feeding articles & support | NCT

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Tongue-tie (ankyloglossia) in babies can affect both breastfeeding and bottle-feeding. Here we explain about tongue-tie symptoms and treatment.

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has vomit that's green or yellow, or has blood in it

is projectile vomiting (being sick with more force than usual)

has blood in their poo

has a swollen or tender tummy

has a very high temperature or they feel hot or shivery

keeps being sick and cannot keep fluid down

has diarrhoea that lasts for over a week or has signs of dehydration

will not stop crying and is very distressed

is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

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Find out about reflux, where a baby brings up milk during or soon after a feed.

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What is baby reflux? Symptoms and support | NCT

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What is baby reflux? Symptoms and support | NCT

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What is baby reflux?

It's something many parents talk about but what is baby reflux? It's basically when a baby brings milk back up during, or just after, a feed (NHS start4life, 2019).

Babies get reflux when the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed. Food or milk can leak out and travel back up the food pipe (NHS, 2019). Other potential causes for reflux can include an intolerance to cow's milk protein or other allergies (La Leche League 2017).

Baby reflux affects at least four in ten newborns and it isn't usually cause for concern (NICE, 2015). Most of the time, it gets better on its own - often by the time a baby is one (NICE, 2015; NHS, 2019). That's because over a baby's first 12 months their digestive system naturally develops and they spend more time upright as they start to sit up (Tighe et al, 2014; NICE, 2015; NHS, 2019).

Is baby reflux just vomiting?

Baby reflux is effectively the same thing as posseting, which is when babies bring up a small amount of milk (usually a teaspoonful) without seeming to mind (NHS start4life, 2019). Reflux is common in babies under six months for completely normal physiological reasons and doesn't need medication. Baby reflux is also different from gastro-oesophageal reflux disease (GORD), which is when reflux symptoms become troublesome or cause complications (NICE, 2019).

Baby reflux signs and symptoms

Many of the common signs of baby reflux can also be signs that a baby is distressed for any number of reasons; for example, they're hungry, need a cuddle or they're cold. So it's good to remember that while there are some recognisable signs of baby reflux, this isn't necessarily a disease that needs medicated. Nonetheless, signs can include:

A baby arching their back and turning their head.

Crying for long periods and becoming irritable during and after feeds.

Choking or coughing during a feed or seeming to have a sore throat.

Spitting up milk during or after feeds several times a day, which upsets them.

Persistent hiccups.

Frequent ear infections.

Fighting feeding or refusing to feed.

Poor weight gain.

Waking very frequently at night.

Signs of pain or discomfort when feeding.

(NHS, 2016; La Leche League GB, 2017; Essential Parent, 2019)

Are some babies more likely to get reflux?

Reflux is more common among babies who are born prematurely and babies with low birth weight. It's also common in babies or children with some impairment of their muscles and nerves, such as cerebral palsy, or those with a cow's milk allergy (Patient, 2018).

When should you seek medical advice for reflux?

Baby reflux isn't usually a cause for concern if your baby is happy and is gaining weight. However, if reflux starts after six months of age, continues beyond a year or if your baby has any problems mentioned below, contact your midwife, health visitor or GP:

Spitting up feeds frequently or refusing feeds.

Coughing or gagging while feeding.

Frequent projectile vomiting (forceful vomiting that lands some distance away).

Green or yellow vomit (maybe bile), or blood in vomit.

Blood in poo or persistent diarrhoea.

Excessive crying or irritability.

Swollen or tender tummy.

High temperature of 38⁰C or above.

Not gaining weight or losing weight.

(NICE, 2015; NHS, 2016)

In a small number of babies, reflux might be associated with a more serious problem, such as gastro-oesophageal reflux disease (GORD). This is a form of long-term baby reflux where stomach contents are able to rise up and irritate the oesophagus (NHS, 2016).

Silent reflux in babies

Sometimes babies don't spit out what comes back up but swallow it instead. This is known as 'silent reflux'. Babies with silent reflux might gain weight normally but show some of the symptoms as reflux (NHS start4life, 2019).

How to ease your baby's reflux

You can help ease your baby's reflux by making small changes to the way you feed them. Talk to your midwife or health visitor who might suggest:

Gently burping your baby regularly throughout feeding.

Ensuring they take breaks during a feed.

Giving your baby shorter but more frequent feeds.

Keeping your baby's head higher than their bottom during feeds.

Keeping your baby upright for a bit after feeding.

Changing baby on their side to avoid any discomfort caused by lifting their legs up towards their stomach.

Using thickened 'anti-reflux' formula milk. You can buy these without a prescription but it's important to talk to a healthcare professional before you do. There is some caution about their use, such as the fact that they are made at a lower temperature than is currently recommended to get rid of harmful bacteria.

If your baby has a cow's milk allergy, your doctor might suggest using special formula milk that doesn't contain cows' milk.

(NHS, 2016 ; La Leche League GB, 2017; First Steps Nutrition Trust, 2018; Patient, 2018)

Some parents might be advised to raise the head end of their baby's cot slightly or place a rolled up towel under the mattress. It's important to say that there is no scientific evidence that this works and it might increase the risk of sudden infant death syndrome (SIDS) (Lullaby Trust, 2019).

Diagnosis and treatment

Usually, babies with reflux don't need any tests as the condition can be diagnosed based on their symptoms. But in rare cases and if a healthcare professional thinks they might be helpful, an endoscopy, pH monitoring or barium swallow test can be done (NICE, 2015; NHS, 2016).

Baby reflux usually doesn't need any specific treatment but the feeding suggestions above might be helpful. In severe cases, a GP or gastroenterologist can prescribe medicines that might help with pain and discomfort (Tighe et al, 2014). Surgery might also be recommended for a small number of babies who have underlying medical conditions, such as cerebral palsy (NICE, 2015; NHS, 2016).

If you have a baby with a reflux, it can feel stressful and worrying at times. There's lots of support and information to help you though. Read other parents' experiences here.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0333 259 6180.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Living with reflux is a UK non-profit for information and support for sufferers of GOR and GORD.

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What is baby reflux? Symptoms and support

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It's something many parents talk about but what is baby reflux? It's basically when a baby brings milk back up during, or just after, a feed (NHS start4life, 2019). Babies get reflux when the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed.

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Introducing solid food to your baby's diet

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Introducing solid food to your baby's diet

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It's a cute and controversial video that's been spreading through online breastfeeding groups, and it's got mamas talking.

In a clip that now has more than 26 million views, a newborn baby takes sips of milk not from a breast or bottle, but from a little cup that looks like a shot glass.

Plenty of Facebook commenters have wondered why a parent would attempt to feed such a young baby without a nipple, and whether the method used in the undated clip (that appears to have been shot in Turkey) is even safe.
The answer-much like feeding a baby-is simple and complicated all at the same time.
Cup feeding, as this method is called, is a real thing. It's safe when done properly and is sometimes suggested by medical professionals, particularly in locations where breast pumps or even bottles are not readily available. It's not an attempt to get a newborn to skip nipples entirely, but usually just a temporary way for parents to feed very young babies who are experiencing difficulty nursing.

As Motherly's Digital Education and Certified Nurse Midwife Diana Spalding notes, both the World Health Organization and Unicef recommend cup feeding for babies who are unable to breastfeed. "It's generally recommended when parents want to avoid using a bottle, to prevent nipple confusion, if the baby is going to be breastfed eventually," Spalding explains. "Some has found that it is safe-though there is more spilling of milk when using a cup. Other studies, though, state that the evidence still isn't strong enough to be able to routinely recommend cup feeding for babies, so it's always best to check with your pediatrician first," she says.

Advocates for cup feeding hope to see more research on the method in the coming years, and suggest that a cup already in use in some low resource countries would be better for babies than the one in the viral video.
It's called the NIFTY (Neonatal Intuitive Feeding Technology) cup, and it was designed by experts at the University of Washington, Seattle Children's hospital, the international health innovation nonprofit PATH, and Laerdal Global Health, a not-for-profit company dedicated to saving the lives of mothers and babies.

Originally intended for use in countries where bottles, pumps and formula are not options, the team behind the NIFTY cup wanted to reduce spillage and get more breast milk into the mouths of hungry infants. The result is a silicone cup wide enough for mothers to hand express into, with a little reservoir that puts baby in charge of the pace of their feeding. It's proved invaluable in countries where moms and babies need it most, and one of the researchers behind the design, Christy McKinney, thinks it could benefit mothers and babies all over the world.

"A lot of times these things we create for low resource settings boomerang back here, to have benefit for us here in the United States. This is really a cup for infants with breastfeeding difficulties regardless of what the origin is," McKinney, an associate professor at the University of Washington told King5 News.

You can't go out and buy a NIFTY cup just yet, but the team behind it hopes that one day, mamas all over the world will have access to the design so that cup-fed babies don't have to drink out of the kind of spill-prone cup featured in the viral video.
The video proves that when it comes to baby feeding, there's no one solution that works for every family.
We don't know why that now famous baby was being cup fed, but it is likely their parents were advised by medical professionals (the baby is wearing a hat with hospital branding, so they were probably either still in the hospital or had recently been discharged).

There are many ways to get an infant the nutrients they need, and whatever way you and your medical providers decide on is the right way for you. Your baby probably won't get 26 million views, but they'll be just as cute and well fed as this little viral star, whether it's from a breast, bottle or even a cup.

You might also like:

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This viral video has everyone asking: What is cup feeding?

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It's a cute and controversial video that's been spreading through online breastfeeding groups, and it's got mamas talking. In a clip that now has more than 26 million views, a newborn baby takes sips of milk not from a breast or bottle, but from a little cup that looks like a shot glass.

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NCT's guide to feeding your baby

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Whether you're breastfeeding, formula-feeding or both, you'll find lots of useful articles about feeding here. Plus, tips on introducing solids when you're ready.