Anna Branch
Tongue Tie & Feeding Specialist Midwife
Tongue Tie Service & Fees
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Following an online booking request, a home visit (dependent on location) will be confirmed for a face to face consultation. (Babies 0-10 months based on an individual assessment) We will discuss any concerns that you have with breast or bottle feeding. We will discuss any relevant medical history. The procedure and any potential risk factors associated.
Option 1 - £220 plus calculated mileage
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HOME VISIT TONGUE TIE ASSESSMENT AND DIVISION.
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Babies seen up to 10months of age.
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(Fee reduced to £150 if no procedure is required)
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Twins £320.
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POST PROCEDURE BREASTFEEDING GUIDANCE/SUPPORT WITHIN APPOINTMENT,
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FOLLOW UP NEXT DAY VIA TEXT..
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OPEN ACCESS FOR 2 WEEKS POST PROCEDURE FOR ADVICE AND SUPPORT.
Option 2- £100 plus calculated mileage
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HOME VISIT REFORMATION ASSESSMENT (Previously seen families only)
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2-4% occurrence rate within 2-4 weeks..
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(Fee reduced to £70 if no procedure is required)
(Re-assessment + procedure if required from 4-6 weeks healing time from original procedure)
"What happens during your appointment"
History of pregnancy, birth & postpartum.
A full history is taken to determine whether pregnancy or birth could be having an impact on your feeding journey. An assessment of family history of blood clotting conditions,
vitamin k or any other medical conditions that your baby is being screened for.
Hazel baker ATLFF Tool.
An assessment of the tongue function using the Hazelbaker tool whereby assessing babies ability to stick their tongue out (extension), observing movement of the tongue around their mouth (lateralisation) and the lift of their tongue (elevation). Assessing their suck, palate and shape of their tongue and finally the frenulum itself.
Division of the tongue-tie (if deemed clinically necessary) with aseptic technique. Post procedure feeding support will be provided.
Post division support.
You will offer baby a feed (breast or bottle) where this will help baby to be comforted and allow compression of the wound to stem any bleeding. I will talk you through position and attachment and signs of effective milk transfer at the breast. If baby is bottle feeding, we will talk through good bottle feeding techniques.
-Follow up text the next day & open support for 2 weeks.
- Tongue tie information leaflet.
- Post procedure care leaflet.
Assessment of babies feeding.
Observations of baby feeding whether that being breast or bottle feeding.
Frenulotomy (Division).
*Baby will be wrapped securely in a large muslin or a blanket
*A parent or family/friend present will be requested to steady the babies head
*I will lift babies tongue with index finger and a small incision through the frenulum with sterile scissors will be performed to release the restriction
*Small piece of gauze will be held to the would to stem any bleeding (usually a small smear), baby will be unwrapped and given back to the parent to feed which will help to compress the wound and to decrease any further risk of bleeding and provides your baby with comfort
Aftercare.
Whilst current research does not support the use of wound massage/stretching post frenulotomy, there are some gentle exercises that can be performed as outlined on the Association of Tongue tie Practitioners (ATP) downloadable PDF Leaflet .
With a clean finger and short nails:-
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Poke your tongue out - encourage family/friends to do the same. This will go onto strengthen good tongue extension.
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Tug of war - allow your baby to suck on your finger and then play a little tug of war , pulling your finger out a little at a time and letting them suck it back it.
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Around the gums - sweep your finger around their lower gum line to encourage them to follow your finger with their tongue aiding laterilisation.
Tongue-tie release is one part of the puzzle. During an oral assessment, an open discussion is had around utilising other health professionals for ongoing feeding support to aid the optimal outcome. Where there is a Tongue-tie, there would have been tension that had been created due to compensatory methods of feeding. In addition, pregnancy and birth can also add towards bodily tension.
*Craniosacral Therapy (body work) to help release tension due to overworked muscles that have been used to compensate for poor tongue function. It is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord.
https://www.greenchildmagazine.com/craniosacral-therapy-for-babies/
*Breastfeeding support with an IBCLC, NHS community breastfeeding counsellors, drop-in cafes. Post tongue-tie division baby now has to re learn to use their new tongue function so it it key to utilise as much support as possible.