This service includes a comprehensive assessment of the function and appearance of your baby's lingual frenulum, discussion of risks and benefits of frenulotomy, division of tongue tie if indicated or requested, followed by a supervised feed and advice in positioning and attachment, if breastfeeding. Please ensure you bring the baby hungry enough to want to actively feed post procedure. I will require the Child Health book (red book) to document your visit in order to share details with other health care providers. Please visit www.tongue-tie.org.uk (http://www.tongue-tie.org.uk/)to gain information to help guide you in making an informed decision about the benefits of this service. If you are uncertain whether this service will meet your needs please call me prior to the appointment to discuss.

This procedure is commonly done without anaesthesia as it is a quick simple procedure and causes a pinch like response in babies. Some babies sleep through the surgery and do not appear to feel the release. This is regardless of age. Most NHS trust will only treat young babies, under a few months old, and if surgery is required in an older child a general anaesthetic will be used to ensure safety of fingers and babies teeth! Local anaesthetic is rarely used in the NHS as it is more distressing to the baby and prevents the baby from feeding adequately afterwards as they have a numb mouth. I treat babies under one year without anaesthetic. However with babies over 3 months, parents may consider giving some baby paracetamol one hour before the procedure.

I will treat babies, with no additional risk factors, who have not had Vitamin K providing parents understand the risks involved. The consent discussion will cover the risks at the appointment. It is essential that a family history of clotting disorders is fully disclosed.

Should you require services that are eligible then you are advised to contact your insurance directly for details of providers. upon request I will supply an itemised receipt detailing my professional qualifications. NOTE Bupa only support procedures undertaken by members of the GMC.

Your baby will be swaddled in a blanket, to protect little fingers and assist with a good visualisation of the mouth. I use gloves to protect your baby from any germs and gently examine your babies ability to move the tongue. Some babies object to a finger in their mouths but most are happy to play. I will encourage your baby to protrude their tongue, move their tongue from side to side and suck on my finger to ascertain the effectiveness of their suck and swallow. Then I will look at the shape of the tongue and the height of the roof of their mouth. Finally I will feel under their tongue. I may suggest you would like to watch what I am doing so you can understand my final recommendations. If the procedure is indicated we will discuss the risks and potential benefits before I obtain your written consent. I use single use, sterile scissors to divide the frenulum and then insert a small piece of gauze. This distracts the baby and also mops up any droplets of blood. The baby will be returned immediately to you for feeding. If you are breastfeeding you will be supported with positioning and attachment. Once the baby has finished feeding I will check for any evidence of continued bleeding. When I am confident your baby is fit I will then advise you can take the baby home.

It is recommended that you discuss this with your general practitioner for an NHS referral. If you wish to access private services, your GP will be able to support your referral to a suitable surgeon.

Recent research concluded: There was a statistically significant improvement in speech outcomes and tongue mobility in children who underwent frenotomy compared to individuals who declined the operation. As a result of the data presented within this study, there appears to be a long-term benefit beyond feeding when frenotomy is performed in newborns with ankyloglossia.

Please visit: The Association of Tongue Tie Practitioners Lip Tie position statement(https://www.tongue-tie.org.uk/atp-position-statements) Currently there is no published evidence supporting a link between breastfeeding issues and lip tie. NICE have not issued any guidance on this issue, and therefore, training in not available in the UK in lip tie division for practitioners. This situation may change in the future if new research and evidence influences best practice guidelines. Currently nurse/midwife tongue-tie practitioners working in the UK will not offer lip tie division as the Nursing and Midwifery Council’s code of conduct states that nurses, midwives and health visitors must: Use the best available evidence • 35. You must deliver care based on the best available evidence or best practice. • 36. You must ensure any advice you give is evidence based if you are suggesting healthcare products or services Keep your skills and knowledge up to date • 39. You must recognise and work within the limits of your competence • 40. You must keep your knowledge and skills up to date throughout your working life On the rare occasions that lip ties are divided by surgeons in the NHS it is usually done in relation to concerns about dental issues, not breastfeeding. If you have concerns about lip ties we suggest you discuss this with your dentist.

I would hope that you were satisfied with the service provided, felt fully informed and involved in any decisions made. However, if you have any concerns please do not hesitate to share with me, in the first instance, by email, text or mobile. You may wish to provide constructive criticism or suggestions anonymously through the links provided in follow-up emails. Any specific concerns, received in writing, will be responded to within a 2 week period. If you feel that your concern is serious in nature you may wish to contact the Nursing and Midwifery Council to discuss. I hold professional indemnity insurance with Hiscoxs Insurance Company.

Heidi is a helpful tool that allows the clinician to focus entirely on your care whilst allowing them to accurately capture medical information, ensuring a comprehensive and precise record of your care. Your consent will be obtained prior to use and you are welcome to withhold consent.