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Our advisors will explain how we address baby's tongue-tie problems.
Frenulum problems aren't just a fad; they're a reality that's being diagnosed more and more often because, fortunately, there are an increasing number of healthcare professionals trained in this area. At Maternify, we're experts in Tounge-tie assessment for babies and children.
Our founder Carla Quintana @matronaparami explains what problems require tongue-tie release in babies.
Tounge-tie assessment
The lingual frenulum is the thin membrane that connects the tongue to the floor of the mouth. All babies are born with one, and for most, it causes no problems. Ankyloglossia occurs when the frenulum is shorter, thicker, or attached at a point that restricts tongue movement.
It is neither a malformation nor a disease; it is an anatomical variation that, in some babies, makes it difficult to perform such basic actions as latching onto the breast properly or moving the tongue freely. Not all cases of ankyloglossia require treatment: the only way to know for sure is for a professional to evaluate that specific frenulum in that specific baby.
A distinction is often made between an anterior frenulum—which is visible when the baby lifts its tongue because the membrane extends almost to the tip—and a posterior frenulum, which is deeper and less visible to the naked eye, and sometimes goes unnoticed during a quick examination. This distinction is important because a posterior frenulum can cause breastfeeding symptoms without anyone having detected it beforehand, and it is one of the reasons why a specific evaluation is recommended rather than just a visual examination.
It can be assessed from the very first days of life, and in fact, it is usually detected during the first few weeks, because that coincides with the time when breastfeeding is established. It can also be assessed later on, if difficulties arise later or if concerns had not been raised earlier. There is no age limit for requesting an assessment, although the sooner any concerns about latching are resolved, the sooner breastfeeding can be supported.
The evaluation is conducted jointly by a midwife and a physical therapist. They assess the function and anatomy of the frenulum, the mobility of the tongue, and—based on the Hazelbaker scale—the actual benefits of performing a frenotomy or not. During the same session, the physical therapist works on the baby’s neck muscles and tongue mobility and teaches exercises to do at home, regardless of whether a frenotomy is needed. The outcome of this assessment is always individualized: the team may recommend a frenotomy, may recommend only Physiotherapy, or may not recommend any intervention at all.
From there, there are two paths, and which one to follow is determined by the assessment of that specific baby—never the other way around. If the frenulum is restrictive and limits functionality, a frenotomy is considered along with Physiotherapy. If it is not, treatment involves only Physiotherapy and exercises at home. Both the assessment and the frenotomy are performed by healthcare professionals: Maternify’s Breastfeeding Unit is led by Carla Quintana, a midwife who specializes in Tounge-tie assessment and ankyloglossia.
Tounge-tie assessment addresses questions about latching, tongue mobility, and whether or not a frenotomy is recommended. It is not a substitute for pediatric emergency care. If your baby has a fever, is having trouble breathing, persistently refuses to feed, or is losing a significant amount of weight, contact your pediatrician first or go to the emergency room: these issues cannot wait for an evaluation appointment.
Many families come here after struggling with breastfeeding for weeks. If latching still hurts or you're worried about your milk supply, we can help you with that, too:
Maternify offers you a team of midwives and physiotherapists specialized in identifying and treating problems that require tongue-tie release or other treatments.
The risks of not addressing a tongue-tie problem can include: having to stop breastfeeding, increased risk of infection due to not being able to clean the tongue properly, choking or difficulty speaking, plagiocephaly, colic, palate deformation, rhinitis, sleep apnea...among others.
Ankyloglossia, or short lingual frenulum, is a congenital anomaly that can restrict tongue mobility and cause muscle tension. Two types of treatment are distinguished, depending on whether or not a frenotomy (cutting of the baby's frenulum) is performed.
From a multidisciplinary perspective, an assessment of the symptoms and restrictions caused by the frenulum is carried out, Physiotherapy treatment is started Physiotherapy advice is given on whether or not to perform a frenotomy.
Frenotomy is a short and simple procedure in which parents can be present at all times. It consists of a small cut in the baby's frenulum, made with sterilized scissors, lifting the tongue slightly, which leaves a rhombus that indicates that the tongue is correctly unanchored. Bleeding is minimal and tissue healing is rapid. After making the cut, it is dabbed with gauze and the baby is immediately put to the breast, bottle or pacifier.
The treatment is carried out in person at associated clinics.
97% of families surveyed indicated that, in similar circumstances, they would have chosen this treatment again.
How does it work?
Our advisors will explain how we address baby's tongue-tie problems.
We will mark in the agenda the initial Tounge-tie assessment appointment for when it suits you best.
We help you solve the tongue-tie problem and accompany you until the final check-up.
The service is provided at the Vicetto Clinic (2 Raimundo Lulio Street, 28010 Madrid), next to Plaza de Olavide. Appointments are usually available within the same week.
To make the reservation, only the assessment session will be paid.
For availability outside of Madrid, please inquire via the contact form.
The 7-10 day follow-up session will be paid for on the day of the appointment at the Vicetto clinic.
Do you have any more questions? We have the answers.
The goal is to find the right treatment, so our expert midwives and physical therapists will evaluate the restriction of the frenulum based on functionality and anatomy criteria, as well as the benefits of performing a frenotomy based on the Hazelbaker scale.
There are two types of ankyloglossia:
A) Ankyloglossia with a restrictive frenulum that requires frenotomy (cutting of the frenulum).
B) Ankyloglossia that does not require cutting and can be treated by midwives and Physiotherapy.
In addition, in this session, the initial treatment with the physiotherapist will focus on the cervical muscles and tongue mobility, and exercises will be taught for home use.
Frenotomy is a short and simple procedure in which parents can be present at all times and consists of making a small cut in the baby's frenulum, lifting the tongue slightly. It is performed with sterilized scissors, with minimal bleeding, as the tissue heals very quickly. After making the cut, it is tamponed with gauze and immediately the baby is put to the breast, bottle or pacifier, according to the parents' preference.
Our experts recommend doing it on the same day as the assessment, always respecting the parents' decision.
After a frenotomy to correct ankyloglossia and the continuation of the Physiotherapy session Physiotherapy rehabilitation exercises for home will also be taught, it is necessary to follow up with the physiotherapist 7-10 days after the procedure to continue treatment of the scar and the muscles associated with the neck, as the tension that has existed in the baby's mouth and neck is significant.
If you have reimbursement insurance, it is possible. Although we do not work directly with medical companies, you can always submit the supporting invoice if you have reimbursement insurance and the service is within the coverages included in your policy. They usually cover up to 80% of the cost of services like this.
The anterior frenulum is easily visible when the baby’s tongue is lifted, because the membrane extends almost to the tip. The posterior frenulum is deeper and may go unnoticed during a quick visual examination, even though it causes the same difficulties with latching or mobility. That is why Maternify’s assessment goes beyond simply looking; it evaluates the tongue’s full functionality.
No. Having a short frenulum does not automatically mean it needs to be cut. There are babies whose frenulum does not limit function, and they are managed solely with Physiotherapy and exercises at home. The decision is always made after an individual assessment, never before.
It is a brief procedure with minimal bleeding and rapid tissue healing. It may cause a brief cry, which is to be expected with any manipulation of a baby’s mouth. After the procedure, the baby is given the breast, a bottle, or a pacifier, depending on the parents’ preference; the parents may be present at all times.
No, it is an anatomical variation present from birth and is not related to anything the family did or did not do during pregnancy. What can be done, however, is to detect it early through an evaluation, in order to better support breastfeeding and the baby’s tongue mobility from the start.
There is no specific age at which it ceases to be relevant. It is often assessed during the first few weeks, when it coincides with breastfeeding difficulties, but it can also be assessed later if concerns arise at that time. The important thing is that the assessment be performed by a professional who evaluates the actual function of the frenulum, not just its appearance.
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