Shared learning database

Cwm Taf Health Board
Published date:
August 2011

Implementation of NICE IPG 149 - Division of Ankyloglossia (Tongue Tie) for Breastfeeding and to review cases of tongue-tie in accordance with the guidance.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To implement NICE Interventional Procedure Guidance No.149 - Division of Ankyloglossia (Tongue Tie) for Breastfeeding and to review cases of tongue-tie in accordance with NICE Guidance. The main objective of this piece of improvement work is to review implementation of NICE IPG 149 and to regularly audit cases of tongue-tie in accordance with the NICE guidance and finally to identify the outcome of cases, looking at the success of the procedure and the complication rate.

Reasons for implementing your project

Many tongue-ties are asymptomatic and cause no problems. However, some babies with tongue-tie experience breastfeeding difficulties. Conservative management includes knowledgeable breastfeeding advice and skilled help. Careful assessment is important to determine whether the frenulum is affecting feeding, and whether its division is appropriate. Some practitioners believe that if division is required, this should be undertaken as early as possible. This may enable the mother to continue to breastfeed, rather than having to feed artificially. An Implementation Steering Group was set up on publication of the NICE Guidance which involved key stakeholders. A care pathway was established with the following aims:- - Early identification and assessment of problems - Skilled intervention to safeguard breastfeeding - Avoidance of delay and swift treatment where necessary - Ongoing audit of service effectiveness - Provision of patient information

How did you implement the project

All cases from 2007 referred to the Maxillofacial Department via the Infant Feeding Co-ordinator are prospectively audited. An audit form is completed at the time of procedure and then at follow up intervals (24 hours, 1 week and 1 month).

Key findings

Division of tongue tie in this small cohort of young babies during 2007 to date has proved to be a straightforward intervention with no complications. By 1 month, the procedure proved to be effective in facilitating success of breastfeeding for 70% of the babies, and was partially effective for another 20%. Parent's responses to the procedure were overwhelmingly positive; all parents, including those who did not continue breastfeeding, stated to the auditor that they were glad the frenectomy was done, and many were glowing in their praise of the service. Some examples of final audit comments at one month:- The baby's mother is very happy that his tongue tie was released; she is quite sure that feeding would have remained painful, as she had experienced no improvement during the 5 weeks prior to the procedure, in spite of skilled help with attachment & positioning. The mother tells me that she has been surprised and impressed by the level of support that she has received to continue breastfeeding. She firmly believes that she would have been unable to keep up the breastfeeding for very much longer, if the service had not been provided. In this case, releasing the tongue tie did not result in the baby being able to breastfeed successfully. The mother reports that the baby had got used to feeding from a bottle and teat, and didn't know how to feed from the breast. However, she says that she is not sorry that the frenectomy was performed, as her baby seems happier to be able to poke his tongue out.

Key learning points

Keep the implementation process as simple as possible, Involve all key stakeholders at the outset, Ongoing audit of the service.

Contact details

Leanne Cunningham
National Guidance Facilitator
Cwm Taf Health Board

Is the example industry-sponsored in any way?