We also have this comprehensive checklist.

Mother:

• Pain latching on (not always), damaged nipples, nipple gets flattened after drinking or is discouloured (sometimes Raynaud) ;
• The use of a nipple shield, otherwise latching on not always possible;
• Baby cannot drink the breast well, causing clogged mammary glands or inflammation of the breast (mastitis);
• In addition to breastfeeding, formula feeding is required or the mother needs to pump to get production going.

Babies:

• Clicking sound (releasing vacuum);
• Baby cannot open mouth wide, sucks only the nipple in;
• Baby drinks very “forcefully”, sometimes bites, or clamps with the jaw;
• Drinks restlessly / impatiently at the breast or is quickly tired; Drinks briefly, releases a lot, or drinks “all day” on the breast;
• Drinking a lot of air, reflux symptoms, colic, spitting, burping, distended belly, wind;
• Moderate growth of the baby;
• Because the tongue does not reach the palate can up moving the palate sometimes remains high. This may give less space in the nose, making the baby appear to have a cold and continue to breathe through the mouth.
• Because the baby has difficulty fully using the tongue, a white deposit remains on the tongue. This is not a thrush, but taste buds with plaque (see photo);
• Babies with a tight lip tie where the front teeth come through around a year,  sometimes get problems with feeding again and “bite”.

Children:

• Problems with the pronunciation of letters where the tongue has to be raised to the palate. Unclear speech. Eating solid food gives problems when the bolus of food cannot be moved well in the mouth from left to right and from front to back and is difficult to swallow. The child pushes his fingers, or leaves the food in the cheeks or chokes. Some little ones refuse certain textures or “pieces.”
• It is difficult to lick the rear molars, which can cause cavities. Brushing teeth is difficult, especially if a lip tie is present.
• Or have middle ear infection, because they do not properly empty the Eustachian tube when swallowing.

More good information on www.drghaheri.com.

Tongue tie:

• Heart-shaped tongue;
• Indetation in the middle
• During crying a low tongue position with sometimes a dent or a bowl shape;
• White debris from halfway the tongue to the back

Liptie:

• Suction blister upper lip in babies;
• Bloodless and red/ white line under nose when drinking babies; (see photo)
• Blanching attachment of tie on the edge of the upper jaw (see photo);
• A diastema when teeth come through

With bottle feeding, the baby may have trouble drinking the bottle completely because it is not possible to make a good seal with the lips and create negative pressure with the tongue. Other symptoms may include: “playing” with the bottle, clicking sounds, consuming a lot of air, colic, spitting, burping and reflux may play a role. Drink the bottle very slowly or not completely empty. Less than average growth can also sometimes be a reason.

A frenectomy, frenulotomy or frenulum extirpation means that the tongue tie or lip tie is removed by means of a surgical instrument. The choice of the instrument depends on the practitioner.

In the Netherlands children up to 18 years are insured for dental care. The applicable dental rates that are calculated are determined by the Dutch Healthcare Authority. Prices 2024

When you have a Dutch insurance, the consultation or treatment is directly invoiced to the health insurance. You do not have to pay in advance. If you do not have Dutch health insurance, you pay after the consultation. You receive a letter for the insurance which explains about the treatment and costs, so you may can get it reimbursed. Always make sure to check with your insurance if all costs are covered. Extra consults next to the treatment might not be fully covered.

For the costs of a consultation or treatment of therapists other than dentists, you should contact the relevant practitioner.

In this short online lecture, Kirsten Slagter explains how healthcare in the Netherlands is arranged around treatment of a tongue tie.

Mucous membranes heal differently than skin. A wound resurfaces on the skin like a brown crust. Mucous membranes heal white yellowish with a red border around it. Generally, the wound heals within 2 weeks (see photo). Do not remove the new mucous membrane on purpose.

Inflammation rarely occurs. With an inflamed wound, the wound image is more red and swollen. When in doubt always contact your provider.

There is a lot of discussion about determine and treating the types of tongue tie and / or lip ties. Sometimes there is no clear membrane visible under the tongue and parents are sent home by the doctor without treatment, while a “hidden” tongue tie is the cause of feeding problems. Therefore, the classification does not determine the severity of the feeding problem, it only determines the degree of attachment.

The classification that is generally used is Kotlow his classification of the lip tie (1 to 4) and Coryllos her classification of the tongue tie (1 to 4) (see frequently asked questions what does a liptie or a tongue tie look like).

The midwife, lactation consultant, maternity care nurse or speech therapist, may have told you about the possible functional problems in babies and children due to a tongue tie or a lip tie. The knowledge is also shared among parents through the internet.

A tongue tie is not always easy to see, especially if it is deeper under the tongue. Not every doctor, midwife, lactation consultant IBCLC or maternity care nurse has enough experience to assess this properly. It is wise to find a practitioner with experience in this area. A lactation consultant IBCLC who has experience in assessing the tongue tie and lip tie may be able to assess it.  After doing an oral examination she may even find the tie “hidden” behind the oral mucosa. When in doubt, make an appointment with a lactation consultant or a practitioner with experience. Sending a photo is possible for review, but can never provide a definite answer.

Pediatrician Dr. James Murphy (link) came up with the following method. When the finger slides under the tongue, it should be easy and smooth. If it is difficult to move from left to right under the tongue over the floor of the mouth and a “string”, “speed bump” or “fence” is felt, this may indicate a tongue tie.

When the baby is crying, and the tongue stays down, it could be caused by a tongue tie actually pulling the tongue down. Sometimes only the sides of the tongue rise so that the tongue makes a bowl shape.

The upper lip should be able to flange relatively easily. If the lip is lifted and gently pulled, and the upper jaw turns bloodless where the lip tie is attached, that may be an indication of a lip tie. This test is also called “blanching” or anaemia test (see photo).