If you have been advised that your baby has a Tongue tie, what are your first steps, do you turn to the internet to find your nearest practitioner, or do you reach out to your delivering hospital to find that the waiting list for surgery is too long?

 Consider my advice below to assist you in your choice of Provider/place of treatment.

1. How many assessments and procedures do they provide each year, do they audit their practice and outcomes as required by NICE?

2. What is the practitioner/service’s recurrent scar, prolonged post- surgical bleed, and adverse incident rate.

3. Are they CQC registered, insured, and able to display relevant documents confirming this. Where does the procedure take place, ideally in a clinical setting where the risk of complications can be managed.

4. How does the provider manage post-operative complications, are they available and contactable to answer any concerns you may have and review you and baby face to face.

5. How thorough is the pre-surgical assessment and consultation appointment, is a full feeding history taken, are you fully informed of the benefits, risks and alternatives to the surgery in order that you can give fully informed consent prior to surgery. Frenulotomy can be life changing for mother and baby if completed correctly. It is important that you have all the information prior to agreeing to treatment.

6. What support does the provider offer post-surgery? Ideally face to face feeding and surgical review at day 5-7 and again at 10-14 days and as often as required at no additional cost enabling you to attain your personal feeding goals.

7. Does the provider offer and perform a full and complete Frenulotomy where a diamond shaped wound under the tongue is attained and visible. Are you assisted to feel the Tongue tie prior to surgery and view the surgical site post-surgery.

8. Which instruments does the Provider use are they sterile single use, or do they have adequate sterilisation and packing facilities. do they use blunt tip strabismus scissors and a grooved director to ensure that only the frenular tissue is divided and not surrounding structures for example sub-lingual blood vessels, the salivary ducts, or the tongue itself.

9. What strategies does the Provider advise to minimise the risk of recurrent scar tissue? Active wound and scar management, tongue mobilisation exercises, both or none?
   1. What does the Provider advise for your baby’s post frenulotomy pain and wound guarding: Age-appropriate paracetamol/teething gel/breastmilk?
   2. Do they demonstrate to parents in detail wound and scar management?

10. Have all your questions been answered, at the end of the day you are making a decision for a surgical procedure on behalf of your child, and with their best interests. Parents should not feel obliged to complete treatment on the same day as assessment and consultation, particularly if your questions are unanswered, an option for you to go home and consider all the information you have been given and return for surgery