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Clinically effective care

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What is a tongue-tie?

A tongue-tie results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted.

Tongue-tie is present at birth and hereditary, and occurs relatively often with between 0.2% and 2% of babies born with tight frenulums.

Why is reducing tongue-ties important?

  • Tongue-tie in newborns can cause multiple issues in the initiation and continuation of breastfeeding [World Health Organisation]
  • We wanted to provide the most effective treatment for tongue restriction caused by tongue-tie in order to support the continuance of breastfeeding

Our goal was to establish a service to assess and treat tongue-tie in newborns for the Waitemata district.

What did we find?

  • The most effective treatment for tongue restriction caused by tongue-tie is frenotomy, which is a division of the frenulum [Cochrane 2010].
  • Waitemata DHB did not have a publically funded frenotomy service which meant that parents had to pay to have this service provided in the community by private providers.

What have we done?

Service planning

  1. We developed an evidence-based clinical pathway (see below) with a multidisciplinary team
  2. The team identified that midwives were the most appropriate workforce to provide a tongue-tie assessment and frenotomy service
  3. We developed a process to credential midwives to provide this service, as although this is part of the midwifery scope of practice, it is not a core competency

Tongue-tie pathway for breastfed babies
Tongue-tie pathway for breastfed babies

Workforce development

A peer reviewed credentialing process was developed for midwives to provide a frenotomy service including:

  • theory readings / workbook
  • 8-hour workshop on the use of the agreed assessment tool (Hazelbaker)
  • theoretical assessment
  • supervised clinical practice of both assessment and technique
  • training in documentation and record keeping, including ongoing data collection

Did we make a difference?

Frenotomy clinics were commenced in October 2015 at North Shore and Waitakere hospitals with 4 credentialed midwives with the following results:

  • 127 babies assessed with 104 frenotomies performed and 5 referrals to Starship ORL department
  • average 68% increase in tongue function score at re-assessment
  • more babies fully breastfeeding
  • high satisfaction reported from mothers and community midwives


There has been high satisfaction reported from mothers and community midwives for the service:

Feedback from mothers and community midwives