Tongue tie referrals

COVID-19 and Restrictive Lingual Frenulum (tongue tie) referrals

In common with most other specialties, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.
Due to the infection risks to infants, their parent/s and the unknown risks to Health Care Professional staff from performing an oral procedure we are only accepting referrals for potential frenulotomy where a baby is unable to feed safely by breast or bottle.
We have an extremely limited capacity of face to face appointments at the hospital, and this will be only for critical cases.
This will mean we will only be able to accept referrals to see babies with:

1. An inability to gain weight normally, even when fed supplemental expressed breastmilk, screened human donor milk or formula milk by bottle.
2. Jaundice requiring phototherapy, due to an inability to feed by direct breastfeeding, bottle feeding expressed breastmilk, screened human donor milk or formula milk
3. In term babies, an inability to feed effectively due to a RLF necessitating a nasogastric tube, when at least 2 different types of bottles and teats have been tried.
   Please do not refer and other cases to us at this time. We will not be able to see them.
   We will be assessing all babies referred to us by telephone triage and seeking to offer
   telephone and video-based support as far as possible. We will only be able to do this for
   babies born at NNUH or at home under NNUH midwifery care.
   We ask that all babies born in other hospitals receive telephone and video-based infant feeding support from the infant feeding team at that hospital in the same way.
   Breastfeeding and access to breastmilk for babies is obviously more important than ever at a time of a worldwide pandemic. We feel we will need to support mothers to express their breastmilk and bottle feed their milk if they are unable to breastfeed- or use nipple shields,
   or a supplemental nursing system as an interim measure.
   This is obviously unprecedented, and we are trying to balance risks and benefits. We are also acting without clear evidence of the risks and benefits of frenulotomy in these cases.
   We will update you on our ability to see and treat infants again as the situation progresses.