Feeding Together

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service, this key question was rated as good. This meant peoples outcomes were consistently good, and feedback confirmed this.

We reviewed all 6 quality statements for effective. This included assessing needs, delivering evidenced based care and treatment, how staff, teams and services work together, supporting patients to live healthier lives, monitoring and improving outcomes and consent to care and treatment. We found:

Care and treatment were delivered in line with current national guidance and evidence-based practice. The registered manager regularly reflected on and reviewed the service to ensure care remained appropriate and in the best interests of babies receiving treatment.

Before any procedure was carried out, the registered manager ensured informed consent had been obtained through a well-established consent process. We observed the registered manager discussing feeding concerns with caregivers, assessing the baby and providing feeding support prior to treatment.

Following the frenulotomy procedure, the registered manager monitored the baby while feeding to check they were able to latch effectively and feeding had not been adversely affected.

Caregivers were provided with individualised advice and practical guidance to help them support their baby after treatment and understand any ongoing care needs

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure babies and caregivers care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service used a comprehensive pre-assessment questionnaire to gather information about each baby's health and identified any additional support needs. The service had a current tongue tie policy which reflected guidance .

Before treatment, the registered manager reviewed the information provided and explored any concerns with caregivers. We saw a detailed assessment had been completed, which included the baby's medical and birth history, as well as relevant information about the mother's health. The registered manager observed feeding, examined the baby's oral anatomy and tongue function, and discussed findings with caregivers, ensuring they had opportunities to ask questions throughout the process.

Individual circumstances relating to health, wellbeing and communication were considered when planning care. This helped ensure assessments and treatment were tailored to the needs of both babies and their caregivers.

During the inspection, we observed a frenulotomy procedure. The registered manager used the Hazelbaker Assessment Tool to assess tongue appearance and function, supporting decisions about whether treatment was clinically appropriate. The Hazelbaker Assessment Tool helps clinicians assess the impact of a tongue-tie on tongue movement and feeding and supported decisions about whether a frenulotomy procedure was clinically appropriate.

We observed the registered manager monitoring feeding and reviewing the baby's progress following the procedure. Practical advice was provided to help caregivers improve feeding techniques and support their baby's ongoing development. Caregivers were encouraged to contact the registered manager by telephone, text or email if they had questions or concerns after returning home.

The service adopted a family-centred approach to care. Assessments considered not only the needs of the baby, but also any support caregivers required to manage feeding following treatment. Families were provided with information from the Association of Tongue-tie Practitioners (ATP), including guidance on managing bleeding after the procedure and advice about when further medical assistance should be sought.

The registered manager worked within their scope of practice and had clear arrangements for obtaining specialist input when required. Babies with complex medical needs or requiring further investigation were referred to NHS services for additional assessment and management.

We reviewed 5 patient records and found documentation was detailed, person-centred and completed to a good standard. Records demonstrated assessments, clinical decisions and follow-up actions were clearly documented. Information was stored securely within a electronic records system which the caregivers consented to., Feedback from caregivers was consistently positive. People told us they were given sufficient time to understand the assessment process and felt fully involved in decisions about care and treatment. Caregivers described assessments as thorough and individualised. One person told us the registered manager "treated us as individuals and understood that not all feeding problems were the same".

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The registered manager was qualified, experienced and had the skills required to meet the needs of babies accessing the service. They had completed recognised frenulotomy training and undertook regular professional updates. To further develop their knowledge and practice, they attended both national and international conferences relevant to tongue-tie assessment and treatment.

Care and treatment were delivered in accordance with current evidence and recognised guidance. The registered manager followed guidance produced by the National Institute for Health and Care Excellence (NICE) and the Association of Tongue-tie Practitioners (ATP) when assessing and treating babies with tongue-tie.

The service was supported by a range of policies and protocols designed to promote safe and effective care. We reviewed these documents and found they reflected current guidance and accepted practice within the tongue-tie community.

Families were provided with information to help them make informed decisions about treatment. The service website outlined the potential benefits and risks associated with frenulotomy, including the possibility of reformation. It also contained guidance on tongue exercises intended to support recovery after the procedure. During our inspection, we saw the registered manager explain the outcome of treatment to caregivers and a discussion of what normal healing would look like following the procedure.

Feeding support formed an integral part of the service. A clear protocol was in place for assessing feeding techniques, promoting a consistent approach to care. Caregivers received advice on both breast and bottle feeding during appointments, and additional guidance was available through the service website to support feeding after treatment.

The service worked well across teams and services to support babies. They made sure caregivers only needed to tell their story once by sharing their assessment of needs when babies moved between different services.

The registered manager gathered relevant information before appointments to support effective decision-making and care planning. Caregivers were asked to bring their child's Personal Child Health Record (PCHR), commonly known as the 'red book’, which provided important background information about the baby's health and development.

The service had established arrangements for identifying and responding to risk factors that could affect treatment. Where there was a known or suspected family history of a blood clotting disorder, the registered manager sought advice from the baby's GP and local haematology services before proceeding. This helped ensure treatment was only provided when it was clinically safe to do so.

Clear referral pathways were available for babies who required additional investigation or support beyond the scope of the service. The registered manager could refer babies to hospital tongue-tie clinics, GPs and other specialist healthcare services when further assessment was required.

Arrangements were in place to support continuity of care should urgent treatment be needed following a procedure. Families were provided with a Quick Response (QR) code for inclusion in the baby's red book, enabling Accident and Emergency (A&E) staff to access guidance on the management of post-frenulotomy bleeding. This ensured relevant clinical information could be accessed quickly if emergency care was required.

The service supported caregivers to manage their babies health and wellbeing to maximise their independence, choice and control.

We saw the registered manager encourage caregivers to ask questions and take an active role in managing feeding and recovery at home. Clear aftercare information was provided, and caregivers were reassured they could contact the service for further support or advice if required. Caregivers received clear information about caring for their baby after the procedure, including practical advice to help reduce the risk of reformation.

We saw evidence caregivers were actively involved in decisions about their baby's health and wellbeing. The registered manager discussed feeding progress, healing and any concerns raised by families, ensuring care remained responsive to individual needs.

People felt well supported to manage their baby's care following treatment. One person told us, "we felt confident with feeding when leaving the appointment and knew we could make contact with the service if we had any questions".

The service routinely monitored babies care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of caregivers themselves.

The registered manager maintained oversight of service performance through a system that monitored completed assessments, redivisions and infection rates. This information contributed to national data collection and enabled comparisons with other tongue-tie services.

Performance was reviewed using a range of quality and safety indicators, including post-procedure infection rates, episodes of excessive bleeding, redivision rates and other complications following frenulotomy. Data was shared with the Association of Tongue-tie Practitioners (ATP) to support national benchmarking.

Information from the service showed positive outcomes in 2025. No excessive bleeding events or post-procedure infections were reported. During the same period, 144 frenulotomies were carried out, with 2 babies requiring a redivision following reattachment of the tongue-tie, giving a rate of 1.4%. This compared favourably with the most recent ATP national survey (2024), which reported more than 4% of babies required a second frenotomy.

We saw effective arrangements for monitoring outcomes following treatment. After the procedure, babies were observed to ensure they were feeding effectively before leaving the service.

The service undertook a programme of annual audits, including reviews of adverse incidents, tongue-tie reformation rates and infection prevention and control arrangements. These processes supported ongoing quality improvement and assurance.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

On the day of the procedure, consent was reviewed during the consultation and confirmed again immediately before the frenulotomy was undertaken. This helped ensure caregivers remained informed and supported to make decisions throughout their baby's care and treatment.

We observed the registered manager checking whether caregivers had any questions before the procedure and provided clear explanations throughout the consultation. Consent was introduced through the pre-appointment health questionnaire and revisited during the assessment process. The registered manager also sought verbal consent before handling the baby or providing feeding support.

Caregivers were involved throughout the assessment process and their views and wishes were considered when planning their baby's care. The registered manager explained the appearance of the tongue-tie, how it affected tongue movement and shared the assessment findings with caregivers. Information was provided to support informed decision-making about whether they wished to proceed with the procedure. People consistently told us they were given sufficient time to understand the outcome of the frenulotomy assessment before making a decision.

The service had a consent policy which reflected the principles of informed consent and provided guidance on obtaining and recording consent. We found the consent form was aligned with national standards.