Tongue Tie in Babies: Signs, Diagnosis and Treatment

Quick answer: Tongue tie is a short or tight frenulum that restricts tongue movement and often makes breastfeeding painful and difficult. Signs include nipple pain and damage, clicking, slipping off the breast and poor weight gain. A trained midwife, health visitor, IBCLC or GP should assess it. Treatment is frenotomy, a few-second snip, but mild ties causing no problems may need no intervention.

What parents need to know

Tongue tie — or ankyloglossia — is a condition where the strip of tissue (frenulum) connecting the underside of the tongue to the floor of the mouth is shorter, tighter, or positioned further forward than usual. It restricts the tongue's movement and range, which can cause significant difficulties with breastfeeding — and sometimes bottle feeding, speech, and oral health later on.

Tongue tie affects around 4–11% of newborns and is more common in boys than girls. It's one of the most frequently missed causes of breastfeeding difficulties in the UK.

Types of tongue tie

• Anterior tongue tie: The frenulum attaches near the tip of the tongue, visible when you look in the baby's mouth.
• Posterior tongue tie: The frenulum attaches further back and may be submucosal (under the mucosa). Harder to see, easier to miss, but can be just as significant.

Signs of tongue tie in a breastfed baby

Tongue tie should be suspected when breastfeeding is painful and difficult despite working on positioning and latch. Signs include:

• Painful feeding that doesn't improve with latch adjustments
• Nipple pain, damage, or distortion (nipple comes out lipstick-shaped or creased)
• Baby feeding for very long periods without seeming satisfied
• Baby making clicking sounds during feeding (air getting in due to poor seal)
• Baby slipping off the breast frequently
• Poor weight gain or slow weight gain
• Mastitis or blocked ducts from poor milk transfer

Signs of tongue tie in the baby themselves

• A tongue that can't extend past the lower gum or lip
• A heart-shaped or notched appearance to the tongue tip when extended
• Difficulty lifting the tongue to the roof of the mouth

How is tongue tie diagnosed?

Tongue tie should be assessed by a trained healthcare professional: a midwife, health visitor, lactation consultant (IBCLC), or GP trained in tongue tie assessment. Not all healthcare professionals have been trained to assess for posterior tongue tie, which is why many cases are missed.

If you're struggling with breastfeeding and standard latch advice isn't helping, ask specifically to be assessed for tongue tie. You may need to seek out a specialist referral or an independent IBCLC if your NHS trust doesn't have a tongue tie service.

Treatment: division (frenotomy)

The treatment for tongue tie causing significant feeding difficulties is a simple procedure called frenotomy (or frenulotomy): using sterile scissors to snip the frenulum. The procedure:

• Takes only a few seconds
• Is usually performed without anaesthetic in young babies, as there are very few nerve endings in the frenulum at this age
• Has minimal blood loss (a few drops)
• Can be followed immediately by a breastfeed, which provides comfort

Problems after the procedure are rare, but they can include bleeding and infection. Contact your GP urgently if there are signs of infection afterwards, such as redness, swelling, a high temperature, your baby being reluctant to feed, or your baby being sleepy or irritable.

Most parents find the improvement in feeding is immediate or within a few days. For some, it takes a little longer as both mother and baby adjust to the new mechanics of feeding.

Is treatment always necessary?

Not all tongue ties require treatment. A mild tongue tie that isn't causing feeding difficulties, speech issues, or discomfort may not need any intervention. The decision should be made on a case-by-case basis in consultation with a healthcare professional.

Accessing treatment on the NHS

Frenotomy is available on the NHS, but provision varies significantly by area. Some trusts have dedicated tongue tie clinics; others have long waiting lists or refer to private practitioners. Your midwife or health visitor can advise on local provision. Private tongue tie practitioners can also perform the procedure if NHS access is difficult, but only registered healthcare professionals who have been properly trained in tongue tie division should do it.

Frequently asked questions

How common is tongue tie in babies?

Tongue tie affects around 4–11% of newborns and is more common in boys than girls. It's one of the most frequently missed causes of breastfeeding difficulties in the UK.

Does tongue tie division hurt the baby?

Frenotomy takes only a few seconds and is usually done without anaesthetic in young babies, as there are very few nerve endings in the frenulum at this age. Blood loss is minimal and a breastfeed can follow immediately for comfort.

Can you get tongue tie treatment on the NHS?

Yes, frenotomy is available on the NHS, but provision varies significantly by area. Some trusts have dedicated clinics; others have long waiting lists or refer to private practitioners. Your midwife or health visitor can advise on local provision.

Does every tongue tie need treating?

No. A mild tongue tie that isn't causing feeding difficulties, speech issues or discomfort may not need any intervention. The decision should be made case by case with a healthcare professional.