What tongue-tie is
Everyone has a lingual frenulum under the tongue. In tongue-tie, it is short, tight, thick or attached close to the tip of the tongue, restricting how far the tongue can move up, out and to the sides. Tongue-tie can run in families.
The degree of restriction, rather than the appearance alone, determines whether it causes problems.
Signs in the baby
- Difficulty latching on or staying latched to the breast.
- Feeding for a long time, with short breaks, and seeming hungry again soon.
- A clicking sound during feeding.
- Poor weight gain.
- Dribbling milk or swallowing a lot of air, leading to wind.
- Difficulty lifting the tongue or sticking it out past the lips.
- A heart-shaped or notched tongue tip.
Signs in the breastfeeding parent
- Sore, cracked or damaged nipples.
- Nipples that look flattened or pinched after feeds.
- Low milk supply.
- Mastitis or blocked ducts.
- Feeling exhausted from constant feeding.
Tongue-tie and bottle feeding
Bottle-fed babies with tongue-tie may also have difficulty, such as leaking milk, taking a long time to feed or swallowing air. Trying different teats and feeding positions with guidance can help.
Assessment
Many feeding difficulties are caused by positioning and attachment rather than tongue-tie, so a skilled assessment of feeding is the first step. An infant feeding specialist, midwife, health visitor, lactation consultant, speech and language therapist or doctor looks at the appearance and function of the tongue and observes a feed.
Tongue-tie should be treated only if it is clearly contributing to feeding problems.
Tongue-tie division (frenotomy)
- The baby is wrapped and their head is held still.
- The frenulum is snipped with sharp, sterile scissors; it takes a few seconds.
- Young babies usually do not need anaesthetic; there may be a little bleeding.
- The baby is fed straight away, which comforts them and helps stop bleeding.
- Older babies and children may need a general anaesthetic.
Laser treatments are offered by some providers, but there is no clear evidence that they are better than scissors.
After the procedure
Many parents notice an improvement in feeding within days, although some babies need time and continued feeding support to learn to use their tongue more effectively. A white patch under the tongue is normal healing and disappears within a couple of weeks. Rarely, the frenulum can reattach or there may be bleeding or infection.
Possible risks
- Bleeding, usually minor.
- Infection, rare.
- Ulcer under the tongue, which heals.
- Reattachment of the frenulum.
- No improvement in feeding if the main problem was something else.
Tongue-tie and speech
Tongue-tie rarely causes speech problems, because the tongue usually has enough movement for clear speech. Occasionally, it may affect some sounds such as “l”, “r”, “t”, “d” or “th” in older children. Late talking is not caused by tongue-tie. A speech and language therapist can assess whether sounds are affected and whether a release is likely to help.
See when do babies start talking and speech sound development chart.
Tongue-tie in older children and adults
Older children and adults may notice difficulty licking an ice cream, playing wind instruments, cleaning teeth with the tongue, or a gap between the lower front teeth. If it causes problems, a release can be done, sometimes followed by tongue exercises.
Feeding support before and after
Whether or not a tongue-tie is divided, skilled feeding support makes a big difference: positioning, attachment, managing nipple pain and protecting milk supply. Some babies feed better quickly after division, while others need several weeks to adjust their sucking pattern. Gentle play with the baby’s mouth and tongue can be encouraged, though there is limited evidence for routine stretching exercises.
When to seek help
- Your baby is not gaining weight or has few wet nappies.
- Breastfeeding is very painful or causes nipple damage.
- Feeds take a very long time and the baby is not settled.
- Bleeding after a tongue-tie division that does not stop with feeding and pressure.
- Fever or a baby who refuses feeds after the procedure.
Key points to remember
- Tongue-tie is a short or tight frenulum restricting tongue movement.
- Many tongue-ties cause no problems and need no treatment.
- Division can improve breastfeeding when tongue-tie affects feeding.
- Tongue-tie rarely causes speech problems.
Questions about tongue-tie
These answers are general information and do not replace an examination or individual medical advice.
How do I know if my baby has tongue-tie?
Signs include difficulty latching, clicking while feeding, poor weight gain and a tongue that cannot lift or stick out well.
Does tongue-tie division hurt?
Babies may cry briefly, but it is quick and they usually settle with feeding.
At what age should tongue-tie be cut?
If it affects feeding, it is usually done in the first weeks of life.
Can tongue-tie fix itself?
The frenulum can stretch a little over time, and many children with mild tongue-tie never have problems.
Does tongue-tie cause speech delay?
No. It rarely affects speech and does not cause late talking.
Can tongue-tie come back?
Rarely, the frenulum can reattach.
Is laser better than scissors for tongue-tie?
There is no clear evidence that laser is better.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.