Tongue-Tie in Babies: Signs, Feeding Problems and Whether It Needs Treating

Not every tongue-tie causes problems, and not every feeding problem is tongue-tie. Some babies with a tight band under the tongue feed perfectly well. Others struggle, and a quick procedure can make a real difference. A proper feeding assessment is the key.

Imagine your newborn feeds for an hour at a time, keeps slipping off the breast with a clicking sound, and still seems hungry. Your nipples are cracked and painful. When your baby cries, you notice the tip of their tongue looks heart-shaped and doesn’t lift far. A midwife or infant feeding specialist watches a feed and checks under the tongue. Now you can make a decision together.

What is tongue-tie?

Tongue-tie (ankyloglossia) is when the strip of skin connecting the underside of the tongue to the floor of the mouth (the frenulum) is shorter or tighter than usual, limiting how well the tongue moves. It’s present from birth and more common in boys.

Signs in the baby

• Difficulty latching or staying attached to the breast or bottle
• A clicking sound while feeding
• Very long or very frequent feeds, and poor weight gain
• A tongue that can’t stick out past the gums or lift up, sometimes heart-shaped at the tip
• Dribbling milk during feeds

Signs in the breastfeeding parent

• Sore, cracked or flattened nipples after feeds
• Low milk supply, or blocked ducts and mastitis

Treatment

First, get skilled feeding support. Many latch problems improve with better positioning and attachment. If tongue-tie is clearly affecting feeding, a trained practitioner can do a tongue-tie division (frenotomy): a quick snip of the frenulum with sterile scissors. In young babies it usually takes seconds, is often done without anaesthetic, and babies can feed straight afterwards. Complications such as bleeding or infection are uncommon.

But should every tongue-tie be cut?

No. Health bodies advise against cutting a tongue-tie that isn’t causing problems. In recent years there’s been concern about tongue-ties being “diagnosed” and cut too often, sometimes with more invasive procedures, and sometimes for problems the tongue-tie didn’t cause. Choose a qualified practitioner who assesses a full feed, and ask what else could be causing the difficulty.

Sources: NHS (Tongue-tie), NICE interventional procedure guidance on division of ankyloglossia, American Academy of Pediatrics, American Academy of Otolaryngology–Head and Neck Surgery. This guide is for general information and does not replace advice from your own midwife, nurse, doctor or lactation consultant.