Parents Guide to Tongue Tie

What is Tongue Tie?

Tongue tie, also known as ankyloglossia is caused by a tight or short membrane(frenulum) under the tongue. The membrane may be attached at the tip of the tongue, or further back. This can cause problems with breastfeeding because the tethered tongue is not able to move freely, and so prevents the baby from attaching efficiently to the breast. Instead, baby isn’t breastfeeding, but nipple feeding, which is inefficient, and can be excruciating painful for the mother.

How Common is it?

Estimates vary, but a commonly quoted figure is that 1 in 20 babies have some form of tongue tie. It is commoner in boys and there may be other members of the family who have also had a tongue tie.

How is it diagnosed?

Sometime a tongue-tie is indentified in the routine examination after birth.

Other times, it may take a couple of weeks to give a firm diagnosis, especially in the case of posterior tongue tie.

Any of the following can be symptoms of tongue-tie in a breastfed baby:

  • Difficulty latching onto the breast and then difficulty staying latched on
  • Almost continuous feeding day and night
  • Poor weight gain
  • Poor nappy output

Mum’s that are breastfeeding may experience the following symptoms:

  • Painful breastfeeding
  • Sore and damaged nipples
  • Not enough milk
  • Engorged breasts

How are tongue ties divided?

Dividing your baby’s tongue tie doesn’t need a general anaesthetic, providing they are less than 3 months old. It only takes a minute or so. A trained health professional will wrap your baby up with a towel, divide the tongue tie with sterile scissors and bring your baby back to you quickly so that you can feed. It is important that you have a good breastmilk supply running up to the procedure – any difficulties a baby may have with latching will be helped by a good breastmilk supply.

Does it hurt?

Logically, dividing a tongue tie ought to hurt. However, a significant number of small babies (about one in six) are asleep when their tongue tie is divided and stay asleep during the procedure. Immediately following division, your baby is quickly unwrapped and returned to you for feeding.

What about the wound?

Problems after the procedure are rare. The following are possible: bleeding, infection, ulcers, pain and damage to the tongue and surrounding area. It is also possible that the tongue tie may return.

A few drops of blood are normal, but this should stop quickly.

The inside of the mouth heals much faster that most of the rest of the body because the lining of the mouth is being worn away and renewed all the time. Saliva also has healing properties to speed healing, so there is no need for wound management – the baby just needs to be fed.

Often there is a white patch under the tongue, which takes 24-48 hours to heal. This doesn’t seem to cause the baby any discomfort.

How do I go about having my baby’s tongue tie divided?

Once I have observed a complete feed and diagnosed the tongue tie, I will put in place a detailed feeding plan tailored to suit your difficulties. At the same time I will refer for frenulotomy as necessary.

Once a referral has been made you will be contacted with an appointment. At the appointment the paediatric surgeon will then take a full history and make an assessment of the tongue tie and whether there is need for division.

I will review you and your baby 1 week after the procedure.

Practical tips to help your baby feed:

  • Offer the breast in different positions – the rugby ball hold is often very effective for tongue tie problems
  • Consider the use of nipple shields – it’s important to get the right size and correct fit – please discuss with a lactation consultant beforehand
  • If your baby finds it difficult to breastfeed, express 8-12 times over 24 hours, and offer this expressed breastmilk via cup or bottle. This promotes an adequate milk supply – most babies who are having difficulty with any aspect of breastfeeding, will be encouraged if their efforts are made easier by a good milk supply
  • Offer as much skin to skin as possible – this will be beneficial to stimulate the production of brastfeeding hormones and promote a good supply. It will also give your baby a sense of calm and well-being.
  • Observe your baby’s wees and poos
  • Get help. Please don’t struggle on your own. There are lots of people qualified to help. Find a lactation consultant on