Tongue Tie Division (Frenulotomy): What to Expect

Tongue tie — or ankyloglossia — affects approximately 4–11% of newborns. It occurs when the lingual frenulum (the band of tissue connecting the underside of the tongue to the floor of the mouth) is shorter, thicker, or more tightly anchored than typical, restricting the tongue's range of movement. When this restriction causes feeding difficulties, a procedure called a frenulotomy (also known as tongue tie division or frenotomy) may be recommended.

What Is a Tongue Tie?

The lingual frenulum varies considerably in length and attachment point from baby to baby. In most people, it presents no problems. A tongue tie is only clinically significant when it interferes with function — primarily feeding in babies, and speech in older children.

Tongue ties are graded in various ways. The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) is one commonly used scale, assessing both the appearance of the frenulum and the functional movement of the tongue. Other clinicians use simpler anterior/posterior classifications.

Posterior tongue ties — where the frenulum is positioned further back under the tongue and may not be visible without lifting the tongue — are more controversial in terms of both diagnosis and management (see our lip tie guide for related context).

How Tongue Tie Is Identified

A skilled midwife, lactation consultant, or infant feeding specialist can identify a tongue tie by examining the underside of your baby's tongue. The assessment should include functional observation — watching your baby feed, not just inspecting the anatomy.

Signs that may suggest a tongue tie is affecting breastfeeding include:

• Difficulty achieving or maintaining a deep latch
• Clicking sounds during feeding (indicating the tongue is breaking the seal)
• Nipple pain or trauma disproportionate to what is expected in early feeding
• Nipple compression or lipstick-shaped nipple after feeds
• Your baby feeding very frequently and not seeming satisfied
• Poor weight gain despite frequent feeding
• A heart-shaped or notched tongue tip when your baby cries

It is important to note that none of these symptoms is unique to tongue tie, and a feeding assessment should consider all possible causes.

The Frenulotomy Procedure

A frenulotomy is a simple, quick procedure, typically completed in a few minutes. There are two main methods:

Scissors division (the standard NHS approach): The tongue is lifted and the frenulum is divided with sterile, blunt-ended scissors. In babies under a few months, the frenulum has very few nerve endings or blood vessels, so local anaesthetic is not routinely used (though some practitioners do use a small amount of topical anaesthetic). There is minimal bleeding, which typically resolves quickly. The baby can feed immediately afterwards.

Laser frenulotomy: A laser (usually CO2 or diode) is used instead of scissors. This is more commonly offered privately. Advocates suggest it provides greater precision, particularly for posterior ties. However, the evidence that laser offers clinical advantages over scissors is limited, and NICE guidance does not specifically recommend one over the other.

NHS Versus Private Routes

NHS

Referral for NHS tongue tie division requires a healthcare professional — typically a midwife, health visitor, or GP — to identify a tongue tie that is causing a functional feeding problem and refer to an NHS tongue tie service.

NHS tongue tie services vary significantly by area. Some areas have well-established community services offering prompt appointments; others have very long waiting times (sometimes weeks to months). In areas where NHS provision is inadequate or waiting times are long, parents of breastfeeding babies who are struggling may find that the wait causes the breastfeeding relationship to break down before treatment is available.

Private

Private tongue tie practitioners include lactation consultants with frenulotomy training, paediatric dentists, and some paediatricians. Fees typically range from approximately £150 to £350 and include a consultation and the procedure. Waiting times are usually shorter.

If you go privately, ensure the practitioner is appropriately trained and registered with a relevant professional body. The Association of Tongue Tie Practitioners (ATP) and similar organisations maintain lists of accredited practitioners.

Recovery and What to Expect Afterwards

The wound heals within a matter of days. Most babies cry briefly during the procedure but often settle quickly when offered a breast or bottle.

Feeding: The aim of frenulotomy is to improve feeding immediately. In practice, improvement can be immediate, or it can take days to weeks as your baby relearns how to use the tongue effectively. Feeding is assessed before and after the procedure, and a period of follow-up with a lactation consultant or infant feeding specialist is recommended to support the transition.

Aftercare exercises: Some practitioners recommend tongue and jaw exercises after the procedure to prevent reattachment and encourage the baby to use their tongue more freely. Evidence for the necessity of these exercises is mixed, but many practitioners include them as part of routine aftercare.

Reattachment: In a small number of cases (estimates vary from around 3–5%), the wound heals with reattachment of the frenulum. This is more common with posterior ties. A second division may be needed.

When Revision Is Needed

If symptoms do not improve after the initial procedure, or if reattachment is suspected, a review by the practitioner should be arranged. Some families find that further assessment reveals either that reattachment has occurred or that another factor (such as a posterior tie that was not fully divided) is contributing to ongoing symptoms.

Beyond Infancy

If a tongue tie is not causing feeding problems in infancy, it does not necessarily require treatment. Some tongue ties resolve spontaneously as the frenulum stretches with growth. Others persist and may affect speech development — this is generally assessed by a speech and language therapist (SALT) in early childhood rather than being treated prophylactically in the newborn period.