Tongue Tie in Babies: Signs, Diagnosis & Division

Tongue tie — medically known as ankyloglossia — is when the strip of tissue (frenulum) connecting the underside of the tongue to the floor of the mouth is shorter, thicker, or tighter than usual. It restricts tongue movement and can make breastfeeding significantly harder.

How common is tongue tie?

It affects an estimated 4–10% of babies in the UK. It's more common in boys than girls, and can run in families.

Why does it matter?

The tongue plays a crucial role in breastfeeding. To feed effectively, a baby needs to extend the tongue over the lower gum, cup the breast, and create a seal with rhythmic wave-like tongue movements. A tongue tie can prevent this, leading to:

• Painful feeding for mum — nipple pain, compression, bleeding or cracking
• Poor latch — baby slides off, clicks while feeding
• Reduced milk transfer — baby can't drain breast efficiently
• Slow weight gain — baby is working hard but not getting enough milk
• Wind and colic-like symptoms — baby swallows more air when latch is poor
• Unsettled baby — frequently hungry or needing to feed constantly

Signs of tongue tie

In the baby:

• Difficulty latching or staying latched
• Clicking sound while feeding
• Dribbling excessively
• Poor weight gain
• Frustrated at the breast
• Tongue that can't reach the roof of the mouth or extend past the lower gum
• Tongue looks heart-shaped or notched at the tip

In the breastfeeding mother:

• Nipple pain throughout the feed (not just at latch-on)
• Nipples appear flattened, creased, or lipstick-shaped after feeding
• Engorged breasts despite frequent feeding
• Mastitis or blocked ducts from incomplete drainage
• Low milk supply developing over time

Getting a diagnosis

Tongue tie is assessed using the Hazelbaker Assessment Tool or similar scoring systems. Ask for an assessment from:

• Your midwife or health visitor
• A trained lactation consultant (IBCLC)
• Your GP
• A specialist tongue tie practitioner

The NHS offers tongue tie assessment and division services, but availability varies by region. Waiting lists can be long — many parents opt for private assessment (typically £150–£300 for assessment + division).

NICE guidance recommends division for tongue tie that is causing breastfeeding difficulties.

Tongue tie division (frenotomy)

Division is a simple procedure where the frenulum is snipped with sterile scissors. It is:

• Very quick — takes seconds
• Performed without general anaesthetic in babies under 6 months
• Causes minimal bleeding — the frenulum has few nerve endings and blood vessels
• Babies typically feed immediately after and most settle quickly

A mild aftercare stretching programme may be recommended to prevent reattachment.

Does it always need treatment?

Not necessarily. Posterior tongue tie (at the back of the tongue) is controversial and some practitioners don't routinely divide these. If breastfeeding is going well and baby is gaining weight, watchful waiting is reasonable.

For formula-fed babies, tongue tie is less likely to cause feeding problems and division may not be needed.

After division

Most mothers notice an improvement in latch and pain within days, though it can take 1–2 weeks for baby to learn how to use the tongue differently. Working with a lactation consultant post-division is highly recommended.

TinyYears helps you track what matters

If you're navigating tongue tie, logging feed length, weight gain, and painful moments in TinyYears helps you build a picture of progress — and gives your healthcare team the data they need to help you.