This article discusses tongue tie (ankyloglossia) and the impact it has on babies in breastfeeding. Find out more about tongue tie symptoms and treatment here.
What is tongue-tie?
What problems does tongue tie cause for babies?
Tongue tie symptoms: Can I see if my baby has ankyloglossia?
Do I need to get my baby’s tongue-tie fixed?
Tongue tie treatment: what can be done to treat my baby?
How can I find someone to do this?
Does the treatment resolve the problems?
Tongue-tie, or ‘ankyloglossia’ to give it its medical term, describes a condition that affects the way the tongue moves in the mouth.
For some babies (between 3 and 10%), their frenulum – the cord-like skin joining the underside of the tongue to the floor of the mouth – limits the movement of their tongue. This is called tongue-tie. It often means that the baby can't stick their tongue out beyond their lower lip, and may not be able to move it fully up and down or side-to-side. Some babies suck extra strongly to compensate for the restricted tongue movement.
In the most easily visible tongue-ties, the frenulum is joined to the tip of the tongue, which looks heart-shaped when the baby tries to extend their tongue, but the frenulum can be joined anywhere along the underside of the tongue.
Some babies with tongue-tie have difficulty breastfeeding and, occasionally, a bottle-fed baby with tongue-tie has difficulty feeding too.
To breastfeed effectively, babies need to latch onto both breast tissue and nipple, but babies with tongue-tie may not be able to latch on properly. Some babies with a tongue-tie seem unable to open their mouths really wide. Not only can this can result in feeding difficulties for the baby but also squashed, sore and damaged nipples for mum. Improving the baby's latch is sometimes enough for them to feed well and for mum to find breastfeeding comfortable, so action is not always needed if a baby has tongue-tie.
Bottle-fed babies can have difficulty in creating a good seal on the teat which can result in ineffective sucking. This may lead to milk leaking out of their mouths and them swallowing air, resulting in a ‘windy’ baby.
If you think your baby may have a tongue-tie, or if you have unexplained feeding problems, do ask an infant feeding specialist, breastfeeding counsellor, your midwife or health visitor to check. Perhaps look yourself.
The impact of tongue-tie was overlooked for much of the latter part of the 20th century and some healthcare professionals may not be confident in what they’re looking for. Do keep asking questions or request a second opinion if you’re not entirely satisfied after your baby’s first check.
If you look into your baby’s mouth when they are yawning or crying, you may be able to see a tie. Tongue-ties at the back of the tongue (posterior) are much harder to see than the ones tying the tip of the tongue. However, the effect on feeding is not related to how easy it is to see the tie. Some babies with the frenulum attached near the tip of the tongue manage to breastfeed well, while others with a small tie that is hard to see may really struggle to feed.
Not necessarily. If your baby appears to have tongue-tie, but neither you nor your baby is experiencing any problems then you don’t need to do anything.
The frenulum can be cut (sometimes called ‘divided’) by someone trained to do the procedure. It’s quick and simple, and young babies usually don’t need any pain relief. The procedure releases the tie, and allows the tongue to move more freely. It is preferable if the baby goes to the breast immediately after the tongue-tie division, as breastfeeding is both calming for them and provides an opportunity to try out their freer tongue movement.
Although some babies may cry briefly, the procedure doesn't seem to cause discomfort or distress. As with all procedures, there are some risks, such as significant bleeding rather than a few drops of blood when the cut is made, but the chances of this happening are small. The procedure is normally only carried out if it seems very likely that feeding will improve as a result.
Ask your health visitor, midwife or local breastfeeding counsellor. At present, the procedure is only available in some places through the NHS, and the service is variable so treatment may be offered within a week or two or your baby may be put on a waiting list.
It is important to seek help quickly though as a tongue-tie causing problems needs to be treated promptly, so that baby can feed properly and, if mum is breastfeeding, that this is comfortable for her.
There are private tongue-tie services offered in some areas. As with all private services it’s important to check the practitioner’s background and qualifications.
Yes, research has shown that if babies have difficulty breastfeeding due to a tongue-tie, division results in improved feeding for the majority of babies.
Occasionally, a tongue-tie may need snipping more than once, because of a tendency to re-attach. Often a baby’s feeding can be improved if their parents are also shown how to do oral exercises that encourage them to move their tongue.
We have written to Health Minister Dr Dan Poulter MP calling on him to improve the diagnosis and treatment of tongue-tie in the UK, saving the NHS money and parents and babies stress and anxiety. We're calling for more professionals trained to recognise and deal with the problem as current NHS treatment is often patchy and sometimes non-existent.
You can write to your MP to call for better services to diagnose and treat tongue tie using this template letter. Find out who your MP is, and if you receive a reply do let us know by emailing firstname.lastname@example.org.
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.
Attending a Baby Cafe or other breastfeeding support drop-in is often helpful. You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
Pictures of babies with tongue-tie can be found on Catherine Genna’s website.
Tongue-tie UK raises awareness about tongue-tie and lip-tie in the UK to help parents get information and support.