Tongue tie in babies: symptoms and treatment

Newborn · Health · Reviewed 18 June 2026 · All articles

Tongue tie is a condition that generates a great deal of concern among new parents, and for good reason: it can make breastfeeding genuinely difficult and painful for both mother and baby. At the same time, it is frequently over-diagnosed, unevenly assessed, and sometimes treated unnecessarily. Understanding what tongue tie actually is, how it is properly assessed, and when treatment is genuinely helpful will help you navigate the healthcare system with confidence if you suspect your baby may be affected.

This article draws on guidance from the NHS, NICE, the AAP, and current peer-reviewed research to give you a complete picture of tongue tie in newborns and young babies.

What tongue tie is and why it matters

Tongue tie, known medically as ankyloglossia, is a congenital condition in which the lingual frenulum, the small band of tissue connecting the underside of the tongue to the floor of the mouth, is shorter, thicker, or more tightly attached than usual. This restricts the tongue's range of motion.

The tongue plays a critical role in breastfeeding. To feed effectively, a baby needs to extend their tongue beyond their lower gum line, cup it around the breast, and create suction by moving the tongue in a wave-like motion. When the frenulum is too tight, the baby cannot achieve the full range of tongue movement needed. The result is a poor latch, which can cause nipple pain and damage for the feeding parent and inadequate milk transfer for the baby.

Not all tongue ties cause problems. The NHS notes that some babies with tongue tie feed perfectly well, either because their restriction is mild or because they compensate effectively. Tongue tie only becomes a clinical concern when it is causing measurable difficulties for the baby or the feeding parent. The presence of a short frenulum alone, without functional impact, is not an indication for treatment according to NICE guidelines.

Tongue tie occurs across a spectrum of severity, and several classification systems exist. The most commonly used in clinical practice is the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), which assesses both the appearance of the frenulum and the functional capacity of the tongue. A simpler tool, the Bristol Tongue Assessment Tool (BTAT), is widely used by midwives and health visitors as an initial screening measure. Neither tool should be used in isolation; assessment must always include observation of the baby feeding.

Symptoms and signs to look for

The signs of tongue tie fall into two categories: things you may notice in the baby, and things the feeding parent may experience. Neither list is diagnostic on its own, but a combination of several symptoms should prompt you to seek a formal assessment.

Signs in the baby:

A baby with tongue tie may struggle to latch onto the breast and may slide off the nipple repeatedly during a feed. You may notice the baby chomping or chewing rather than drawing the nipple deeply into their mouth. Many babies with tongue tie make clicking sounds during feeding, which happens because they lose suction and have to re-establish it. They may come off the breast frequently and appear unsatisfied or frustrated, even after long feeds. Some babies with tongue tie experience significant wind and colic-like symptoms because they swallow more air than usual when feeding. Weight gain may be slow or insufficient because of inefficient milk transfer.

On visual inspection, the tongue may appear notched or heart-shaped at the tip when the baby cries, because the frenulum tethers the midpoint of the tongue and the tip is pulled into two lobes. The baby may not be able to extend their tongue beyond their gum line or to move it side to side freely. However, these visual signs can be misleading: some significant tongue ties are not visible at rest, and some visible notching has no functional impact.

Signs in the breastfeeding parent:

Pain is the most consistent symptom reported by parents whose babies have tongue tie. Because the baby cannot achieve a deep latch, the nipple is compressed rather than drawn into the mouth, which can cause severe pain, bruising, and damage to the nipple tissue. Nipple shape after feeds is a useful indicator: a nipple that is compressed into a wedge shape, sometimes described as looking like a new lipstick, suggests the baby is not latching correctly. Persistent low milk supply can also result from tongue tie, because inefficient feeding does not stimulate the breast adequately to maintain supply.

How tongue tie is formally assessed

A proper assessment of tongue tie should be carried out by a trained practitioner, usually a midwife, health visitor, lactation consultant, or specialist tongue tie practitioner. It should include both a physical examination of the frenulum and direct observation of the baby feeding at the breast or with a bottle.

Assessment tools such as the BTAT assign scores to a range of tongue appearance and function criteria. A score indicating a significant restriction, combined with observed feeding difficulties, is the basis for a referral for treatment. Assessment in the first few days after birth is often difficult because the baby is still learning to feed and both parent and baby are adjusting. A second assessment at two to three weeks, when a clearer feeding pattern is established, can sometimes give a more accurate picture.

Parental report of pain and feeding difficulty is a valid and important part of the assessment. NICE guidance makes clear that the severity of the impact on breastfeeding, not just the anatomical classification of the tie, should guide decisions about treatment.

It is worth noting that the landscape of tongue tie assessment has become more complex in recent years with the rise of private tongue tie practitioners and the identification of so-called "posterior tongue tie," a condition that remains controversial among researchers and clinicians. The NHS and AAP recommend that assessment and treatment decisions should be made by trained healthcare professionals using validated tools, and that posterior tongue tie diagnoses should be treated with particular caution given the limited evidence base for the concept.

Treatment: frenotomy and what to expect

The standard treatment for tongue tie that is causing significant feeding difficulties is a frenotomy, also called a frenulotomy or tongue tie division. This is a brief procedure in which the frenulum is cut using sterile scissors or a laser device.

For newborns and young babies, the procedure is typically carried out in a clinic or community setting without general anaesthetic. A small amount of local anaesthetic cream or injection may be used. The baby is swaddled and the head is supported. The practitioner lifts the tongue, visualises the frenulum, and makes a single clean snip. The whole procedure takes only a few seconds.

There is a small amount of bleeding, which usually stops quickly. Most practitioners encourage the parent to breastfeed the baby immediately after the procedure, both to provide comfort and to encourage the baby to begin using their tongue differently. The breast milk itself has mild anti-infective properties that help keep the cut area clean.

Results vary. Many parents report a noticeable improvement in latch and a reduction in nipple pain within one or two feeds. Others find that the baby needs several days or even weeks to learn how to use their tongue in a new way. This is normal: the baby has been feeding with a restricted tongue since birth and may need time to adjust. Follow-up with a lactation consultant after the procedure is strongly recommended by both NICE and the AAP to support this transition.

Complications from frenotomy are uncommon but not absent. Minor bleeding is expected. Infection is rare. Approximately 3 to 5 percent of babies require a second procedure because scar tissue forms during healing and re-restricts tongue movement. Parents are usually given exercises to do with the baby after the procedure, such as gently lifting and moving the tongue, to help prevent reattachment. The evidence base for post-procedure exercises is still developing, but many specialist practitioners recommend them.

For older babies or children in whom speech or eating difficulties are the primary concern, the assessment and treatment pathway is different and typically involves a speech and language therapist as part of the team.

When treatment is not needed

It is equally important to understand when frenotomy is not indicated. NICE is explicit that tongue tie should only be treated when it is causing functional difficulties. A short or tight frenulum that is not affecting feeding or development does not require intervention.

There is currently no strong evidence to support prophylactic frenotomy (performing the procedure before problems develop) or to support treating tongue tie as a preventive measure for future speech difficulties. The AAP recommends that decisions about frenotomy be based on current, documented feeding difficulties and that unnecessary procedures be avoided.

Formula-fed babies with tongue tie rarely require treatment, as bottle feeding places different demands on tongue mechanics and most formula-fed babies with tongue tie feed without difficulty. If a formula-fed baby with tongue tie is gaining weight well and feeds comfortably, treatment is generally not recommended.

Frequently asked questions

How common is tongue tie in newborns?

The NHS estimates that tongue tie affects around 4 to 11 percent of newborn babies. It is more common in boys than girls. Many cases are mild and resolve without treatment as the frenulum stretches naturally with movement and feeding. Only a proportion of babies with tongue tie will experience significant feeding difficulties that warrant intervention.

Can tongue tie affect speech later in childhood?

The evidence on tongue tie and speech is mixed. NICE notes that some studies have found associations between tongue tie and difficulties producing certain sounds, particularly those that require tongue elevation such as 't', 'd', 'n', 'l', 'r', and 'th'. However, many children with tongue tie develop normal speech without any intervention. Current guidance does not recommend routine frenotomy for speech prevention in the absence of current feeding difficulties. Any speech concerns should be assessed by a speech and language therapist after the age of two.

What happens during a frenotomy?

A frenotomy (also called a frenulotomy or tongue tie division) is a brief procedure in which the frenulum is snipped using sterile scissors or a laser. For newborns, it is typically carried out without general anaesthetic; a local anaesthetic cream or a small amount of local anaesthetic injection may be used for older infants. The procedure takes only a few seconds. The baby can usually breastfeed immediately afterwards, which also helps with comfort and bleeding control. Most families notice an improvement in latch within a few feeds, though some babies need time to adjust their feeding technique.

What should I do if I think my baby has tongue tie?

Speak to your midwife, health visitor, or GP as soon as possible. They can carry out or refer you for a formal assessment using a validated tool such as the BTAT or Hazelbaker tool. If you are experiencing pain during breastfeeding, request support from a lactation consultant or infant feeding specialist at the same time, as positioning and attachment adjustments can help while you wait for an assessment. Do not attempt to assess or treat tongue tie at home.

Does tongue tie division always resolve feeding problems?

Frenotomy significantly improves breastfeeding outcomes for many families. A Cochrane systematic review found improvements in maternal pain scores and breastfeeding duration following division. However, not all feeding difficulties are caused by tongue tie, and some babies need additional support from a lactation consultant to learn a new latch technique after the procedure. Occasionally a second procedure is required if scar tissue re-forms. Discussing realistic expectations with your healthcare provider before the procedure is important.

Track your baby's feeds and health in Cubby

When you are working through a feeding challenge like tongue tie, having an accurate record of feeds, duration, and your baby's weight makes appointments with your midwife, health visitor, and lactation consultant much more productive. Cubby lets you log every feed in seconds, track nappies and sleep, and keep a running health diary, so you always have the full picture to hand.

Start tracking free