Tongue tie and breastfeeding: what it is and what happens next

Newborn · Breastfeeding · Updated July 2026 · All articles

If breastfeeding is painful in a way that does not improve however you adjust your position, or your baby cannot seem to stay on the breast, tongue tie might be part of what is making things hard. It is one of the most searched breastfeeding topics and one of the most commonly missed causes of feeding difficulty in newborns. You are not imagining it, and it is not something you caused.

This article covers what tongue tie is, why it matters for feeding, what the signs look like for you and for your baby, how it is diagnosed and what treatment involves.

What is tongue tie?

Everyone has a small band of tissue connecting the underside of the tongue to the floor of the mouth. This is called the lingual frenulum. In most people, this band is long and flexible enough to allow the tongue to move freely in every direction it needs to.

Tongue tie, known medically as ankyloglossia, happens when the lingual frenulum is shorter, tighter, or attached in a different position than usual. This restricts how far and how freely the tongue can move. It can affect whether your baby can lift their tongue, extend it forward, cup it around the breast, or maintain the seal needed to draw milk effectively.

Tongue tie is relatively common. It affects somewhere between four and eleven percent of newborns, though estimates vary depending on how it is defined. It runs in families and is slightly more common in boys than in girls.

Why does tongue tie affect breastfeeding?

Effective breastfeeding depends on your baby being able to draw a large mouthful of breast tissue into their mouth and use their tongue to compress the breast rhythmically against the roof of their mouth. The tongue needs to be able to extend forward over the lower gum, cup around the breast and create a seal, and then move in a wave-like motion from front to back to transfer milk.

When the frenulum is too tight or too short, the tongue cannot do all of this. Your baby may only be able to grip the nipple rather than taking in a full mouthful of breast, which leads to a shallow latch. A shallow latch causes pain and damage to the nipple, and because the tongue cannot compress the breast tissue effectively, milk transfer is poor. Over time this can affect your milk supply because your breasts are not being stimulated and drained as they should be.

Signs your baby might have tongue tie

Not all of these will be present at once, and some of them have other causes too. But if several of these sound familiar, tongue tie is worth investigating:

• Difficulty latching or staying latched. Your baby may struggle to attach to the breast or repeatedly slide off, especially as the feed goes on and they tire.
• A clicking sound during feeds. This happens when suction breaks and air enters. It is one of the most commonly reported signs of tongue tie.
• Feeds that seem to go on forever or never settle your baby. Because milk transfer is inefficient, your baby may feed for a long time but still seem unsatisfied and hungry again very quickly.
• Poor weight gain. If milk transfer is consistently limited, your baby may not be gaining weight as expected. This is one of the more important signs to act on promptly.
• Excessive wind, colicky behaviour, or gulping during feeds. A poor seal on the breast means your baby takes in more air.
• A heart-shaped or notched appearance to the tip of the tongue, or inability to stick the tongue out past the lower gum or lift it toward the roof of the mouth. Not all tongue ties are visible from the outside though, so absence of a visible sign does not rule it out.

Signs you might notice yourself

Tongue tie is often described as a problem for the baby, but the impact on the breastfeeding parent can be significant and is sometimes how it first comes to attention:

• Severe nipple pain during feeds that does not improve with positioning adjustments, especially pain that persists beyond the first few seconds of latching.
• Nipple damage. A classic sign is a stripe or compression mark across the tip of the nipple after a feed, or a nipple that comes out of the baby's mouth looking flattened, wedge-shaped, or lipstick-shaped rather than round. This happens because your baby is compressing the nipple against their gum rather than drawing in breast tissue.
• Cracked, blistered, or bleeding nipples that do not respond to normal care.
• Recurrent blocked ducts or mastitis. Poor drainage of the breast because of ineffective feeding can cause milk to back up and lead to recurring mastitis.
• Low milk supply. If your breasts are not being effectively stimulated and drained, supply can drop over the weeks following birth.

If you are in significant pain with every feed and things are not improving, please do not wait and hope it resolves. Reach out to a midwife, health visitor, or lactation consultant sooner rather than later.

Anterior and posterior tongue tie

Not all tongue ties look the same, and this matters for diagnosis.

Anterior tongue tie is the most visible type. The frenulum attaches close to the tip of the tongue and the front of the floor of the mouth. When you look under the tongue you can usually see a tight, obvious band of tissue. This type is the easiest to identify and is less likely to be missed.

Posterior tongue tie sits further back under the tongue, sometimes hidden beneath a membrane, and is not always visible at all without a careful hands-on examination. The tongue may appear normal and even extend forward, but when an assessor lifts it and feels underneath, the restriction becomes clear. Posterior tongue tie is more controversial: some practitioners diagnose it frequently and others rarely recognise it, partly because there is no universally agreed definition. However, it can cause the same breastfeeding problems as anterior tongue tie, and dismissing symptoms on the basis that nothing is visible is not good enough.

This is one reason why a thorough assessment from someone experienced in tongue tie matters so much.

How tongue tie is diagnosed

There is no blood test or scan for tongue tie. Diagnosis is a clinical assessment carried out by someone experienced in infant feeding and in examining the oral anatomy of newborns. Not everyone in the healthcare system has this training.

The standard used by most UK specialists is the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), which assesses both the appearance of the frenulum and what the tongue can functionally do. A good assessment includes watching a feed, examining the baby's mouth carefully and feeling under the tongue with a gloved finger, and taking your feeding history into account.

People who are trained to assess and divide tongue tie in the UK include:

• International Board Certified Lactation Consultants (IBCLCs)
• Specialist infant feeding teams within the NHS (where they exist)
• Midwives, health visitors, and some GPs with additional tongue tie training
• Some private practitioners who specialise in infant oral function

A general GP appointment alone is not usually enough to diagnose or rule out tongue tie, particularly posterior tongue tie. If you have been told your baby does not have tongue tie but your feeding problems are continuing, it is reasonable to ask for a second opinion from someone who specialises in this area.

The Association of Tongue Tie Practitioners (ATTP) maintains a directory of registered practitioners at tongue-tie.org.uk, which can help you find someone with the right training whether on the NHS or privately.

Treatment: frenotomy (tongue tie division)

If tongue tie is diagnosed and is contributing to feeding problems, the standard treatment is a small procedure called a frenotomy or tongue tie division. The lingual frenulum is snipped with sterile scissors, releasing the restriction and allowing the tongue greater range of movement.

Here is what to expect:

• The procedure is quick. The actual snip takes seconds, and the whole appointment including assessment usually lasts less than 30 to 45 minutes.
• It is usually done awake. In very young babies, the frenulum has few nerve endings and the procedure is generally carried out without anaesthetic. Some practitioners use a small amount of topical or local anaesthetic, particularly in older babies. Your baby will cry, as with any brief discomfort, but this usually settles quickly.
• Bleeding is minimal. There is typically a very small amount of bleeding, comparable to a minor cut. The area in the mouth heals quickly.
• Feeding immediately after is encouraged. Most practitioners encourage you to breastfeed your baby straight away. For many parents, there is a noticeable improvement in latch from the very first feed after division.
• Results are not always immediate. Even when the division goes well, it can take days to weeks for the tongue to gain the strength and coordination to feed differently. Feeding support is an important part of the process, not an optional extra.
• Exercises are sometimes recommended. Your practitioner may show you gentle stretches under the tongue to prevent the frenulum from reattaching as the area heals. Follow the guidance from your specific practitioner as recommendations vary.

Serious complications from frenotomy are rare. Reattachment of the frenulum can occasionally occur, and a small number of babies need a second procedure.

Getting treatment on the NHS

Access to tongue tie assessment and division on the NHS is, unfortunately, very uneven across the UK. Some areas have well-established specialist infant feeding teams with trained tongue tie practitioners and a relatively straightforward referral process. Other areas have long waiting times, limited provision, or no specialist service at all.

Your first step is to ask your midwife or health visitor for a referral. They can tell you what is available locally and how long the wait is likely to be. If your baby has feeding difficulties and poor weight gain, make the urgency clear because some services can prioritise accordingly.

If you cannot access NHS care in a timeframe that works for you and your baby, or if waiting means continuing in significant pain, many families choose to see a private practitioner. Costs vary, but the ATTP directory lists registered practitioners and some include a combined assessment and division appointment. It is also worth knowing that having a private assessment does not prevent you from continuing to access NHS breastfeeding support alongside it.

The debate around tongue tie

It is worth being honest about this: tongue tie is a genuinely contested area in medicine and lactation. Rates of diagnosis vary enormously between practitioners and between regions. Some healthcare providers believe tongue tie is frequently overdiagnosed and that many frenulums that are divided would have resolved on their own or were not the true cause of feeding problems. Others, particularly those who work closely with breastfeeding parents, find that meaningful tongue ties are commonly missed and that families go weeks in pain before getting a diagnosis.

The evidence base is growing but not yet definitive. A Cochrane review found that frenotomy may help improve breastfeeding outcomes and reduce maternal pain, but acknowledged that the evidence is of limited quality. NICE guidance notes that frenotomy appears safe and may benefit some breastfed infants but that more research is needed.

What this means in practice is that the quality of assessment matters enormously. A thorough assessment from someone experienced in infant feeding, who watches you feed and takes a detailed history, is far more reliable than a brief look and a verdict either way. If the symptoms are real and persisting, a comprehensive assessment is worth pursuing even if an initial check came back negative.

The key question is always this: is there meaningful restriction present, and is it contributing to the symptoms you are experiencing? Tongue tie that is not causing problems does not need treatment. Tongue tie that is causing significant pain, nipple damage, or poor weight gain deserves proper investigation.

If breastfeeding is too difficult right now

Tongue tie assessment, waiting lists, and multiple appointments can take time you may not feel you have when you are in pain and your baby is not feeding well. And even after division, improvement is not always immediate or complete.

It is important to say clearly: combination feeding and formula feeding are valid, loving choices. If breastfeeding is causing you significant pain, if your baby is not gaining weight, or if you are at the end of what you can manage, moving to formula is not giving up. It is caring for both of you.

Tongue tie division is not a requirement. You do not owe anyone a breastfeeding journey that causes ongoing harm. Whatever you decide, your health visitor and midwife can support you, and you can track your baby's feeds in Cubby whichever method you are using.

If you are struggling, the National Breastfeeding Helpline (0300 100 0212) is available 24 hours a day, 7 days a week. UNICEF UK's Baby Friendly Initiative and La Leche League Great Britain also offer support and can help you find local groups and practitioners.

Frequently asked questions

How do I know if my baby has tongue tie?

There is no test you can do at home. The clearest signs are a painful latch that does not improve despite good positioning, a baby who slips off the breast repeatedly, a clicking sound during feeds, poor weight gain, and very frequent short feeds that never seem to settle your baby. On your side, a stripe mark or flattened nipple after feeds, severe nipple pain, and recurring blocked ducts or mastitis are all signals worth taking seriously. A formal assessment by an IBCLC or specialist infant feeding team is the right next step if you suspect tongue tie.

Does tongue tie always need treatment?

No. Tongue tie only needs treatment if it is causing real problems. Some tongue ties cause no feeding difficulties at all and require no intervention. The decision to proceed with division is based on whether meaningful restriction is present and whether it is genuinely contributing to the symptoms. If symptoms are mild and improving with feeding support alone, many families and practitioners choose to monitor rather than proceed straight to division.

What is frenotomy like?

A frenotomy is a quick procedure, usually carried out awake. In young babies, the frenulum has very few nerve endings and no anaesthetic is typically needed. The practitioner lifts the tongue and makes a small snip with sterile scissors. The whole procedure takes less than a minute. There is minimal blood. Many parents feed their baby immediately after and notice an improvement in the latch from the first feed. Some babies are briefly unsettled, but serious complications are rare.

Can tongue tie affect bottle feeding?

Yes, though less commonly than breastfeeding. Tongue movement is also involved in controlling flow from a bottle teat, and a baby with tongue tie may take in a lot of air, struggle with certain teat shapes, or become very tired and frustrated during bottle feeds. If you are formula or combination feeding and your baby seems to really struggle, mention this alongside other signs when you see your health visitor or GP.

Will the NHS treat tongue tie?

Access varies significantly across the UK. Some areas have specialist infant feeding teams with tongue tie practitioners and a clear NHS referral pathway. Others have limited provision or long waiting times. Your midwife or health visitor can tell you what is available locally. If you cannot access NHS care quickly enough, many families go private. The Association of Tongue Tie Practitioners (ATTP) at tongue-tie.org.uk has a directory of registered practitioners.

What if my baby has tongue tie and I cannot get breastfeeding to work?

Tongue tie division is not a requirement. Combination feeding and formula feeding are always valid options, and a caring choice if breastfeeding is causing significant pain or your baby is not thriving. You do not need to keep breastfeeding at great cost to yourself. Your health visitor can support you through any change in feeding approach. Whatever you decide is the right decision for you and your baby.

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