If you are struggling with feeding your baby, you may have started to wonder: “Could my baby have a tongue-tie?”
Tongue-tie is something many new parents hear about, particularly if breastfeeding is painful or your baby is struggling to latch. But knowing whether your baby actually has a tongue-tie – and whether it is affecting breastfeeding or bottle feeding – is not always straightforward.
A tongue-tie can be easy to spot in some babies, whilst in others it may only become apparent when breastfeeding or bottle feeding problems develop.
Most importantly, having a tongue-tie does not automatically mean your baby needs treatment. What matters is whether the frenulum is restricting your baby’s tongue function and contributing to feeding difficulties, and not necessarily what it looks like.
What is a tongue-tie?
Tongue-tie, also known as ankyloglossia, is where the band of tissue underneath the tongue, called the lingual frenulum, restricts the movement of the tongue.
All babies have a frenulum. It is a normal part of the mouth. The important question is whether it is restricting the tongue sufficiently to affect its function.
Some babies with a tongue-tie feed perfectly well and have no problems at all. In these circumstances, treatment is not usually necessary.
You may be able to see a frenulum when your baby yawns or cries, but looking in your baby’s mouth is not enough to tell you whether a tongue-tie is causing a problem.
The appearance of the frenulum can vary considerably, and a baby can have a visible frenulum without having any functional problems.
This is why a good tongue-tie assessment looks at how the tongue moves and functions, as well as how your baby feeds. This should be done by a qualified tongue tie practitioner.
What are the signs of tongue-tie in a breastfed baby?
Sometimes the first indication of a tongue-tie isn’t what you can see in your baby’s mouth – it’s what is happening during breastfeeding.
You might notice that your baby:
- Struggles to latch onto the breast
- Frequently comes off the breast during a feed
- Finds it difficult to stay attached
- Makes clicking or smacking sounds while feeding
- Has very long or very frequent feeds
- Seems unsettled or hungry shortly after feeding
- Coughs or splutters when trying to manage the flow of milk
- Dribbles milk during feeds
- Is not gaining weight as expected
You may also experience:
- Persistent nipple pain
- Cracked or damaged nipples
- Nipples that look misshapen or squashed after a feed
- Breasts that do not feel well drained after feeding
- Recurrent blocked ducts or mastitis
- Concerns about your milk supply
- Feeling that breastfeeding is taking up almost all of your day
These symptoms can be associated with tongue-tie, but they can also have many other causes. For example, positioning and attachment, milk supply issues, breast anatomy and a baby’s age or feeding behaviour can all affect breastfeeding.
This is why it is important not to assume that tongue-tie is the cause simply because one or more of these signs are present. Skilled breastfeeding support is so important!
Can tongue-tie affect bottle feeding?
Yes. Tongue-tie isn’t only a breastfeeding issue.
Some babies with a restrictive tongue-tie can have difficulties feeding from a bottle too.
You might notice that your baby:
- Takes a long time to finish a bottle
- Frequently dribbles milk
- Pushes the teat out of their mouth
- Struggles to maintain a good seal around the teat
- Coughs or chokes during feeds
- Takes relatively small amounts of milk
- Seems particularly windy or unsettled after feeds
- Is struggling to gain weight
- Seems to struggle with reflux
Again, these signs are not specific to tongue-tie. A feeding assessment is important before deciding that a tongue-tie is responsible.
Why does tongue movement matter?
For effective feeding, your baby’s tongue needs to be able to move in a coordinated way.
During breastfeeding, the tongue helps your baby maintain a deep attachment and remove milk from the breast. If tongue movement is restricted, some babies may compensate by using their jaw, lips or cheeks differently.
This can contribute to inefficient milk transfer and, for some mothers, painful breastfeeding.
However, babies are remarkably adaptable. A baby with a tongue-tie may find ways to feed effectively, while another baby with a similar-looking frenulum may struggle considerably.
The same-looking tongue-tie can therefore have very different effects in different babies.
Can I check for tongue-tie myself?
You can look inside your baby’s mouth, but we would advise against trying to diagnose a tongue-tie based solely on what you see.
A proper assessment should consider:
- Your baby’s medical and feeding history
- How your baby moves their tongue
- The appearance and attachment of the frenulum
- Your baby’s oral function
- How your baby feeds
- Your experience of feeding, including any pain
- Your birth and postpartum journeys and how they might impact on feeding
- Your baby’s weight gain and milk intake where relevant
For breastfeeding babies, watching a complete feed can provide particularly valuable information.
A tongue-tie assessment should also consider whether there are other reasons for the feeding difficulties. This is important because problems with positioning and attachment, milk supply, milk flow and other factors can sometimes look very similar to feeding problems associated with tongue-tie.
Does every baby with a tongue-tie need treatment?
No.
This is one of the most important things for parents to know.
Some babies have a tongue-tie but feed comfortably and effectively. If your baby is thriving and feeding well, there may be no reason to intervene.
The decision about treatment should be based on function and feeding difficulties, rather than simply the appearance of the frenulum.
If breastfeeding is difficult, it is important to have had skilled feeding support and a thorough assessment before considering a procedure. National guidance recognises the importance of skilled breastfeeding support when managing breastfeeding difficulties associated with tongue-tie.
What happens if my baby is diagnosed with a tongue-tie?
If an assessment suggests that a tongue-tie is contributing to your baby’s feeding difficulties, your practitioner should discuss the options with you.
Depending on your baby’s individual circumstances, this may include:
- Feeding support and adjustments to positioning and attachment
- Monitoring your baby’s feeding and weight gain
- Continuing to manage the feeding difficulties without a procedure
- Considering frenulotomy (tongue-tie division) if appropriate
The aim should never be to treat a tongue-tie simply because it is there. It is to understand whether it is causing a problem and what is most appropriate for your baby and your feeding goals.
What if I think my baby has a tongue-tie?
If you are wondering whether your baby has a tongue-tie, you don’t need to work it out on your own.
If feeding is painful, your baby is struggling to latch or stay attached, feeds are taking a very long time, or you are concerned about your baby’s milk intake or weight gain, it is worth asking for help sooner rather than later.
A midwife, Health Visitor or doctor having a quick look in your baby’s mouth is not enough to diagnose a tongue tie, or to say that your baby does not have a tongue tie. To do this it needs to be assessed by a trained tongue tie practitioner.
At The Little Latch Company, we look at the whole picture. We don’t diagnose a tongue-tie simply by looking underneath a baby’s tongue. Our approach is to look at your baby, your feeding experience and the function of your baby’s tongue.
We provide specialist tongue-tie assessment and breastfeeding or bottle feeding support, with care delivered by experienced Midwives, IBCLCs and tongue-tie practitioners. Where a tongue-tie is assessed as potentially contributing to feeding difficulties, we can discuss your options with you, including frenulotomy where appropriate.
Our aim is simple: to help you understand what is happening and make an informed decision about your baby’s care – without pressure.
If you’re concerned that your baby may have a tongue-tie, contact The Little Latch Company to discuss an assessment.
Frequently Asked Questions
How can I tell if my newborn has a tongue-tie?
You may notice that your baby’s tongue has limited movement, does not lift or extend easily, or appears heart-shaped when extended. However, a tongue-tie is best assessed by looking at tongue function as well as its appearance.
Does tongue-tie always cause breastfeeding problems?
No. Some babies with tongue-tie breastfeed effectively and have no problems. Treatment is not usually needed when a tongue-tie is not causing feeding difficulties.
Can a baby with tongue-tie bottle feed?
Yes. Some babies with tongue-tie bottle feed without difficulty, while others may experience problems such as dribbling, prolonged feeds, difficulty maintaining a seal or coughing during feeds.
Does a tongue-tie cause painful breastfeeding?
It can contribute to painful breastfeeding if restricted tongue movement makes it difficult for your baby to achieve and maintain an effective latch. However, there are many other possible causes of nipple pain, so a feeding assessment is important.
Does my baby need a tongue-tie division?
Not necessarily. A tongue-tie does not automatically require treatment. The decision should take into account your baby’s tongue function, feeding difficulties and whether other feeding support has helped.
Can tongue-tie be missed at birth?
Yes. Tongue-tie is not always obvious during the newborn examination and may only become apparent when feeding difficulties develop. It is not always appropriate to look for a tongue tie at birth before your baby has had a chance to establish feeding.
Is tongue-tie the same as a tight frenulum?
The terms are often used interchangeably, but the important issue is whether the frenulum restricts tongue function. The presence or appearance of a frenulum alone does not tell us whether it is causing feeding difficulties.
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