If breastfeeding is painful despite everyone telling you that the attachment looks fine, if your baby is feeding constantly and never seeming satisfied, or if you have been told by a Midwife or Health Visitor to ‘just keep going and it will get easier’ and yet it isn’t, tongue tie may be worth exploring.
Tongue tie is one of the most talked-about and, at the same time, one of the most misunderstood topics in infant feeding. Some parents are told their baby definitely has one, others are told just as firmly that they don’t, usually just from a cursory glance. Some are offered a division immediately; others are sent away without support. It can feel like navigating a minefield, particularly when you are already exhausted and struggling.
In this post I want to give you an evidence-informed overview of what tongue tie is, what it may look like in your feeding experience, and, most importantly, what your options are if you think it may be affecting your baby.
What is tongue tie?
Tongue tie, known medically as ankyloglossia, is a condition present from birth in which the lingual frenulum (the small piece of tissue that connects the underside of the tongue to the floor of the mouth) is shorter, tighter, or positioned further forward than typical. This can restrict the tongue’s range of movement, which in turn may affect a baby’s ability to feed effectively at the breast or by bottle.
Tongue tie is thought to affect somewhere between 4–11% of newborns, though reported figures vary depending on the criteria used to identify it. It can run in families, and statistics show that boys are slightly more commonly affected than girls.
It is important to understand that tongue tie exists on a spectrum. An anterior tongue tie, where the frenulum is clearly visible at the tip of the tongue, is easy to see and therefore more readily identified. A posterior tongue tie, where the restriction sits further back under the tongue and may be partially covered by mucous membrane, is much harder to see, and is frequently missed on a routine check. This does not mean it is not there, nor that it is not affecting feeding.
It is also worth knowing that tongue tie is sometimes described using terms like ‘mild’, ‘moderate’ or ‘severe’ or even ‘small’ or ‘large’. In line with current thinking in lactation practice and the association of tongue tie practitioners, these labels are not particularly helpful. What matters is whether the frenulum is restricting normal tongue function. A frenulum is either restricting normal movement, in which case it is a tongue tie that warrants consideration, or it is not, therefore it is not a tongue tie but a normal frenulum. A tie that looks ‘mild’ on paper can have a very significant functional impact on feeding, while a more visually obvious tie in a different baby may cause very little difficulty at all. This is why functional assessment, not grading, should be at the heart of any tongue tie evaluation.
How does tongue tie affect breastfeeding?
For breastfeeding to be effective and comfortable, your baby needs to be able to open their mouth wide, draw in a generous amount of breast tissue, and use their tongue in a wave-like peristaltic movement to compress the breast and transfer milk. When tongue movement is restricted, this process can be disrupted in a number of ways.
The degree to which tongue tie affects feeding varies enormously from baby to baby. Some babies with a tongue tie feed beautifully and need no intervention at all. Others find feeding very difficult, and without support and treatment, breastfeeding may become unsustainable. The functional impact, how much the restriction is actually affecting feeding, matters far more than simply whether a tie is present or what it looks like.
Signs that tongue tie may be affecting your baby’s feeding
The signs of tongue tie rarely show up in isolation, it is usually a cluster of symptoms, across both you and your baby, that builds the picture. Here is what to look out for.
Signs in your baby
- Difficulty latching, or repeatedly slipping off the breast mid-feed
- A shallow latch, taking mainly the nipple rather than a generous mouthful of breast tissue
- Clicking sounds during feeding caused by the tongue losing its seal on the breast and breaking suction
- Fatigue at the breast, falling asleep quickly without transferring enough milk, or feeding for very long periods without seeming satisfied
- Excessive wind or reflux-like symptoms, caused by swallowing extra air due to the broken seal
- Poor weight gain despite frequent feeding, this may often first reveal itself around 6 weeks when milk supply changes from hormonally driven to mechanically driven (baby removing milk tells the breasts how much to replace).
- A heart-shaped or notched appearance to the tip of the tongue when the baby cries or attempts to protrude their tongue, though this is not always present, particularly with posterior ties
- Inability to lift the tongue to the roof of the mouth, or to extend it past the lower gum line
Signs in you
It is really important to include the maternal signs here, because tongue tie is not only a baby issue, it is a feeding dyad issue. If your baby has a tongue tie that is affecting their latch, it will very often affect you too.
- Persistent nipple pain – throughout feeds, rather than just in the first few seconds as the nipple is drawn in
- Nipple damage – cracking, bleeding, blistering, or the nipple emerging from the feed looking flattened, creased, or lipstick-shaped
- Recurring blocked ducts or mastitis – caused by ineffective milk removal from the breast
- Low milk supply concerns – because if your baby cannot remove milk efficiently, the breast is not adequately stimulated to maintain supply
- Feeding feeling relentless and exhausting – with your baby never seeming truly satisfied
If several of the above resonate it is worth having a proper assessment rather than waiting to see whether things improve.
What about positioning and attachment, could that be the issue instead?
This is such an important question, and the honest answer is: often yes. Positioning and attachment difficulties can cause many of the same symptoms as tongue tie – nipple pain, a shallow latch, clicking, a baby who seems unsatisfied. And sometimes, with skilled support and adjustments to how you are holding and positioning your baby, feeding can be transformed without any further intervention being needed.
However, if a tongue tie is present and restricting your baby’s tongue movement, there may be a ceiling to what can be achieved through positioning changes alone. The tongue restriction is a physical limitation that cannot always be overcome purely by adjusting how your baby is held.
This is why a thorough feeding assessment is so valuable, one that looks at both the feeding dynamics and the oral anatomy together, so that you come away with a clear picture of what is contributing to your difficulties and what the most effective path forward looks like for your specific situation.
What does a tongue tie assessment involve?
A thorough tongue tie assessment should always look at the whole feeding picture, not just the tongue in isolation. In my consultations, I carry out a full feeding assessment that includes observing a complete feed from start to finish, assessing your baby’s positioning and attachment, and performing a detailed oral assessment. The oral assessment involves looking at the structure of your baby’s mouth, the shape of the palate, the mobility of the tongue and lips, the appearance of the frenulum, and also feeling the tongue’s movement and tone through your baby suckling on my gloved finger.
A tongue tie assessment is not a five-second look in the mouth. It is a detailed, holistic evaluation that should leave you with a clear understanding of what is and is not affecting your feeding, and what your realistic options are going forward.
This brings me to something I feel strongly about: it is not possible to fully assess whether a tongue tie is impacting feeding without observing a feed. A practitioner who assesses the mouth but does not watch a complete feed is only seeing part of the picture. Feeding is dynamic, it involves your baby’s tongue, jaw, lips, posture, positioning, and your breast anatomy all working together in real time. Without seeing that, there is no way to know with confidence how much of what you are experiencing is driven by the tongue restriction, and how much might be improved with changes to positioning and attachment alone.
This matters enormously, because as already highlighted, sometimes what appears to be a tongue tie problem is significantly, or even entirely, resolved with skilled positioning support, without any procedure being necessary at all. A good tongue tie practitioner will always observe a feed before recommending division, and will take the time to trial positioning adjustments first. Division should never be the automatic first step.
Equally, observing a feed after a division is just as important. A frenotomy releases the physical restriction, but your baby then needs to learn to use their tongue in a new way, and that does not always happen automatically. Post-division feeding support, including guidance on positioning, attachment and what to expect in the days that follow, makes a real difference to outcomes. A practitioner who performs the procedure and then sends you on your way without any feeding follow-up is leaving out a crucial part of the process.
If you have been told that your baby does not have a tongue tie but your feeding difficulties continue, it is always worth seeking a second opinion.
What are the options if tongue tie is identified?
Not every tongue tie requires treatment. If feeding is going well for both you and your baby, a tongue tie may be present but not need any intervention. The first steps should always be to review if any alterations are needed to your positioning and attachment. If there are some alterations to make, it can be worth working on these for at least a week to give time to see if this is all that is needed. If the challenges you are experiencing continue, then you can feel more confident that a tongue tie division will be beneficial. The decision about whether to treat should always be based on the functional impact, how much the restriction is actually affecting feeding, rather than solely on appearance.
Where treatment is recommended, the procedure used is called a frenotomy (usually referred to as a tongue tie division). This is a quick, minimally invasive procedure in which the frenulum is released using sterile scissors. In young babies, it is generally straightforward and can make a significant difference to feeding when performed by a skilled, experienced practitioner in conjunction with good feeding support. Whilst this is a relatively simple procedure, it is still a procedure and as with any procedures, there can be risks associated. Your tongue tie practitioner should discuss these risks in detail with you prior to performing the division so that you can make a fully informed decision on whether to proceed or not.
It is important to be realistic about expectations. A tongue tie division is not always an instant fix. For some families, the improvement in feeding is immediate and dramatic. For others, it takes time for the baby to learn to use their tongue in a new way, and this process benefits greatly from skilled feeding support before and after the procedure. Positioning, attachment and feeding technique may all need to be revisited post-division as your baby adjusts.
Accessing treatment on the NHS
NHS provision for tongue tie division varies significantly depending on where you live. Some areas have specialist tongue tie clinics with good access; others have very limited provision or long waiting times. Your Midwife, Health Visitor or GP can refer you, and it is worth asking specifically about tongue tie services in your local area. If NHS waiting times are not manageable given the impact on your feeding, private tongue tie practitioners are available, your IBCLC may be able to advise on who to approach locally.
You do not have to keep struggling
One of the things that saddens me most in my work is meeting parents who have been struggling with painful, difficult feeding for weeks, sometimes months, who have been repeatedly told that everything ‘looks fine’, or that it will get easier, or that they just need to keep going. Whilst hopefully well-intentioned, this advice is not good enough when there is a specific, identifiable cause that can be assessed and addressed.
Painful breastfeeding is not a rite of passage. Feeding should not hurt. And if it does, or if your baby is not thriving as expected, you deserve a proper, skilled assessment, not reassurance without answers.
If you are based in Surrey, Berkshire or Hampshire, including areas such as Guildford, Farnham, Fleet, Farnborough, Camberley, Sandhurst, Bracknell, Wokingham, Reading and surrounding areas, I offer home visits that include a full feeding assessment and oral examination. I can give you a clear picture of what is happening, discuss your options honestly, and support you with a realistic plan, whether or not tongue tie is part of the picture. Virtual consultations are also available for families further afield.
Every initial consultation includes two weeks of WhatsApp follow-up support, because tongue tie and feeding challenges rarely resolve overnight, and I want to be there with you as things unfold.