Tongue tie in babies and when cutting it helps breastfeeding

Tongue tie means the thin band of skin under the tongue is short or tight, so the tongue cannot move freely. Many babies with tongue tie breastfeed perfectly well and need nothing. When a tie does cause painful or poor feeding, a quick snip called frenotomy can ease the mother's nipple pain. Cutting is not a cure for every feeding problem. Lip ties and speech worries are much less often a real issue than social media suggests.

What is tongue tie?

Tongue tie is when the band of tissue under the tongue (the frenulum) is attached close to the tip, or is short, thick or tight. Doctors call it ankyloglossia.

It is common. Between 4% and 11% of newborns have some degree of tongue tie.¹ It is diagnosed more often in boys than girls.^2,3 Every baby has a frenulum. Having one you can see does not mean your baby is tongue tied.

How can I tell if my baby has tongue tie?

Look at how the tongue moves, not just how the band looks. A tied tongue may not stick out past the lower gum, may not lift to the roof of the mouth, and may look heart-shaped or notched at the tip when your baby cries.

Feeding clues include: - Trouble latching, or slipping off the breast often - A clicking sound during feeds - Very long feeds, and a baby who still seems hungry - Sore, cracked or flattened nipples, often looking like a new lipstick after a feed

These clues can have many other causes. A doctor or lactation expert should examine the tongue and watch a full breastfeed before deciding.

Does tongue tie cause breastfeeding problems?

It can, but not always. Many tongue-tied babies feed well. Problems are more likely when the tongue cannot reach over the lower gum or lift well.

A baby needs to cup the breast with the tongue and draw milk out with a wave-like motion. A tight frenulum can make this harder, so the baby chews or clamps instead, which hurts. But latch and position problems cause the same symptoms in babies with no tie at all. That is why the first step should always be skilled help with positioning.

Why does everyone seem to be diagnosing tongue tie now?

Diagnosis and cutting of tongue tie have risen sharply in many countries, faster than any change in babies themselves.

In US hospital data, tongue tie diagnoses rose from about 3900 children in 1997 to about 32,800 in 2012, and frenotomies rose from about 1300 to about 12,400.² In Denmark, the yearly rate of frenotomy rose from 5.3 per 100 babies in 2015 to 12.1 per 100 in 2024.³ The rate varied from about 4 to 36 per 100 babies between different areas.³ Such wide variation suggests habit and local practice, not need, drives many procedures.

Does frenotomy help breastfeeding?

Frenotomy helps some mothers, mainly by reducing nipple pain in the short term. It does not reliably make babies feed better.

A Cochrane review of 5 trials with 302 babies found that frenotomy reduced mothers' nipple pain soon after the procedure.¹ It did not find a consistent improvement in the baby's feeding.¹ The trials were small, and most babies in the comparison groups later had the snip too, so long-term effects are unknown.¹ Another review of trials and observational studies judged the overall evidence as moderate and in favour of frenotomy for babies with feeding difficulty.⁴

What did the trials show about frenotomy?

The results are mixed, which is why doctors disagree.

In one US trial of 58 babies, both the frenotomy and the sham (pretend) procedure groups had less nipple pain, but the frenotomy group improved more and feeding scores improved only in that group.⁵ Almost all parents in the sham group chose the real snip at 2 weeks.⁵ This tells us two things. There is a real benefit for some, and there is also a strong placebo effect. My approach is to try skilled breastfeeding support first, then offer frenotomy if a clear tie and clear problems remain.

What happens during a frenotomy?

The doctor holds the baby's head steady, lifts the tongue and snips the thin band with sterile blunt scissors. It takes a few seconds.

In young babies, it is usually done in the clinic. A small drop of blood is common and stops with gentle pressure. Most babies can go straight to the breast, which also comforts them. Thicker ties in older babies may need a different procedure.

Is tongue tie surgery painful for babies?

Babies usually cry briefly, mostly from being held still, and settle quickly at the breast. Serious harm is rare.

The Cochrane review found no serious complications in the trials.¹ In a Danish study of over 56,000 frenotomies, bleeding was recorded within 30 days in 11 babies, about 2 in 10,000.³ Infection, ulcers or damage under the tongue are uncommon. A white patch under the tongue for a week or so is normal healing.

Can tongue tie grow back after cutting?

Sometimes the band tightens again or the first snip was not complete. In the Danish study, 6.3% of babies had a repeat procedure.³

If symptoms return after a period of improvement, go back to the doctor who did the procedure. Do not start forceful mouth stretches at home unless your doctor teaches you a gentle method.

Should every tongue tie be cut?

No. A tongue tie that is not causing a problem should be left alone.

The reasons to consider frenotomy are a clear tie with ongoing feeding trouble, such as poor weight gain or severe nipple pain, that has not improved with good breastfeeding help. The Cochrane review studied babies who had both a tie and feeding problems.¹ Cutting "just in case" adds a procedure without proven benefit. Dr Dutta sees many families in Kolkata told by relatives that a visible frenulum must be cut. That is not true.

Does tongue tie cause speech delay?

Probably not. A systematic review found no clear link between tongue tie and speech problems.⁶

Most of the studies were small and of low quality, so the question is not fully settled.⁶ Cutting a tongue tie in a newborn to prevent speech problems is not supported. If an older child has unclear speech, see a speech therapist first. Most speech delay has nothing to do with the frenulum.

What is lip tie in a baby?

A lip tie is a band of tissue joining the upper lip to the gum. Every baby has one, and in many it reaches down to the gum line. This is normal anatomy.

A Finnish study of 264 newborns found no link between how the upper lip frenulum looked and breastfeeding problems.⁷ A harmful isolated lip tie was rare, and no clear reasons to operate were found.⁷ Mothers feeding for the first time had more problems, which points to the value of support and practice.⁷

What about cheek ties and laser release?

There is very little research on lip ties and cheek ties in babies.⁸ Most papers on lip and cheek tie are opinions, not studies.⁸

Dr Dutta does not recommend laser release of lip or cheek ties in newborns, because she has not seen good trials supporting it. Any procedure should come only after a careful feeding assessment.

How do I know my tongue-tied baby is getting enough milk?

Check wet nappies, dirty nappies and weight. By about day 4, most breastfed babies have about 5 wet nappies, rising to about 7 by day 7.⁹

Few dirty nappies on day 4 can be a sign that a baby is not getting enough.⁹ Not regaining birth weight by 2 weeks is one sign of a real feeding problem.¹ A baby who is back to birth weight and keeps gaining is feeding well, whatever the frenulum looks like.

When should I see a doctor about tongue tie?

See your doctor or a lactation expert if: - Breastfeeding is painful past the first week despite help with latch - Your baby is not back to birth weight by 2 weeks, or is losing weight - Your baby has fewer than 6 wet nappies a day after day 5 - Feeds take over an hour, or your baby is never satisfied

Go to hospital at once if your baby is not feeding well, has a temperature above 37.5 degrees C, or has yellow palms and soles.¹⁰ A very sleepy baby also needs urgent care. Also go if bleeding after a frenotomy does not stop with firm pressure.