Tongue Tie FAQ's

Clinical Information

What is a tongue-tie?

A tongue-tie occurs when the lingual frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth, is tight or short, restricting the tongue's movement and mobility. This restriction can arise from an excess of collagen or abnormal fiber alignment within the frenulum.

What causes tongue tie?

The cause of tongue tie in infants is not fully understood, but genetic and developmental factors are believed to play a significant role:

Genetic Inheritance: Tongue tie often has a familial link.

Embryologic Development: During fetal development (typically weeks 8-12), the lingual frenulum should naturally recede or elongate. If this process fails, a restrictive frenulum results.

Environmental Factors: Research into maternal health and environmental conditions during pregnancy is ongoing, but their direct impact on tongue tie development is less clear.

Symptoms & Red Flags

What are the symptoms of a tongue tie?

For Baby:

Difficulty latching

Frequent detachment or inability to maintain latch during feeding.

Milk dribbling while feeding (breast or bottle).

Very short (under 5 minutes) or very long (over an hour) feeding times.

Falling asleep or losing interest quickly during feeds.

Fussiness, discomfort, or tension before, during, or after feeding.

Excessive weight loss in the first week, slow weight regain, or poor ongoing weight gain.

Excessive gas (wind).

Reflux or vomiting after feeds.

Noisy feeding (clicking sounds) indicating loss of suction.

For Mothers:

Sore or damaged or misshapen nipples.

Exhaustion due to frequent feeding.

Lumpy breasts (blocked ducts), potentially leading to pain, redness, and mastitis.

Mastitis

Low milk supply

Breasts feeling full even after feeding.

For Bottle-Feeding Babies:

Difficulty feeding from a bottle.

Prolonged feeding times (≥ 1 hour).

Frequent, small feeds.

Significant milk dribbling.

Intake of excessive air during feeding.

Curious about common misconceptions? Read my blog post

The Procedure & Safety

Which babies can have a tongue tie division?

Assessment and division are generally suitable for most babies, including babies that have not had vitamin K. However, I do not perform divisions for:

Lip ties.

Babies over 12 months of age.

Babies with a known bleeding disorder or a family history of bleeding (clotting) disorders.

Babies with a known heart condition.

How is a tongue-tie assessed and treated?

The Assessment: A professional assessment involves more than a quick look. It includes a full history of your feeding experience and a gentle physical examination. Using a gloved finger, the practitioner will feel how the tongue moves, lifts, and stretches.

The Procedure (Frenotomy): If a division is necessary, the procedure is quick and safe.

The Process: The restrictive tissue is carefully divided using sterile, specialised scissors. The entire process takes only a few seconds.

Pain Relief: For babies under 12 months, the area has very few nerve endings, so anesthesia is not required. Most babies are comforted immediately by a feed right after the procedure.

What are the risks involved?

While tongue-tie division is a routine procedure, all surgical interventions carry minor risks:

Bleeding: Significant bleeding is rare (approx. 1 in 3,000–5,000).

Infection: Extremely rare (approx. 1 in 10,000).

Reattachment: In roughly 2–4% of cases, the tissue may heal back together incorrectly, which may require a second procedure.

Will it help with feeding immediately?

Every baby is different. Some show an immediate improvement in their latch, while others need time to "re-learn" how to use their tongue. Think of it like a physical therapy recovery; the "tether" is gone, but the muscles need to gain strength and coordination. Consistent aftercare exercises and feeding support are key to long-term success

Recovery & Long-Term Success

After the division, a small diamond-shaped wound will be present under the tongue. Within a day or two, it will develop a white or yellow film that fills the wound. This is a normal part of the healing process in the mouth and is not a sign of infection. We will provide you with gentle exercises to perform at home to ensure the wound heals with maximum mobility.

What if I'm not sure about surgery?

The decision is entirely yours. You may choose to work with a Lactation Consultant (IBCLC) first to optimise feeding positions. Some parents also find bodywork, such as infant osteopathy or cranio sacral therapy, helpful in releasing body tension caused by birth or the tongue tie itself.

Where can I get more information?

NICE Guideline: https://www.nice.org.uk/guidance/ipg149

Association of Tongue-Tie Practitioners: https://www.tonguetie.org.uk

UNICEF: https://www.unicef.org.uk/babyfriendly/support-for-parents/tongue-tie/

La Leche League GB: https://laleche.org.uk/tongue-tie/

Breastfeeding Network: https://www.breastfeedingnetwork.org.uk/breastfeeding-information/problems-with-breastfeeding/tongue-tie/

Book Recommendations:

Why Tongue Tie Matters by Sarah Oakley

Commonly asked questions about tongue tie services