Understanding Tongue-Tie (Ankyloglossia)

Tongue-tie, also known as ankyloglossia, is a condition that can be present from birth where the strip of tissue (lingual frenulum) under the tongue is shorter, tighter, or thicker than usual. This can restrict the tongue’s movement and lead to feeding challenges.

Tongue-tie affects around 4–11% of newborns (NICE, 2005; NHS England, 2019). However, not every baby with a tongue-tie experiences difficulties, and many will feed without needing treatment.

What Is Tongue-Tie?

A baby's tongue plays an important role in feeding — helping them latch, create a seal, and effectively receive milk whether breastfeeding or bottle-feeding. When tongue movement is restricted, it can lead to challenges for both baby and parent.

As a highly skilled midwife and specialist tongue-tie practitioner, I provide in-depth, compassionate assessments to determine whether a tongue-tie may be affecting your baby's feeding. I will take the time to listen carefully to your experience, assess tongue function, and discuss all findings with you before supporting you in deciding whether a frenulotomy is the best path for you.

Signs That May Suggest a Tongue-Tie

Signs During Breastfeeding

  • Difficulty latching onto the breast or maintaining a latch

  • Clicking or noisy feeding sounds

  • Prolonged or very frequent feeds

  • Baby appearing frustrated, fussy, or tired at the breast

  • Poor weight gain or slow weight gain

  • Maternal nipple pain, grazes, or bleeding

  • Distorted nipple shape after feeding (e.g., lipstick-shaped)

  • Frequent blocked ducts or mastitis

Research shows that up to 80% of breastfeeding mothers of tongue-tied babies report significant nipple pain (Geddes et al., 2008).

Signs During Bottle Feeding

Even bottle-fed babies with a tongue-tie can experience feeding difficulties. These may include:

  • Dribbling or leaking milk from the sides of the mouth

  • Difficulty maintaining a good seal around the teat

  • Noisy sucking or clicking sounds

  • Taking a long time to finish a feed

  • Gulping air leading to excessive wind, colic, or reflux symptoms

  • Poor weight gain or feed fatigue (falling asleep mid-feed)

Feeding issues are not exclusive to breastfeeding — tongue-tie can impact bottle-feeding efficiency, comfort, and the baby's digestion too.

What Is a Frenulotomy?

A frenulotomy is a quick, low-risk procedure where the tight frenulum is gently divided to allow greater freedom of tongue movement.

Key facts about frenulotomy:

  • Performed in just a few seconds

  • Minimal or no bleeding

  • No general anaesthetic needed in young babies

  • Babies usually return to feeding immediately afterwards

NICE Guidance supports frenulotomy as a safe and effective treatment for feeding difficulties caused by tongue-tie. Studies cited by NICE show that 60–80% of babies have improved breastfeeding outcomes following the procedure.

Complication rates are very low — serious complications occur in less than 1% of cases.

After the procedure, I remain available to support you with feeding advice and encouragement, helping you and your baby adjust and thrive.

Deciding Whether to Have a Frenulotomy

Choosing to proceed with a frenulotomy is a personal decision. It’s important to weigh:

  • Feeding impact: Is feeding causing ongoing concern or distress?

  • Your experience: Is pain, exhaustion, or worry affecting your breastfeeding or bottle-feeding journey?

  • Professional advice: What did the full tongue function and feeding assessment show?

Not all babies with a tongue-tie need a frenulotomy. Sometimes, with feeding support, babies adapt beautifully. Other times, a simple procedure can make a profound difference to both feeding effectiveness and parental well-being.

Rest assured, you are not alone.

Tiny Ties is here to offer expert assessment, warm reassurance, and evidence-based advice, ensuring that you feel empowered, informed, and supported every step of the way.