Tongue Tie and Breastfeeding: Signs, Assessment, and Whether a Release Helps

Somebody has already said the words "tongue tie" to you, probably in a Facebook group, and now every clicking sound and sore feed looks like evidence. Tongue tie is real and a release can help, and it has also become the most over-diagnosed thing in newborn feeding, with US diagnoses rising almost tenfold between 1997 and 2012 and doubling again by 2016. So the useful question isn't "does my baby have one" (a lot of babies have a visible frenulum and feed perfectly well) but "is it actually stopping the tongue from doing its job".

What tongue tie actually is

Every baby has a frenulum, the strip of tissue under the tongue. Tongue tie (ankyloglossia) is when it's short or tight enough to limit tongue movement, and the Academy of Breastfeeding Medicine is blunt that a visible frenulum on its own is a normal structure and not a reason for surgery. Depending on the study, somewhere between 2 and 11 percent of newborns show signs of it, it's more common in boys, and it often runs in families.

The signs that are worth noticing

In the baby: trouble latching or staying latched, clicking or popping off the breast, long and very frequent feeds that never seem to satisfy, dribbling, and the one that counts most, poor weight gain. When the tongue lifts it may look heart-shaped at the tip.

In you: nipples that are sore, cracked or pressed into a wedge shape after feeds, engorgement, blocked ducts, and in the longer run low supply because milk isn't being removed well.

The problem is that every one of those symptoms has other common causes. The NHS, Cleveland Clinic, La Leche League and the AAP all say the same thing in different words: most breastfeeding pain is positioning and attachment, not anatomy, and a skilled person adjusting the latch fixes more feeds than any procedure does.

How it should be assessed

The AAP's 2024 clinical report asks that any pair with painful or ineffective feeding gets a comprehensive breastfeeding assessment before treatment, with a lactation consultant and the pediatrician involved. That means watching a whole feed, checking your comfort, checking the baby's weight history, and examining how the tongue moves, not just how the frenulum looks. Scoring tools exist (the Hazelbaker tool and the shorter Bristol Tongue Assessment Tool are the common ones), and they're useful for consistency, but the ABM warns that no tool should be the sole basis for deciding on a release.

A good sign you're in the right hands: the first thing they do is try to improve the latch. A bad sign: a diagnosis from a photo, or a clinic that offers the procedure before anyone has watched the baby feed.

What the evidence says about cutting it

The evidence supports a short-term reduction in pain and little else. The Cochrane review pooled five randomised trials and found that frenotomy reduced mothers' nipple pain in the short term but did not show a consistent improvement in how babies fed, and no trial followed families long enough to say whether it kept anyone breastfeeding. The AAP's 2024 report reached the same conclusion, that research on effectiveness is limited, and it recommends reserving a release for significant functional problems where latch work has failed, then checking afterwards that the symptoms actually improved.

A few things the AAP and ABM say not to do: don't release a tie in a baby who is feeding normally, don't treat "posterior tongue tie" as a surgical diagnosis (the AAP calls it poorly defined), don't cut lip or cheek ties to help breastfeeding, and don't do post-release stretching exercises. Laser isn't better than scissors, and a release won't prevent future speech problems or sleep apnoea.

If your baby does need a release

In the first months it's a quick procedure with no anaesthetic: the baby is swaddled, the frenulum is divided with sterile scissors, it takes a minute or two, and you feed straight afterwards. There's a small white patch under the tongue that heals in a day or two. Many mothers feel the difference at that first feed, while the baby can take a week or two to relearn, and occasionally a second division is needed. Complications are rare but real (bleeding, infection, feeding aversion), which is why it should be done by someone trained for it, within the first month if possible.

In the UK, the NHS divides tongue ties on referral from a midwife, health visitor or GP, and the Association of Tongue-tie Practitioners lists both NHS and private practitioners. In the US, pediatricians, ENTs, oral surgeons and dentists perform releases, and your insurance's lactation benefit should cover the assessment that comes first.

Why a feed log helps here

The assessment that decides all of this rests on three things you can only know if you've been writing them down: how long feeds take, how often they happen, and whether they're getting shorter as the baby gets stronger. A week of timed feeds, with the side noted, is the most useful thing you can bring to that appointment. MilkMode keeps that record with a tap and keeps it on your phone, and a notebook does the job too.

Quick answers

How do I know if my baby has a tongue tie? A visible frenulum isn't enough. The signs that matter are a baby who can't latch well or stay latched, clicks or pops off, feeds constantly without settling, and isn't gaining weight, usually alongside nipple pain. A lactation consultant or pediatrician should watch a full feed before anyone diagnoses it.

Does cutting a tongue tie help breastfeeding? The Cochrane review and the AAP both find it reduces nipple pain in the short term but hasn't been shown to consistently improve the baby's feeding, so it's reserved for real functional problems after latch work has failed.

Is laser better than scissors for tongue tie? No. The AAP's 2024 report found no evidence that laser frenotomy is better than scissor division, and scissors remain the most common method.

Do I need to do stretches after a tongue tie release? The AAP recommends against post-release stretching exercises, and it also found no good evidence for the physical, craniosacral or myofascial therapies sometimes sold alongside a release.

Keep reading

• Is My Baby Getting Enough Breast Milk? How to Tell
• How Long Should You Breastfeed on Each Side?
• How to Find a Lactation Consultant (and What It Costs)

This article is general information, not medical advice. Sources: NHS, "Tongue-tie" (2024); American Academy of Pediatrics clinical report on ankyloglossia (Pediatrics, 2024) and press summary; Academy of Breastfeeding Medicine position statement on ankyloglossia (2021); Cochrane review, frenotomy for tongue-tie in newborn infants (2017); Cleveland Clinic, "Tongue-tie"; La Leche League GB, "Tongue-tie and breastfeeding"; Ingram et al., Bristol Tongue Assessment Tool (2015). If you have concerns about your baby's feeding or weight, talk to your pediatrician, midwife, or a lactation consultant.