Tongue Tie and Breastfeeding: What You Need to Know
Tongue Tie and Breastfeeding: What You Need to Know
If you've been struggling with breastfeeding, you may have heard the term "tongue tie" mentioned. But what exactly is it, and how can it affect feeding?
What is tongue tie?
Tongue tie (ankyloglossia) is a condition where the frenulum — the small piece of tissue connecting the tongue to the floor of the mouth — is tight, short, or restrictive. Recent research has given us a better understanding of how the frenulum works. Rather than being a simple strand of tissue, it forms an integral part of the floor of the mouth, drawing upward into a midline fold under tension when the tongue lifts. This helps explain why a restricted frenulum can have such a significant impact on tongue movement and, in turn, on feeding.
How does tongue tie affect breastfeeding?
For a baby to feed effectively at the breast, the tongue needs to be able to do several things at once. It needs to extend comfortably past the lower lip to take in enough breast tissue for a deep latch. The sides of the tongue need to cup around the breast to hold it steady. The tip of the tongue needs to be able to lift above the midpoint when the mouth is open, and the back of the tongue needs to rise and drop in a rhythmic wave to create the suction that draws milk out (Diana West, IBCLC).
When the frenulum is restrictive, any or all of these movements can be limited — making it harder for a baby to latch deeply, feed efficiently, or transfer milk well.
How common is tongue tie?
The exact figures vary depending on how tongue tie is assessed, but estimates generally range from 3–5% of babies. It tends to run in families, and while the exact cause isn't fully understood, it is thought to involve a combination of genetic and environmental factors.
How is tongue tie classified?
Tongue tie is typically described by the position of the frenulum — anterior (near the tip of the tongue), midline, or posterior (further back, often harder to see). It can also be described as a percentage of tongue restriction, ranging from 25% to 100%.
It's worth knowing that the classification describes the frenulum, not the severity of the impact. A posterior tongue tie that is harder to see can be just as — or more — problematic than one that is clearly visible. This is why a proper functional assessment matters far more than appearance alone.
What are the signs of tongue tie in babies?
Difficulty latching or staying latched
Poor milk transfer or slow weight gain
Clicking or smacking sounds during feeds
Short, frequent, or unsettled feeds
Fussiness or frustration at the breast
Reluctance to feed
What are the signs in mothers?
Sore, cracked, or bleeding nipples
Engorgement or blocked ducts
Mastitis
Low milk supply
Anxiety or frustration around feeding
What should you do if you're concerned?
If you suspect your baby may have a tongue tie, a good first step is to see an IBCLC (International Board Certified Lactation Consultant). They will take a full feeding history and assess both breastfeeding and tongue function together — because identifying a tongue tie is about understanding how the tongue works in the context of feeding, not simply checking a list of symptoms or looking at the tongue in isolation.
If a restrictive tongue tie is identified, your lactation consultant can arrange a referral to a tongue tie practitioner for further assessment.
Is treatment always necessary?
Not always. Not every tongue tie needs to be divided. The decision depends on the degree of restriction and the impact on feeding.
Where treatment is recommended, it is important to understand that tongue tie release is a process, not a single procedure. Dividing the frenulum — a frenotomy or frenulotomy — may improve the tongue's range of motion, but on its own it is rarely the whole answer. A comprehensive approach also includes optimising positioning and attachment, tongue exercises to help the baby learn to use their tongue differently, and often some form of bodywork to support the baby's overall function and comfort. This is why ongoing lactation support before and after any release is so important.
There is some debate in the literature about technique — whether scissors or laser is preferable — and current evidence does not clearly favour one over the other (Messner et al.; American Dental Association, 2020). What the evidence does support is that outcomes are better when release is part of a holistic, supported care plan rather than a standalone intervention.
Moving Forward
Tongue tie is one of the more complex areas of infant feeding — not because it is rare, but because no two babies are the same, and the impact on breastfeeding varies enormously from family to family. What matters most is not the diagnosis itself, but understanding how it is affecting your baby's feeding and what, if anything, needs to be done about it.
If you are struggling with breastfeeding and suspect tongue tie may be a factor, the most important first step is a thorough assessment — one that looks at how your baby feeds, not just how their tongue looks.
I have extensive experience assessing tongue function in the context of breastfeeding, working with families through the process of diagnosis, referral, and recovery, and supporting mothers to reach their feeding goals on the other side of a release. Whether you are in the early days of feeding and something does not feel right, or you are further down the road and not seeing the improvement you hoped for after a release, I am here to help.
A Breastfeeding Consultation is a good place to start. We will take time to look at the full picture — your history, your baby's feeding, and what support or next steps might be right for you.
You do not have to figure this out on your own.