Tongue Tie and Breastfeeding: What Every Parent Needs to Know
If you are struggling with breastfeeding and someone has mentioned tongue tie, you are probably looking for clear, honest information — not more confusion. This post explains what tongue tie is, how it affects feeding, what a proper assessment looks like, and what happens if treatment is recommended. I have tried to write it in the way I would speak to you in clinic: straightforwardly, without alarm, and with the caveat that no two babies are the same.
What is tongue tie?
Tongue tie — the medical term is ankyloglossia — is a condition where the frenulum, the small band of tissue connecting the underside of the tongue to the floor of the mouth, is tight, short, or restrictive in a way that limits tongue movement.
We have a much better understanding of this now than we did even ten years ago. Rather than being a simple strand of tissue, the frenulum forms an integral part of the floor of the mouth. Under tension, it draws upward into a midline fold when the tongue lifts. This helps explain why a restrictive frenulum can have such a significant effect on the tongue's range of motion — and why that matters so much for feeding.
How does tongue tie affect breastfeeding?
For a baby to feed effectively at the breast, the tongue needs 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 securely. The tip of the tongue needs to lift above the midpoint when the mouth is open, and the back of the tongue needs to move in a rhythmic wave to create the suction that draws the milk down.
When the frenulum is restrictive, any or all of these movements can be affected — making it harder for a baby to latch deeply, feed efficiently, or transfer milk well. The impact varies enormously from baby to baby, which is one reason why tongue tie can be easy to miss, and why a functional assessment — looking at how the tongue works during feeding, not just how it looks at rest — matters so much.
How common is tongue tie?
Estimates vary depending on how tongue tie is assessed and defined, but figures generally range from 3 to 10% of newborns. It tends to run in families.
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 beneath the mucous membrane and harder to see). It can also be described as a percentage of restriction, from 25% to 100%.
One thing that is worth knowing: the classification describes the frenulum itself, not the severity of its impact on feeding. A posterior tongue tie that is difficult to spot can be just as — or more — problematic than one that is clearly visible. This is precisely why a visual check alone is never sufficient, and why assessment needs to be done by someone with specific training in this area.
What are the signs of tongue tie in a baby?
Difficulty latching, or difficulty staying latched
Clicking or smacking sounds during feeds
Feeding that is short, frequent, or unsettled
Poor milk transfer or slow weight gain
Fussiness or frustration at the breast
Reluctance to feed
What are the signs for a breastfeeding mother?
Sore, cracked, or bleeding nipples
Nipple pain that does not improve in the first couple of weeks
Engorgement, blocked ducts, or recurring mastitis
Feeling as though your baby is never fully satisfied
Concerns about your milk supply
It is worth saying clearly: none of these signs confirms tongue tie on its own. Many feeding difficulties have more than one cause, and it is possible to have a tongue tie that is not causing significant problems. A thorough assessment looks at the full picture, not just the frenulum.
What does a tongue tie assessment involve?
A proper tongue tie assessment is not simply a quick look under the tongue. It involves taking a full feeding history, assessing how your baby feeds at the breast, and evaluating tongue function in the context of that feeding — because the question is not just whether a frenulum is present, but whether it is causing a functional problem.
As an IBCLC, this is exactly the kind of assessment I carry out. If a restrictive tongue tie is identified and I think a referral for division is warranted, I will discuss this with you and support you in getting that referral.
Is treatment always necessary?
No. Not every tongue tie needs to be divided. The decision depends on the degree of restriction and — more importantly — the functional 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 complete answer. A thorough approach also involves optimising positioning and latch, specific tongue exercises to help your baby learn to use their tongue differently after the release, and often some form of bodywork to support the baby's overall comfort and function. This is why continued lactation support before and after any division matters so much.
There is ongoing debate in the clinical literature about technique — scissors versus laser — and current evidence does not clearly favour one approach over the other. What the evidence does support is that outcomes are better when release is part of a well-supported holistic care plan, rather than a standalone procedure.
What if my baby has already had a tongue tie release but feeding is still difficult?
This is something I see regularly in clinic, and if it is where you find yourself, please know you are not alone. Release does not always immediately resolve feeding difficulties. There may be compensatory patterns that have developed over weeks of difficult feeding, the wound may need careful management, and some babies need significant support to learn to use their tongue differently after the procedure.
If feeding is still painful or unsatisfying after a release, a follow-up consultation with an IBCLC is a really valuable next step.
How I can help?
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 so much from family to family.
I have extensive experience assessing tongue function in the context of breastfeeding, supporting families through assessment, referral, and recovery, and helping mothers reach their feeding goals on the other side of a release. Whether something has not felt right from the early days, or you are further down the road and not seeing the improvement you had hoped for, I am here to help.
A Breastfeeding Consultation is a good place to start. We will take the time to look at the full picture — your history, your baby's feeding, and what support or next steps make sense for you both.
You do not have to figure this out on your own.
