Tongue-tie is a problem that occurs in babies who have a tight piece of skin between the underside of their tongue and the floor of their mouth.

The medical name for tongue-tie is ankyloglossia, and the piece of skin joining the tongue to the base of the mouth is called the lingual frenulum.

It can sometimes affect the baby’s feeding, making it hard for them to attach properly to their mother’s breast.

If you’re concerned about your baby’s feeding and think they may have a tongue-tie, speak to your infant feeding specialist, lactation consultant, health visitor, midwife or GP.

The following information explains tongue-tie and the problems it can cause, and describes a quick and painless procedure to snip the skin, known as tongue-tie division, which should be considered if your baby is affected.

What is tongue-tie?

Tongue-tie is a birth defect that affects 3-10% of newborn babies. It is more common in boys than girls.

Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the lingual frenulum. In babies with tongue-tie, this piece of skin is unusually short and tight, restricting the tongue’s movement.

This prevents the baby from feeding properly and also causes problems for the mother.

Breastfeeding problems

To breastfeed successfully, the baby needs to latch on to both breast tissue and nipple, and the baby’s tongue needs to cover the lower gum so the nipple is protected from damage.

Babies with tongue-tie are not able to open their mouths wide enough to latch on to their mother’s breast properly.

They tend to slide off the breast and chomp on the nipple with their gums. This is very painful and the mother’s nipples can become sore, with ulcers and bleeding. Some babies feed poorly and get tired, but they soon become hungry and want to feed again.

In most cases, these feeding difficulties mean the baby fails to gain much weight.

How is tongue-tie treated?

If your baby has a piece of skin connecting the underside of their tongue to the floor of their mouth but they can feed without any problems, treatment is not necessary. If feeding is affected, the tongue-tie needs to be divided.

Tongue-tie division

Tongue-tie division involves cutting the short, tight piece of skin that connects the underside of the tongue to the floor of the mouth. It is a simple and painless procedure that usually resolves feeding problems straight away.

The National Institute for Health and Clinical Excellence (NICE) supports the use of tongue-tie division, as it is safe and there is evidence that it can improve breastfeeding. See the NICE guidelines on Division of tongue-tie for breastfeeding.

The Baby Friendly Initiative provides a list of hospitals where tongue-tie division can be carried out.

How tongue-tie division is carried out

In babies only a few months old, division of tongue-tie is usually performed without any anaesthetic (painkilling medication), or with a local anaesthetic that numbs the tongue.

A general anaesthetic is usually needed for older babies with teeth, which means they’ll be asleep during the procedure.

The baby’s head is held securely, while sharp, sterile scissors are used to snip the tongue-tie. This only takes a few seconds. You can start feeding your baby immediately afterwards.

Some babies sleep through it, while others cry for a few seconds. In small babies, being cuddled and fed are more important than painkillers.

There should be little blood loss, though some bleeding is likely.

A white patch may form under the tongue, which takes 24-48 hours to heal but does not bother the baby.