Tongue-tie

Also called Ankyloglossia

A tight band under the tongue that can make breastfeeding painful and ineffective. Division is quick and effective when it is the actual problem.

What it is

A short or tight band of tissue tethering the underside of the tongue to the floor of the mouth, present from birth in a proportion of babies.

Most babies with a tongue-tie feed perfectly well and need nothing done. It becomes a problem when it restricts tongue movement enough to prevent an effective latch, and the sign of that is not the appearance of the tie but what is happening with feeding.

When it is causing a problem, division, called frenotomy, is a quick procedure done with scissors, usually without anaesthetic in small babies, with minimal bleeding and immediate feeding afterwards. It often improves feeding straight away.

Two cautions balance each other. Tongue-tie is under-recognised, and mothers are frequently told their pain is normal, that they are doing it wrong, and end up stopping breastfeeding they wanted to continue. It is also over-diagnosed in some settings, with division performed privately for problems it will not fix.

The correct sequence is an assessment of the whole feed by a skilled infant feeding specialist first. Division without a feeding assessment is treating an appearance rather than a problem.

Effects on speech are much less clear and mostly not supported by evidence; division for speech alone is rarely indicated.

Signs you might notice

In the baby: difficulty latching or staying attached; clicking during feeds; feeding for a very long time, or very frequently, and still seeming hungry; poor weight gain; dribbling milk; a tongue that cannot extend past the lower gum or lift, or that looks heart-shaped when it tries.

In the mother: nipple pain that continues throughout the feed rather than easing; cracked, flattened or misshapen nipples after feeding; low milk supply; repeated blocked ducts or mastitis.

Later: difficulty with solids in some children, and difficulty licking or clearing food from the teeth.

Urgent: a baby who is not feeding at all, has fewer than the expected wet nappies, is very sleepy or difficult to rouse, or is losing weight. See dehydration.

How it can affect day-to-day life

The emotional weight is disproportionate. Painful feeding, a hungry baby and being told to try harder is a common route to stopping breastfeeding and to feeling like a failure, and that experience compounds the risk of postnatal depression.

Feeding difficulties in the first weeks are often multifactorial, and positioning and attachment support fixes many of them without any procedure.

Waiting lists for NHS division vary enormously, and desperate parents pay privately in the early weeks when the difference matters most. Ask what the local pathway is early.

After division, most improvement is quick, but the baby has to relearn how to feed, and continued feeding support matters as much as the procedure.

Formula feeding after tongue-tie is a legitimate choice, and a supported decision to stop breastfeeding is a better outcome than an unsupported one.

Supporting someone well

Get a full feeding assessment first, by a midwife, health visitor or infant feeding specialist, before anything is divided.

Fix positioning and attachment first; it resolves a large share of feeding pain without any procedure.

Judge by the feeding, not by how the tie looks.

Ask for referral to the local tongue-tie service and what the waiting time is.

After division, keep the feeding support going for the following days and weeks.

Watch weight and wet nappies; those are the objective measures.

Look after the mother: pain, exhaustion and mood are part of the picture and often unasked about.

Do not pursue division for speech concerns without a speech and language therapy assessment.

Where to get help

A midwife or health visitor first, and the local infant feeding team.

The NHS tongue-tie service for division.

Association of Tongue-tie Practitioners list qualified practitioners and explain the evidence.

The National Breastfeeding Helpline on 0300 100 0212.