Quick answer: Tongue tie (ankyloglossia) is when the frenulum — the strip of tissue connecting the tongue to the floor of the mouth — is shorter or tighter than normal, restricting tongue movement. It affects 4–11% of newborns and can cause significant breastfeeding difficulties, though its impact varies widely.
Types of tongue tie
Anterior tongue tie (the classic presentation): the frenulum is visible and tight at the front of the tongue, the tongue tip is notched or heart-shaped when extended, and restriction is obvious. Posterior tongue tie: the frenulum is at the back of the tongue, not visible at a glance, and the tongue appears normal on casual inspection — but restricted movement is present. Posterior tongue tie is significantly underdiagnosed because it requires an examiner to run a finger along the floor of the mouth to feel the tight posterior frenulum. Lip tie (tight upper frenulum): often co-exists with tongue tie and can compound breastfeeding difficulties by affecting the upper lip’s ability to flange.
Signs that tongue tie is affecting breastfeeding
Breastfeeding difficulties associated with tongue tie include: nipple pain that persists beyond the first 2 weeks (the tongue cannot cup the breast correctly, causing compression and shear force on the nipple); poor weight gain (baby cannot transfer milk effectively despite appearing to feed frequently); clicking sound during feeding (air entering because of a poor seal); baby slipping off the breast repeatedly; dimpling of the cheeks during suckling; unsatisfied behaviour after feeds; and breast refusal. Not all tongue ties cause feeding problems — the functional impact depends on the degree of restriction and the baby’s ability to compensate.
Assessment and diagnosis
A tongue tie assessment should be carried out by an IBCLC (International Board Certified Lactation Consultant), a tongue tie practitioner, or a relevant medical professional trained in assessment. The HATLFF (Hazelbaker Assessment Tool for Lingual Frenulum Function) is a validated assessment tool used to score both appearance and function. Diagnosis based on appearance alone (without functional assessment) misses posterior ties and misrepresents the clinical significance of anterior ties that are not functionally restricting.
Division: what it involves
Frenotomy (tongue tie division) is a simple procedure in young babies: the frenulum is cut with sharp sterile scissors. In babies under approximately 12 weeks, no anaesthesia is required — the frenulum has few nerve endings and the procedure takes seconds. The baby is then offered a feed immediately after to provide comfort and activate the new range of tongue movement. Division is not always the right response to tongue tie — it should be considered when functional problems are present and identified by proper assessment, not as a routine response to any tight frenulum. Post-division wound exercises (stretching the healing site to prevent reattachment) are commonly recommended, though evidence for their necessity is emerging rather than definitive.
Frequently Asked Questions
My baby was assessed and told they don’t have tongue tie, but breastfeeding is still painful — what next?
Tongue tie is one cause of breastfeeding pain; others include latch technique, breast anatomy, vasospasm, thrush, and mastitis. If tongue tie has been ruled out, a comprehensive breastfeeding assessment by an IBCLC is the next step — they can observe a full feed and identify the actual cause of pain.
Will tongue tie affect speech if not divided?
Some children with unresolved tongue tie develop compensatory articulation patterns — difficulties with sounds requiring the tongue tip (t, d, n, l, r, s, z). Others compensate naturally without speech problems. The decision to divide for speech concerns is best made by a speech and language therapist who has assessed the specific sounds affected.
How do I find a tongue tie specialist?
In the UK: the Association of Tongue-Tie Practitioners (ATTP) lists trained assessors by region. Some NHS trusts offer NHS-funded assessment and division; others require private referral. IBCLC lactation consultants often work closely with tongue tie practitioners and can guide you to local services.
Related Reading
- Breastfeeding in the first week: latch, supply and sanity tips
- Breastfeeding pain: causes and solutions that actually work
Found this helpful? Sign up to the LylyMama newsletter — evidence-based answers to the questions every new parent actually has.
