Tongue Tie in Breastfed Babies: Signs, Assessment and Whether to Treat It

If breastfeeding hurts, your baby struggles to stay latched or feeds seem endless, someone may suggest a tongue tie. It’s one of the most talked-about breastfeeding topics online, and diagnoses have risen sharply in recent years.

Tongue tie can make breastfeeding harder. But many babies with a visible tie feed perfectly well, and most breastfeeding pain has other causes. This guide covers the signs, how a proper assessment works, what the research says about treatment and what to expect if your baby has a frenotomy.

What is tongue tie?

Under your baby’s tongue is a small fold of tissue called the lingual frenulum. Everyone has one. Tongue tie, or ankyloglossia, means this band is short, tight or attached close to the tip, so it limits how far the tongue can lift, stretch forward or move side to side.

Babies are born with it. Cleveland Clinic notes it seems to be more common in boys and may run in families. How often it’s diagnosed varies a lot: the 2024 American Academy of Pediatrics (AAP) clinical report found newborn diagnosis rates from 1.7% to 10.7% across studies in the US, Canada and England.

The key point is that a frenulum you can see is not the same as a problem. Cleveland Clinic explains that a diagnosis needs both a restrictive frenulum and limited tongue function.

Signs of tongue tie in your baby

The NHS lists these possible signs during feeding:

• Trouble latching or staying latched for a full feed
• Long, frequent feeds, with short breaks and then feeding again
• Seeming hungry all the time
• Poor weight gain
• Clicking sounds, dribbling, or coughing and choking during feeds
• Taking only small amounts of milk

You might also notice the tongue can’t lift far or stick out past the gums, or that it looks notched or heart-shaped at the tip when your baby cries or sticks it out.

Here’s the catch: almost every item on that list can also come from a shallow latch, positioning, a fast let-down, low supply or other issues. Cleveland Clinic calls these signs nonspecific. That’s why a tie should be diagnosed by someone who watches a feed, not from a photo of the tongue.

Signs in the breastfeeding parent

Tongue tie often shows up first as a problem for you:

• Nipple pain during feeds, which the AAP describes as the most common complaint
• Sore or cracked nipples
• Painful, swollen breasts, or mastitis from milk not being removed well
• Lower milk supply over time if your baby isn’t transferring milk effectively

Pain is worth taking seriously at any point. But early soreness that comes from latch and positioning is far more common, and it usually improves with hands-on help. Our guide on how to breastfeed walks through a deep latch step by step.

How tongue tie is assessed

There’s no blood test or scan for tongue tie, and there’s no single agreed scoring system. The AAP report notes the lack of standard diagnostic criteria, and the 2020 consensus statement from the American Academy of Otolaryngology–Head and Neck Surgery could not agree on a preferred grading tool.

A good assessment looks at the whole feeding picture. According to Cleveland Clinic and the AAP, a trained provider will usually:

• Take a feeding history and ask about your pain and comfort
• Check your baby’s weight gain and diapers
• Look inside your baby’s mouth and feel how the tongue moves
• Watch a full breastfeed to see the latch, sucking and swallowing

The AAP says an ineffective latch and poor weight gain are the main things to weigh when considering the diagnosis. It also recommends a team approach: your pediatrician, an IBCLC (International Board Certified Lactation Consultant) and, where needed, a speech-language pathologist or other specialist. The consensus panel adds that other causes of feeding trouble, such as a blocked nose, airway issues, reflux or a cleft palate, should be checked before any procedure.

Our breastfeeding support page explains how to find an IBCLC near you.

Is tongue tie over-diagnosed?

Experts think so. The AAP describes an almost tenfold rise in diagnoses from 1997 to 2012, then a further doubling from 2012 to 2016. In its own words, frenotomy is likely overused and may not resolve breastfeeding problems.

The 2020 ear, nose and throat (ENT) consensus panel agreed that in some communities, babies are being overdiagnosed and having unnecessary surgery. It linked the rise to more awareness, more social media content about ties and more practitioners offering the procedure.

A few terms you may hear deserve caution:

Term	What the experts say
“Posterior” tongue tie	The ENT panel could not agree on what it means. Some members felt it isn’t a real anatomic entity and that the term should be dropped.
Upper lip tie	The panel agreed that a frenulum under the upper lip is normal in infants, that “lip tie” is inconsistently defined, has an unclear link to breastfeeding and is being overdiagnosed in some communities.
Buccal (cheek) tie	The panel agreed surgery to release a “buccal tie” should not be performed.
Laser release	Both the AAP and the ENT panel say there’s no evidence laser works better than other methods.

If a provider recommends releasing several “ties” at once, it’s reasonable to ask for a second opinion.

What the evidence says about frenotomy

A frenotomy is a quick procedure that snips the tight frenulum so the tongue can move more freely. Here is what the research shows:

• A 2017 Cochrane review pooled five small randomized trials with 302 babies. Frenotomy reduced mothers’ nipple pain in the short term, but the effect on the baby’s breastfeeding was inconsistent. No serious complications were reported, though the numbers were small, and no study looked at long-term breastfeeding success.
• The AAP 2024 report summarizes the evidence the same way: a short-term drop in nipple pain and an inconsistent effect on infant feeding. It says the procedure is safe and poor outcomes are rare.
• The ENT consensus panel agreed that frenotomy is not always effective, that breastfeeding problems may resolve without it, and that families should be told before consenting that feeding might not improve.

Therapies such as craniosacral, myofascial or physical therapy are promoted by some practitioners. The AAP notes they are not well studied and often cost families out of pocket.

When a frenotomy may make sense

The AAP recommends reserving frenotomy for babies with significant feeding problems caused by the tie that haven’t improved with nonsurgical help, such as latch and positioning support. When it is done for that reason, the ENT panel agreed it should ideally happen soon after diagnosis rather than after a long delay. If feeding is going well, there’s no need to release a tie “just in case” to prevent later feeding or speech problems.

While you work on feeding, protect your supply and your baby’s intake. If your baby isn’t removing milk well, hand expressing or pumping after feeds can help, and our breast milk intake calculator gives typical amounts by age and weight.

What happens during a frenotomy

According to Cleveland Clinic and the NHS:

• It’s usually done in the office by a trained clinician, most often with sterile scissors.
• Young babies usually don’t need anesthesia. The ENT panel advises against topical or injected numbing for infants; a little oral sucrose may be offered for comfort.
• With scissors, it takes about a minute.
• You can breastfeed right away. Feeding comforts your baby and helps stop the small amount of bleeding.

Rare complications include bleeding, infection, scarring, feeding aversion and injury to the saliva ducts.

Aftercare: what to do (and skip)

• Feed as usual. Some parents notice less pain and better milk transfer straight away. Others see gradual change over one to two weeks, Cleveland Clinic says.
• Skip wound “stretches.” Some practitioners tell parents to push or lift the tongue several times a day to stop the wound from reattaching. The AAP advises against these exercises, and Cleveland Clinic notes there’s no evidence they help.
• Go to follow-up. Your provider should check healing and whether feeding actually improved. If it hasn’t, keep working with your IBCLC to find the other causes.

When to call a doctor or lactation consultant

Contact your pediatrician or an IBCLC if:

• Breastfeeding is painful beyond the first few days, or your nipples are cracked or bleeding
• Your baby isn’t gaining weight, has fewer wet or dirty diapers (our baby poop color chart lists typical counts), or seems hungry after every feed
• Your baby can’t latch or stay latched
• After a frenotomy, there’s bleeding that won’t stop with pressure and feeding, signs of infection, or your baby refuses to feed

For other causes of breastfeeding pain and latch trouble, browse our Common challenges hub.