Tongue tie and feeding

What tongue tie is

Tongue tie (ankyloglossia) is when the piece of skin that connects the tongue to the bottom of the mouth is shorter or tighter than usual (NHS). The tongue may look heart-shaped when it’s lifted or stuck out. It can limit how far the tongue moves: side to side, up, or out past the lips.

The AAP estimates that 4% to 10% of newborns have tongue tie. It is present from birth, and it’s a variation of a normal mouth, not something you caused.

Most babies with tongue tie feed well

Tongue tie often causes no problems at all. The NHS says treatment is not usually needed if it isn’t causing problems. The AAP says fewer than half of babies with physical signs of tongue tie have trouble nursing, and that the band of muscle under the tongue can stretch with continued feeding.

The AAP also warns that tongue tie is being overdiagnosed. In its 2024 clinical report, it says it isn’t clear whether releasing a tight tongue in newborns improves breastfeeding, and that because many signs of tongue tie overlap with other breastfeeding difficulties, a team approach is needed. Most breastfeeding difficulties, including nipple pain, are not due to tongue tie (AAP).

Signs with milk feeds

The NHS lists these signs that tongue tie may be making breastfeeding or bottle feeding hard. Your baby may:

• have trouble latching on, or staying on, the breast or bottle teat
• feed for a long time and need feeding very often
• dribble a lot during feeds
• cough, choke or make clicking noises when feeding
• take only a small amount of milk at each feed
• lose weight or struggle to put on weight

If you’re breastfeeding, you may have sore nipples or painful, swollen breasts. The NHS says to speak to a midwife, health visitor or GP if you think your baby has tongue tie or is having trouble feeding. In the US, start with your pediatrician, who can involve a lactation consultant. See breastfeeding and starting solids.

Tongue tie and starting solids

Most research on tongue tie is about breastfeeding. Much less is known about solid food, so be wary of anyone who says it will definitely cause problems later.

The tongue does a lot of work as babies learn to eat. ASHA describes babies using the tongue to move food to the back of the mouth to swallow at around 4 to 6 months, moving food around the mouth with the tongue at 6 to 9 months, and moving food from side to side by 12 to 18 months. A tight tongue that can’t easily move side to side or lift up (NHS) may make some of this harder for some babies.

These are normal in the early weeks of solids, with or without tongue tie:

• pushing food back out with the tongue (see spitting out food)
• gagging on new textures (see gagging vs. choking)
• messy, slow eating while they learn (see how babies learn to chew)

ASHA says some trouble at first is typical and should go away over time. Mention tongue tie to your doctor if your baby:

• still has problems chewing, or pushes most food back out, long after the first weeks of solids
• often coughs or gags during meals, or takes a very long time to eat
• holds food in their cheeks (see pocketing food)
• isn’t gaining weight or growing as expected

These signs have many possible causes (ASHA), and tongue tie is only one of them. NHS dietitians at University Hospitals Birmingham list tongue tie among the things to check when a baby is slow to move on to solids, along with reflux, allergies, constipation and whether the baby is ready. Unless your baby’s team advises otherwise, keep moving on to new textures at your baby’s pace: see introducing textures.

Who checks for tongue tie

• Milk feeding: the NHS says a midwife, health visitor or GP. The AAP says your pediatrician should coordinate care with lactation specialists, feeding therapists and surgeons, and that a careful exam looks at sucking, tongue movement and how much milk your baby takes in.
• Solid food: a speech-language pathologist (speech and language therapist in the UK) can watch how your child moves their mouth and tongue, and watch them eat (ASHA). See when to see a feeding therapist.
• Speech: the AAP says tongue tie will not delay speech development. It may affect how some sounds are made, and a speech therapist can check this.

If a procedure is suggested

If tongue tie is causing feeding problems, the NHS says treatment may include feeding advice from a trained health professional, or a small operation to cut the tight skin (frenotomy). The AAP recommends saving frenotomy for babies with real problems with how the tongue works, after non-surgical help hasn’t worked.

What the AAP and NHS say about it:

• In young babies, the NHS says it’s usually done without any anesthetic, and the AAP describes it as a brief office procedure without general anesthesia. Older babies usually have a general anesthetic (NHS). Most babies get better quickly and feed better afterward (NHS).
• Babies cry and fuss, but it takes minutes. Watch for bleeding or pain that doesn’t settle, and call the clinic or your pediatrician if you see either. Long-term complications are rare (AAP).
• The AAP does not recommend stretching exercises after the procedure: there’s no evidence they help.
• There’s no evidence that releasing a tongue tie improves dental health or prevents sleep apnea, and claims that it helps reflux or fussiness aren’t evidence-based. Lip or cheek tie surgery won’t improve breastfeeding (AAP).
• If feeding doesn’t improve afterward, the AAP says other causes should be looked into.

Before you agree, it’s fair to ask: what problem will this fix, what else could be causing it, and what happens if we wait?

When to get help quickly

Talk to your midwife, health visitor, GP or pediatrician soon if your baby is losing weight, struggling to put on weight, or having trouble at most feeds (NHS).

If your baby can’t breathe, cough or cry, they may be choking: start choking first aid straight away. Shout for help and have someone call 911 straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once. Don’t leave your child to find a phone.Shout for help and start back blows and thrusts straight away. If someone is with you, ask them to call 999 now. If you’re alone, call 999 (on speaker) if the blockage hasn’t cleared after one round of back blows and thrusts, and keep going until help arrives.Shout for help and have someone call your local emergency number (such as 112 in Europe or 000 in Australia) straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once.

Call 911 or go to the emergency room if your baby is struggling to breathe, breathing very fast, or turning blue, gray or pale.Call 999 or go to A&E if your baby is struggling to breathe, breathing very fast, or turning blue, grey or pale (NHS).Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby is struggling to breathe, breathing very fast, or turning blue, gray or pale.

Where US and UK advice differs

• Who to ask first. In the UK, a midwife, health visitor or GP (NHS). In the US, your pediatrician, who the AAP says should coordinate a team that can include a lactation consultant and feeding therapist.
• Anesthesia. Both describe the procedure in young babies as brief and done without general anesthesia. The NHS adds that older babies, children and adults usually have a general anesthetic.
• How cautious to be. Both say treatment is only for tongue tie that causes problems. The AAP goes further, warning about overdiagnosis and advising against stretching exercises afterward.