Tongue tie is one of the most over-diagnosed things I come across. Parents often arrive convinced it is the problem, when a careful look at the latch tells a different story. In my experience many babies who have been labelled with a tongue tie feed comfortably once positioning is adjusted. This guide explains what tongue tie is, how to tell whether it is actually affecting feeding, and what can help. Not every tongue tie needs treatment, and the right first step is always a careful look at feeding as a whole.

What tongue tie is

Tongue tie, or ankyloglossia, is when the strip of tissue under the tongue, called the frenulum, is short or tight and limits how the tongue moves. Many babies with a tongue tie feed perfectly well. It only matters if it is stopping your baby moving their tongue enough to feed effectively.

Signs it may be affecting feeding

Tongue tie may be affecting feeding if you notice:

  • A shallow latch that is hard to improve, even with good positioning.
  • Your baby slipping off the breast, or clicking during feeds.
  • Long feeds, or feeds that never seem to satisfy your baby.
  • Slow weight gain, or difficulty moving milk.
  • Painful feeding for you, or cracked, misshapen or blanched nipples.

Why it is often over-diagnosed

Tongue tie has become a popular explanation for all sorts of feeding problems, and it is often blamed when the real issue is positioning and attachment. Many babies who are labelled with a tongue tie feed comfortably once the latch is adjusted, which is why I always look at the whole feed first. You can read more about the latch in Latch and nipple pain. A tongue tie only needs treating if a careful assessment shows it is genuinely limiting feeding.

How it is assessed

A proper assessment looks at far more than the appearance of the frenulum. As an IBCLC I carry out a full oral and functional assessment, checking how your baby's tongue moves and how they feed, alongside your comfort, your baby's weight and how well milk is transferred. Appearance alone does not tell the whole story. Feeding is a partnership between you and your baby, and you can read how that works in How your baby and your body work together.

What can help

  • First, we improve positioning and attachment, which resolves many feeding problems on its own.
  • If a tongue tie is genuinely restricting feeding, it can be released in a quick procedure called a frenulotomy, carried out by a trained practitioner or NHS service. I can advise whether a referral is worthwhile.
  • After a release, feeding support helps your baby learn to use their tongue in a new way.

Get help from your midwife, health visitor or an IBCLC if:

  • Feeding is painful, or your nipples are cracked or misshapen.
  • Your baby is not gaining weight well, or feeds never satisfy them.
  • You have been told your baby has a tongue tie and are not sure what to do.
  • You are struggling, and want feeding looked at properly.

Call 999 or take your baby straight to A&E if your baby:

  • Is floppy or unresponsive
  • Will not wake for feeds
  • Is having trouble breathing, or their lips, tongue or gums look blue or grey
  • Has a sunken fontanelle
  • Is visibly jaundiced and unwell with it, for example floppy, hard to wake or not feeding. Yellowing shows most clearly in the whites of the eyes, the gums, and the palms and soles
  • Has dark urine or pale, chalky stools

How a consultation helps

If you are worried about tongue tie, the most useful thing I can do is a full assessment of how your baby actually feeds, not just how the frenulum looks. I watch a whole feed, check your baby's tongue movement and how well they are transferring milk, and adjust positioning and latch first, because so often that is all that is needed. If a release would genuinely help, I will tell you honestly and point you to the right service. My aim is that you never have an unnecessary procedure, and never miss one that would make a real difference.