Tongue-tie

Tongue-tie is a condition where your baby’s tongue is connected to the bottom of their mouth by a small piece of tissue, called the frenulum. This limits the movement of their tongue.

Key points about tongue-tie

  1. Around 5–10% of babies are born with tongue-tie.
  2. Tongue-tie can cause problems with breastfeeding in 2–5% of babies with the condition.
  3. Some signs of a tongue-tie include your baby having difficulty latching and staying latched during breastfeeding, becoming frustrated when feeding, taking a very long time to feed or having low weight gains.
  4. You may also notice some symptoms, such as reduced milk supply, sore nipples, mastitis or painful breastfeeding.
  5. Some of these signs can have other causes, so see your doctor, midwife or nurse about them.
  6. Most babies with a tongue-tie don’t need treatment, but if they do, it's treated with a procedure called a tongue-tie release.

What are the causes of tongue-tie?

Everyone has a frenulum, and everyone’s frenulum is a different length and thickness. When a baby’s frenulum is short or tight it can stop their tongue from moving properly. This is called a tongue-tie (also called ankyloglossia).

At least half of tongue-tied babies can still breastfeed well, but some may struggle to make a good latch and can’t feed as well as other babies. If your baby has a severe tongue-tie, there may also be problems with bottle feeding.

What are the symptoms and signs of tongue-tie?

Most babies with a tongue-tie don’t have problems with breastfeeding. However, if your baby has tongue-tie, you may notice that they:

  • have difficulty latching or staying latched
  • become frustrated and unsettled when feeding
  • make clicking noises or spill milk out the side of their mouth
  • have low weight gains or ‘failure to thrive’
  • take a long time to feed or need frequent feeds
  • produce less pee and poo.

If you are breastfeeding, some of the signs that you may also notice include:

  • reduced milk supply
  • sore nipples or a sensation of ‘chomping’
  • thrush – damage caused by poor latch is a great place for thrush to settle
  • mastitis
  • painful breastfeeding for the whole of the feed
  • frustration, disappointment.

Some of these signs can also be caused by other problems, so it is important to see your doctor, midwife or nurse to find out what is causing them.

How is tongue-tie diagnosed?

Contact your doctor, midwife or nurse for a breastfeeding assessment by a lactation consultant if you suspect your baby has a tongue-tie. If you are unsure what to do, you can also call PlunketLine on 0800 933 922.

Your healthcare team will ask you some questions about your baby and examine your baby’s mouth, tongue and face. They will also observe how your baby latches during breastfeeding and examine your breast. They can also help adjust your breastfeeding technique if needed.

How is a tongue-tie treated?

Most babies with a tongue-tie don’t need treatment. However, if your baby needs treatment, it will be done with a procedure called tongue-tie release (also known as a tongue-tie snip, frenulum division or frenotomy). It involves cutting your baby’s frenulum with a pair of sterile scissors.

Your baby needs to have vitamin K before the procedure (to reduce bleeding) and you will be encouraged to feed your baby immediately after it (for comfort and pain control).

Healthcare providers who can perform the procedure include:

  • a lactation consultant
  • a registered midwife
  • your GP or doctor
  • a child health doctor
  • a dentist or dental specialist.

Tongue-tie release is usually done before your baby is 2 months old. However, if your baby is older, they may need to be treated under general anaesthetic by a surgeon.

What is the outlook for a baby with a tongue-tie?

Many babies born with a tongue-tie don’t have any problems with breastfeeding and don’t need any treatment.

Some babies can still have problems with feeding even the tongue-tie has been treated. However, most babies who have the tongue-tie release procedure feed well afterwards and have no further issues. Contact your doctor, midwife or lactation consultant if you are concerned about your baby after a tongue-tie release procedure. 

What support is available with tongue-tie?

Learning how to breastfeed takes time for you and your baby. If you need extra support, talk to your doctor, midwife or nurse. You can also call PlunketLine on 0800 933 922 to talk to a Plunket nurse.

Learn more

The following links provide further information about tongue-tie. Be aware that websites from other countries may have information that differs from New Zealand recommendations.    

Tongue-tie handout Community Birth Services, NZ
Tongue-tie Ministry of Health, NZ
Tongue tie KidsHealth, NZ
Tongue tie – information for postnatal women Women’s Health, Auckland DHB, NZ
Tongue-tie HealthInfo Canterbury, NZ
Tongue tie NHS, UK

References

  1. Ankyloglossia (tongue-tie) Starship Clinical Guidelines, NZ, 2020
  2. Tongue-tie releases for babies with breastfeeding difficulties Auckland Regional HealthPathways, NZ, 2018
Dr Arna Letica has worked as a GP for over 13 years, with particular interests in women's and children's health. She is currently focusing on non-clinical roles, including working as a medical assessor.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Arna Letica, FRNZCGP, Auckland Last reviewed: 16 Apr 2021