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pediatric-newborn

Tongue Tie in Newborns: What It Is and How It Can Affect Feeding

Tongue tie is a tight or short frenulum under the tongue that can limit tongue movement. It sometimes affects breastfeeding latch. Severity varies widely. A lactation consultant and a provider experienced in tongue ties can assess whether treatment would help.

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What tongue tie actually is

The lingual frenulum is the small band of tissue visible under the tongue when it is lifted. In some babies, this tissue is shorter, thicker, or attached further forward than typical, restricting how far and freely the tongue can move. Ankyloglossia — the clinical term — affects an estimated 4 to 10 percent of newborns and exists on a spectrum 1. Some babies have a very tight frenulum that noticeably restricts tongue movement; others have a frenulum that is slightly short but causes no feeding difficulty at all. There is genuine variation among providers in how tongue ties are diagnosed and when treatment is recommended 1.

How tongue tie can affect breastfeeding

Effective breastfeeding latch requires the baby to extend the tongue over the lower gum and draw a large portion of the breast into the mouth. When tongue movement is restricted, the baby may:

  • Struggle to maintain suction and slip off the nipple frequently
  • Compensate by clamping with the gums, causing significant nipple pain for the parent
  • Feed for very long periods and still seem hungry
  • Make clicking sounds during feeds (a sign of breaking suction repeatedly)
  • Transfer less milk effectively, which can affect weight gain

Importantly, the AAP notes that most breastfeeding difficulties — including nipple pain — are not caused by ankyloglossia, and the condition may be overdiagnosed 1. Less than half of infants with a tight frenulum experience significant nursing difficulties 2.

How providers assess it

An evaluation typically involves a visual inspection of the frenulum and an assessment of tongue mobility — how well the tongue lifts, extends, and cups around a finger. A feeding assessment, sometimes done with a lactation consultant present, looks at how the baby latches and transfers milk. The AAP's 2024 clinical report on ankyloglossia recommends that a diagnosis of symptomatic ankyloglossia be made when there is a restrictive lingual frenulum that causes breastfeeding problems that do not improve with lactation support 1. Because there is variation in how providers evaluate tongue ties, some families find it helpful to see a provider who has specific experience in this area, or to get more than one opinion.

What a frenotomy involves

A frenotomy is a brief procedure in which the frenulum is snipped with sterile scissors or a laser. In newborns, the frenulum typically has few nerve endings or blood vessels, and the procedure is usually done in a clinic setting without general anesthesia. The AAP notes that evidence for frenotomy shows a short-term reduction in nipple pain for breastfeeding parents and an inconsistent positive effect on infant breastfeeding — and cautions that frenotomy should be reserved for cases where there are significant functional impairments after nonsurgical options have been tried 1. Post-procedure stretching exercises are not recommended by the AAP, as they lack evidence-based support 1. Most babies return to feeding within a short time after the procedure, and working with a lactation consultant afterward can help the baby learn to use the newly released tongue.

What the AAP does not recommend treating

The AAP's 2024 clinical report found no evidence that treating lip tie or cheek tie improves breastfeeding outcomes 1. It also found no evidence that frenotomy in infants prevents later speech delays, dental problems, or sleep-disordered breathing. These limitations are important context for families navigating advice from different providers. The decision about whether to proceed with frenotomy is made with a provider after a thorough evaluation of the specific baby and feeding situation.

Common questions

Does tongue tie always need to be treated?

No. Many babies with some degree of tongue tie feed well and never need any intervention. Treatment is generally considered when there is a clear feeding difficulty that is thought to be related to the restricted tongue movement and does not improve with lactation support. Bottle-fed babies and older children may not need treatment at all unless speech or other issues arise.

My baby has a lip tie too. Does that need to be treated?

Lip tie (a tight frenulum on the upper lip) is often noted alongside tongue tie and generates a lot of parental concern, but the AAP found no evidence that treating lip tie improves breastfeeding outcomes. A provider experienced in infant feeding can assess whether the lip tie appears to be contributing to a specific feeding problem.

Can tongue tie affect speech later on?

The AAP's 2024 review found no evidence that tongue tie causes speech delays or that frenotomy in infancy prevents speech problems. If an older child has articulation challenges, a speech-language pathologist can evaluate whether tongue mobility is a factor. Treatment decisions for speech-related concerns are typically made when the child is older.

How do I find someone who is experienced in evaluating tongue ties?

Pediatric dentists, some pediatricians, ENT surgeons, and lactation consultants with specific training are among the providers who evaluate tongue ties. A pediatrician is often the starting point and can provide a referral based on the baby's specific feeding situation.

Talk to a clinician

Lena Park, PNP — Pediatric NP

kids & families. Gale can match you with a licensed clinician for a visit.

Find care →

When to get care right away

  • —Baby is not regaining birth weight or is losing weight beyond normal newborn weight loss
  • —Baby is not having enough wet diapers (fewer than 6 per day after the first week)
  • —Breastfeeding parent has cracked, bleeding, or severely painful nipples that are not improving
  • —Baby appears very lethargic or is difficult to wake for feeds
  • —Any fever (100.4°F / 38°C or higher) in a baby under 2–3 months

If the baby is very lethargic, not feeding at all, or has a fever under 2–3 months, seek emergency care.

This article is general health information for parents and is not a diagnosis or personalized medical advice. A provider experienced in infant feeding can assess the specific baby.

References

  1. 1.Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, Gilliland A; AAP Section on Breastfeeding, Section on Oral Health, Committee on Fetus & Newborn, Section on Otolaryngology (2024). Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics. doi:10.1542/peds.2024-067605 ✓AAP 2024 clinical report: ankyloglossia affects 4–10% of newborns; frenotomy rate rose 110% since 2012; most breastfeeding difficulties are not due to ankyloglossia; lip/cheek tie treatment not supported; post-procedure stretching not recommended
  2. 2.American Academy of Pediatrics (2024). Tongue Tie in Babies: How Ankyloglossia Affects Breastfeeding & Other Concerns. HealthyChildren.org (American Academy of Pediatrics). link ✓Prevalence 4–10% of newborns; less than half of infants with tongue tie signs experience nursing difficulties; multidisciplinary care recommended before surgery

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.