Tongue-tie

Tongue-tie (ankyloglossia) is a problem affecting some babies with a tight piece of skin between the underside of their tongue and the floor of their mouth (lingual frenulum).

It can sometimes affect the baby's feeding, making it hard for them to attach properly to their mother's breast.

If you're concerned about your baby's feeding and think they may have tongue-tie, speak to your infant feeding specialist, lactation consultant, health visitor, midwife or GP.

The following information explains tongue-tie and the problems it can cause, and describes a quick and almost painless procedure to snip the skin, known as tongue-tie division, which should be considered if your baby is affected.

What is tongue-tie?

Tongue-tie is a birth defect that affects 4-11% of newborn babies. It's more common in boys than girls.

Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the lingual frenulum.

In babies with tongue-tie, this piece of skin is unusually short and tight, restricting the tongue's movement. This prevents the baby feeding properly and also causes problems for the mother.

Breastfeeding problems

To breastfeed successfully, the baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage.

Babies with tongue-tie aren't able to open their mouths wide enough to latch on to their mother's breast properly. They tend to slide off the breast and chomp on the nipple with their gums.

This is very painful and the mother's nipples can become sore, with ulcers and bleeding. Some babies feed poorly and get tired, but they soon become hungry and want to feed again.

In most cases, these feeding difficulties mean the baby fails to gain much weight.

How is tongue-tie treated?

Treatment is not necessary if your baby has a piece of skin connecting the underside of their tongue to the floor of their mouth, but they can feed without any problems.

If feeding is affected, the tongue-tie needs to be divided.

Tongue-tie division

Tongue-tie division involves cutting the short, tight piece of skin connecting the underside of the tongue to the floor of the mouth. It's a simple and almost painless procedure that usually resolves feeding problems straight away.

The National Institute for Health and Care Excellence (NICE) supports the use of tongue-tie division, as it's safe and there is evidence it can improve breastfeeding.

See the NICE guidelines on Division of tongue-tie for breastfeeding.

The Association of Tongue-tie Practitioners website provides a list of NHS tongue-tie practitioners.

How tongue-tie division is carried out

In babies that are only a few months old, division of tongue-tie is usually performed without any anaesthetic (painkilling medication), or with a local anaesthetic that numbs the tongue.

A general anaesthetic is usually needed for older babies with teeth, which means they'll be asleep during the procedure.

The baby's head is held securely while sharp, sterile scissors are used to snip the tongue-tie. Some practitioners may use a laser instead of scissors.

The procedure only takes a few seconds, and you can start feeding your baby immediately afterwards. Some babies sleep through it, while others cry for a few seconds. In small babies, being cuddled and fed is more important than painkillers.

There should be little blood loss, though some bleeding is likely. A white patch may form under the tongue, which takes 24 to 48 hours to heal, but doesn't bother the baby.

Tongue-tie in older children and adults

Untreated tongue-tie may cause no problems as a child gets older, and any tightness may resolve naturally as the mouth develops with age.

However, some cases can persist, and may cause problems such as speech difficulties and difficulty eating certain foods.

Speak to your GP if you're concerned you or your child may be experiencing problems caused by tongue-tie.

Tongue-tie division can be carried out in older children and adults, although this is usually done under general anaesthetic and may involve using stitches to close the resulting wound under the tongue.