Tongue tie

Tongue tie is when the small strip of tissue under the tongue (the frenulum) is short, tight or attached close to the tip, restricting how far the tongue can move. It’s present in a proportion of babies, and while many cause no problems at all, it can sometimes make feeding difficult. If feeding is painful or your baby is struggling, it’s worth having checked.

What it is. Everyone has a frenulum under their tongue; in tongue tie it’s tighter or shorter than usual, which can limit the tongue from lifting, poking out past the lips, or moving side to side. It’s something a baby is born with, and it ranges from barely noticeable to more restrictive.

Does it always cause problems? No. Many babies with a tongue tie feed perfectly well and never need anything done. Tongue tie only matters when it’s actually causing difficulty — so a tie seen on its own, without feeding problems, often needs no treatment at all. The focus is on how feeding is going, not just the appearance.

Signs it might be affecting breastfeeding. For the baby: trouble latching or staying latched, slipping off, clicking sounds while feeding, feeding for a very long time, poor weight gain, or seeming unsettled and hungry. For you: persistently sore, cracked or misshapen nipples (often pinched or lipstick-shaped after a feed) despite trying to improve the latch, and sometimes recurrent blocked ducts or mastitis from the breast not draining well.

It can affect bottle feeding too. Less commonly, a significant tie can make bottle feeding harder — dribbling, clicking, taking a long time, or lots of wind — though many bottle-fed babies with a tie feed fine.

Getting it assessed. Because sore nipples and latch trouble have many causes, the first step is a proper feeding assessment. A midwife, child health nurse, lactation consultant, GP or paediatrician can watch a feed and examine your baby’s mouth and tongue movement — not just look for a tie, but judge whether it’s actually the cause of the problem. Often improving positioning and latch resolves things without any procedure.

Treatment if it’s needed. If a tongue tie is genuinely causing feeding problems, a simple procedure called a frenotomy (dividing the tie) may be recommended. It’s quick, usually done by a trained health professional, and many babies can feed straight afterwards. Like any procedure it has small risks and isn’t always a magic fix, so it’s worth discussing the likely benefit for your baby specifically, rather than assuming a tie must always be cut.

Get skilled feeding support alongside. Whether or not a tie is divided, hands-on help with latch and positioning from a lactation consultant or your child health nurse is often what makes the real difference to comfortable feeding. A procedure without good feeding support may not solve the problem on its own.

Beware over-diagnosis. Tongue tie has become a popular explanation for all feeding troubles, and there’s a risk of unnecessary procedures. A careful assessment from an experienced professional — focused on whether the tie is truly the cause — protects you and your baby from being pushed toward something that may not help.

What about lip ties and speech worries? You may also hear about “lip ties” or fears that a tongue tie will affect speech or teeth later. The evidence here is limited and much debated, and decisions in the newborn period are best based on whether feeding is genuinely affected now, rather than on what might happen years down the track. If you have concerns about speech or dental development as your child grows, your GP, dentist or a speech pathologist can advise at the appropriate age.

If feeding hurts or your baby is struggling, don’t just push through or assume it’s tongue tie one way or the other — get a proper feeding assessment. Many issues are latch-related and fixable with support, and where a tie is genuinely the problem, it can be addressed. The ABA helpline (1800 686 268) and your child health nurse are good starting points.