Tongue tie

Tongue tie is a condition that involves a small piece of tissue that connects our tongue to the bottom of the mouth. This is called the lingual (meaning tongue) frenulum, often just called the frenulum. When a baby’s frenulum is short or tight it can stop their tongue from moving properly. This is called a tongue tie.

How many babies have tongue tie

Around 5 to 10% of babies are born with a tongue tie, but at least half of these babies can still breastfeed normally.

That means around 2 to 5% of babies have a tongue tie that may cause a problem with breastfeeding or bottle feeding.

Why tongue tie can be a problem

Most babies born with a tongue tie do not:

  • have any problems breastfeeding
  • need any treatment.

But for some babies, the tongue-tie means they cannot move their tongue well enough to feed effectively. These babies may also have difficulty latching or staying latched on to the breast. Babies with a severe tongue tie can also have problems bottle feeding.

Some babies have difficulties latching straight after birth even when they do not have a tongue tie. It can take time for both the parent and their pēpi (baby) to recover from birth and learn how to breastfeed. Once they do, these problems often go away.

Signs a tongue tie is causing problems

If your baby’s tongue tie is making it difficult for them to latch on, or stay latched on, you will notice some of these signs.

For the birthing parent

  • Breastfeeding is painful during the whole of the feed.
  • Your nipples may become sore, blistered, cracked, bleeding or bruised.
  • You do not make enough milk to meet your baby’s changing needs.

For your pēpi

  • They may have difficulty latching or staying latched for a full feed.
  • They may seem unsettled or fussy during feeds, for example they may bob on and off the breast.
  • They may make clicking or slurping noises while they are feeding.
  • You may notice you do not have to change their nappies much because they produce less wee and poo.
  • They might gain weight slowly, not at all, or even lose weight.
  • Your baby’s feeds are too short or too long, and they remain unsatisfied, despite being offered at least 8 breastfeeds every 24 hours.

Getting a breastfeeding assessment

If you are worried about how your pēpi is feeding and think they may have a tongue-tie, ask to have a breastfeeding assessment.

Your midwife or Lead Maternity Carer (LMC) can refer you to a lactation consultant for an assessment.

The assessment

During the assessment, a lactation consultant will talk to you about your baby’s feeding history. They will watch your pēpi breastfeeding and adjust your breastfeeding technique if necessary. They will also look at how your baby’s tongue is moving and how their frenulum is attached.

The lactation consultant will use a simple scoring tool to determine the degree of tongue-tie and whether it needs to be treated.
Your pēpi can be assessed as early as 2 days after they are born if they have severe feeding problems. But it is best to wait for a week to let normal feeding patterns develop.

How tongue tie is treated

If your breastfeeding assessment suggests your baby’s tongue-tie is causing problems, baby can have a tongue-tie release, (also called a tongue-tie snip, a division of the frenulum, or a frenotomy). This may make it easier to breastfeed. There is no evidence at the moment that a tongue tie release in a newborn pēpi will prevent later speech or dental problems.

Your lactation consultant or midwife can refer your pēpi to a health professional trained in tongue tie release. This can happen through the public health system, or you can pay to have it done privately.

Health professionals that can conduct frenotomy are: 

  • registered midwife (they may also be a lactation consultant)
  • general practitioner (GP)
  • child health doctor
  • dentist or dental specialist.

Talk to your lactation consultant or Lead Maternity Carer about what will suit you best.

Tongue tie release

A tongue tie release is a quick and simple procedure. Your pēpi must have had vitamin K beforehand. If they have not had vitamin K the release will not be done.

Most babies show very little distress but may be upset about being wrapped and held firmly. Your pēpi will be wrapped securely (swaddled) and held carefully so they do not wriggle while it is being done. They may be given a small amount of breast milk or sucrose (sugar), that reduces pain.

The health professional conducting the tongue tie release will lift your baby’s tongue and cut their frenulum with a pair of sterile scissors. There should be very little bleeding. 

Immediately after the release you will be encouraged to feed your pēpi. You may also be shown some changes you can make to how you breastfeed.

Most babies have a tongue tie release before they are 2 months old. If your pēpi is older, or has a more complicated tongue tie, they may need to be treated under general anaesthetic by a surgeon. 

What to expect after the release

Some parents notice a difference straight away after the release, while others need more time to relearn breastfeeding with their baby’s more mobile tongue. Some parents say it makes no difference. 

If your pēpi is older than 2 months, it is likely to take several days to a few weeks before you see the full effect.

If the feeding difficulties continue it may be that there are other problems affecting your baby’s feeding. Your pēpi may need further assessment. Your midwife, doctor, practice nurse, or Well Child Tamariki Ora nurse will follow up to see how you are going and if you still have problems. They will see what can be done about them.