There are many reasons why mums can find it hard to breastfeed their babies but one reason that is growing in awareness is that of tongue-tie. 

Tongue-tie is a problem that is thought to affect as many as 1 in 10 babies in the UK. 

In recent years tongue-tie has hit the headlines, leading to many more parents being aware of the condition and the possibility that it could be a reason behind difficulty breastfeeding.

But what is tongue tie exactly and how do you know if your baby has it? How do you know if tongue tie is affecting your baby’s breastfeeding and what can you do about it?

We explore all this including tongue tie release procedures, and what help is available to new mothers below.

How do you know if baby has tongue tie?

Tongue tie (or ankyloglossia to give it its medical name) is when the frenulum – which is the piece of tissue that joins the tongue to the floor of the mouth – is too short and thick. 

In some cases tongue tie does not cause any problems for baby. In others, it can create difficulties in feeding for both baby and mother. 

In order to breastfeed well, the baby needs to extend their tongue out over the bottom gum. This helps protect the nipple from damage. When they cannot do this it results in a lot of pain for the mother while breastfeeding.

It can also mean that babies with tongue tie find it harder to open their mouths wide and struggle to latch on to the nipple when breastfeeding. 

They might suck harder to try and feed and may also bite the nipple more, in frustration as well as to try to get milk. 

Tongue tie should ideally be picked up in the first routine check by your midwife. However it’s not always easy to spot and that might mean that it goes undiagnosed until feeding issues become apparent.

What are the signs of tongue tie?

Tongue tie symptoms include:

• Baby not being able to lift their tongue to reach their upper gum.
• Baby struggling to move their tongue from side to side.
• Baby not being able to stick their tongue out past their lower gum or poke their tongue out past their lips.
• The tongue tip itself may look flat or square, instead of pointy when it is stuck out. Or the tip might look heart-shaped.

How does tongue tie affect breastfeeding?

• Trouble latching onto the breast. Your baby might have difficulty latching onto the breast. They might fuss and take lots of breaks when feeding. Listen for a clicking sound when feeding, as this can also be a sign. 
• Unsettled babies. Tongue tied babies often seem unsettled and hungry all the time. They may suck or gulp milk loudly. 
• Pain for you when breastfeeding. If you’re breastfeeding you may have cracked or sore nipples and breastfeeding a baby with tongue tie can be very painful. 
• Lip blister. A blister at the middle of your baby’s upper lip that won’t go away can be an indication of tongue tie too.

Can tongue tie affect bottle feeding?

If you’re bottle feeding, a tongue tied baby might have difficulty sucking.

They might also not be able to create a seal around the bottle teat, meaning they dribble out a lot of milk as they feed.

I was counting to ten over and over in my head when I had to feed her just to try and calm myself. I was sweating, and crying, and had this searing pain.

I had lots of midwives coming in trying to help me and they were saying ‘try all these different positions, put her in the football hold.’ None of them mentioned tongue tie. I got a lot of ‘breastfeeding is hard’ and ‘being a mum is hard’. I kept saying that I thought there was something wrong but I just felt that nobody was really listening. My husband would be bringing Ada to me and I’d be thinking ‘I don’t want her because she’s just going to cause me a world of pain.’

If my baby has tongue tie will he need surgery?

Some babies with tongue tie have no problems at all and are able to latch on and feed well. 

If your baby appears to have tongue-tie, but neither you nor your baby is experiencing any problems, then you don’t need to do anything.

Can tongue tie resolve itself?

Tongue tie can resolve in early childhood if the frenulum loosens by itself and the tongue can then move more freely, making speech and eating easier. 

If tongue tie doesn’t affect your baby’s feeding and does not cause much of a problem for either baby or mum, then it’s reassuring to know that it can resolve as your child grows older. 

But that doesn’t really help any new mums, who are struggling to breast (or even bottle) feed because their baby is tongue tied.

Tongue-tie release – what is a frenulotomy?

A frenulotomy is a common surgery carried out on babies to release tongue tie.

The frenulum is cut (divided) by a trained professional to release the tie and allow baby’s tongue to move more freely.

Is tongue tie surgery painful?

Most often this is a quick (under 15 second) procedure and is relatively painless. 

The frenulum has few nerves in it and is very thin. Babies should therefore feel very little pain. Often no pain relief is needed. Sometimes a local anaesthetic is given.  

Some babies cry briefly during this procedure. There is often only a few drops of blood. And the risks to this procedure are small and complications are rare. Mums are encouraged to breastfeed their babies immediately after the procedure to calm them. 

Having a frenulotomy can be a ‘light bulb’ moment for any mums who have struggled to breastfeed. This quick and easy snip can make a very significant difference for both them and their babies. 

Taking about the experience, one mum said:

The moment it was snipped the difference was incredible; feeding didn’t hurt, he drank more and the blisters vanished.

Are tongue ties diagnosed and treated quickly enough?

Until the 1940s midwives used to carry scissors in their bags to deal with tongue tie right after birth. 

In some European countries such as France and Italy, tongue tie is recognised and taken care of routinely on the first day of birth. 

In the UK, there used to be a trained tongue-tie practitioner (usually a midwife) on every maternity unit.

It used to be common practice in the NHS to train midwives to perform a tongue-tie procedure and to allow it as soon as it was identified, usually a couple of hours after birth. 

But this is now no longer the case and it can sometimes unfortunately be a postcode lottery as to how long it can take for tongue tie in babies to be diagnosed and treated. 

In 2018 the NCT said that the current NHS treatment for tongue tied babies is “patchy and sometimes non-existent”, with many healthcare professionals unsure what to check for.

Right now if your baby is born with tongue tie in the UK, your baby might not be diagnosed or treated quickly. You might not get the support for breastfeeding that you so desperately need.

The call for change

In 2017 a petition was set up by Change.org with the guiding mission to ‘Make the NHS check for, and correct, tongue-ties at birth at all U.K. maternity units’. The petition reached just shy of 98,000 signatures – 2000 less than it takes for any public petition to be debated in parliament. 

Because it can depend on your postcode in the UK as to how routinely midwives will check for tongue tie and how quickly treatment is offered, new parents can find themselves waiting weeks, or even months, for their baby to have a frenulotomy. 

This long wait can really take its toll on new mums (and dads) whose babies struggle to breastfeed. One mum, said: 

Once we had the diagnosis, our hospital said it was likely we’d have to wait three weeks for the procedure to release his tongue tie and, hopefully, allow him to feed better. For a mother struggling to feed her newborn this felt like three years.

Do tongue tied babies really need a frenulotomy?

A recent study claims that ‘Babies don’t need tongue-tie surgery to feed’. BBC News reported in July 2019 that ‘two-thirds of babies referred for the procedure did not need it and were able to feed with other support’. 

Professor Mary Fewtrell, from the Royal College of Paediatrics and Child Health, said: 

For some, tongue-tie can be the cause of poor breastfeeding and maternal nipple pain and the procedure can correct the restriction to tongue movement and allow more effective breastfeeding for baby, and comfort for mum. 

However, parents need good breastfeeding support and advice before considering surgery because, as this study shows, it can sometimes be avoided with the right support.

This recent report provoked a huge response from parents, refuting its claims. It led to a flurry of comments from new mums and dads, talking about how a frenulotomy made a huge difference to their babies and to them:

My daughter had tongue tie and it was agony. I had bleeding nipples and I hate feeding her. When she had her tongue tie snipped it felt almost miraculous.

I believe all babies that have a tongue tie diagnosed at birth should have it cut there and then.

A newborn baby and mother suffers horribly emotionally when not being able to feed, not to mention baby being kept hungry.

There is a total lack of diagnosis and support for new mums with this problem with babies…The hospital need to offer and check and proper support straightway

If your baby has problems feeding, ask for help

If you have problems breastfeeding your baby always ask for help. 

There are many reasons why mums and babies can find feeding difficult and the problem won’t always be tongue tie. 

However, as it’s quite a common cause of breastfeeding problems, it’s worth keeping it in mind. Ask your midwife or health visitor to check for the condition, so that you can either rule it out or seek further advice or treatment.