Frequently Asked Questions

What is a tongue tie?

The term 'tongue tie' is used to describe the lingual frenulum underneath the tongue, when it anchors the tongue to the floor of the mouth, resulting in a restriction of normal tongue movement.

Before birth this piece of tissue is prominent in all babies, fortunately, in most cases this naturally recedes before birth. It is estimated that for 1-2 in 20 babies, this tissue remains prominent and restricting, which can cause it to be difficult for these babies to use their tongues.

True tongue ties are more than just the presence of tissue under the tongue, the diagnosis is based mainly on the function of the tongue. A suitably trained professional can carry out an assessment, this usually involves using a gloved finger to trigger certain tongue movements from the baby.   

What are the symptoms of a tongue tie?

Tongue ties cannot be diagnosed nor ruled out based on appearance alone, this is only half of the story. There are however some common signs and symptoms that may lead you to access an assessment.  

For the infant:

• Pushing away breast or bottle.  

• Colic and reflux.

• Unsettled baby. 

• Biting or chomping whilst feeding.

• Feeding constantly.  

• Long pauses and fatigue between sucks. 

• Guzzling and choking.  

• Slow or static weight gain.  

• Weight loss.  

• Milk leaking from their mouth.  

• Clicking during a feed.  

• Arching of the back during or after feeds. 

• Open mouth when resting or asleep.

• Sucking blisters.

• Frequent night waking. 

For the breastfeeding or chestfeeding parent: 

• Nipple Pain and trauma.

• Blanching nipples (white- or purple-coloured nipples).

• Lipstick-shaped nipples after breastfeeds. 

• Milk blebs. 

• Chronic blocked ducts or mastitis. 

• Low milk supply.

• Engorgement.

• Anxiety and/or postnatal depression 

What is oral dysfunction?

Oral dysfunction is a term used to describe the restricted movement of the tongue due to a variety of reasons.

Evidence suggests that many unnecessary procedures are conducted due to practitioners’ inability to diagnose and resolve alternative causes of oral dysfunction. There can be numerous reasons for oral dysfunction such as a receding jaw, low tone, high tone, muscle tension, torticollis, plagiocephaly, tension within the fascial system or tongue tie.

Jumping straight to a tongue tie release is not only unethical but may delay the correct course of treatment, for many, this delay could mean the premature end of a breastfeeding journey.  

Who can diagnose a tongue tie?

Only the tongue tie practitioner within the frenulotomy clinic is able to diagnose if there is a tongue tie, and whether it is deemed necessary for surgical intervention.

Having the knowledge and training to diagnose and perform a frenulotamy is not a regular occurrence for infant-related medical professionals, such as midwives, health visitors or paediatricians. It requires extensive specialised training to become a tongue tie practitioner. You can find alternative tongue tie practitioners here: https://www.tongue-tie.org.uk/find-a-practitioner/

We would always recommend seeing a practitioner who is a specialist in lactation support (IBCLC).

What can I do if my baby is tongue tied?

Some strategies that may help while you are waiting for a tongue tie release, or if you have decided against a tongue tie release can include: 

• Breast shaping. 

• 'Flipple' technique. 

• Laid-back breastfeeding positioning 

• Paced bottle feeding. 

• Frequent smaller feeds for bottle-fed infants. 

• Sitting babies upright following feeds 

• Access, reliable advice and support to optimise positioning and attachment. 

• Soften breasts through hand expressing if engorged, before attempting to latch baby 

• Encourage tongue movement through exercises and games. 

• If unable to breastfeed directly maintain your milk supply by expressing at least 8 times in 24 hours, including during the night. 

Will a tongue tie resolve by itself?

Every tongue tie is anatomically different, we use an assessment tool which will give us the information on whether to offer a surgical division (if a resolution cannot be reached through conservative methods alone, such as positioning and attachment support, and oral exercises).
This is often seen in tongue ties that are made of the same tissue as the webbing between your fingers and as such do not ‘stretch’ over time.
What may happen is that as your baby grows (and there is more space within their mouth), you may not experience the same symptoms. Likewise, your baby may learn other ways of using their oral muscles to compensate for the restriction.

Do lip ties need cutting?

It is understandable that lip ties are a concern for many parents, they are easily visible and mentioned frequently on parenting forums. Within the UK we do not currently support the division on lip ties for the purpose of improving breastfeeding symptoms.  

The rationale behind this is that, unlike the bottom lip, the top lip remains in a neutral position during feeds. When a baby’s top lip flanges (often described as fish lips), they may be attempting to cling to the breast, indicating a shallow latch. You may also notice sucking blisters along the top lip as a sign your baby is compensating for a shallow latch.  

If we released the frenulum along the top lip, your baby will be able to compensate for a shallow latch better with the ability to cling to the breast. However, this will not treat the primary cause of the shallow latch.   

The Association of Tongue Tie Practitioners (ATTP)'s statement on lip ties can be accessed here ATP Position Statements - Lip tie (2014) and Disruptive Wound Management (2021) - Association of Tongue-tie Practitioners 

Do tongue ties cause speech and dental problems?

A tongue tie division is not recommended by The National Institute of Clinical Excellence (NICE) to prevent speech and dental problems in later life. Although there is evidence to suggest tongue ties may impact the speech development and dental health of some children, it is impossible to predict who will be affected. For this reason, it is not recommended as a preventative measure to avoid many unnecessary procedures.   

If your child’s speech has been affected then a frenulotomy can be performed on older children, this is usually carried out by a surgeon under anaesthetic. The criteria for release under these circumstances will depend on your hospital's policies and guidelines. Generally, the procedure is it is not considered for any child aged under 5 years. Your child should also have received support and interventions from a speech and language therapist before being referred.   

For some infants with a tongue tie, the tongue is unable to sit in its natural resting position on the roof of their mouth, this may form a narrow or bubble palate. This may narrow the space for teeth to erupt, leading to overcrowding and dental decay due to stuck food debris. Dental check-ups are an important part of preventative child health, if you are concerned a tongue tie is impacting your child’s dental health this can be reviewed at routine dental appointments and referred on if required.  

Will my baby’s tongue tie impact introducing solids?

It is possible that restricted tongue movements (caused by a tongue tie) may impair a child’s ability to move food around their mouth, swallow, and chew. This may become evident once a child has started solids at 6 months of age. Symptoms may include gagging and food refusal.  

How do we get our baby to move their tongue?

We advocate the use of regular feeding and gentle oral exercises or games, alongside bodywork and fascial massage.
This is based on scientific knowledge looking at muscle rehabilitation, fascial tension release and wound care.
We aim to use your baby’s natural reflexes to encourage tongue movement to build tone, strength and re-educating their neuromuscular pathways.  

We encourage parents to be led by their baby and only continue if their baby is enjoying the exercises. We work to resolve tension within the muscular or fascial systems prior to performing a tongue tie division, which gives us the best opportunity to maximise positive outcomes and optimise wound healing.
It may be necessary to rebook an appointment for a tongue tie release at a later date to allow time for any tension to resolve. Whilst we understand that this could be disappointing, it is necessary in some cases as releasing the tongue tie will not improve function if the muscles are constricted.   

Will it work?

All our care plans are based on years of expertise, and most families see excellent results. But we can’t guarantee them. Results will mainly rely on your own commitment, but we do offer extensive open-access support to help you. If you’re struggling, consider our optional follow-up appointments (additional fee applies).

What should I expect in the initial oral dysfunction and tongue tie clinic appointment?

Initial appointment can last up to two hours, so we would appreciate if you could be prepared to be in the clinic with your baby for this time.  

During initial appointments we will be: 

• Taking a full medical history  

• Discussing feeding challenges and debrief your experiences 

• Completing an oral assessment (ATLFF) 

• Devising a treatment plan based on this assessment,  

• Supporting with infant feeding (however your infant is fed),  

• Paediatric non-invasive and conservative bodywork  

• Teaching caregivers how to support their infant with at-home exercise programmes 

• Devising a feeding plan that works with your family and feeding goals 

If it is not possible to surgically release my infant's tongue tie at the first appointment, how can I feed my baby?

For most families we support, acute feeding challenges have become an emergency, and understandably your main concern about delaying surgery is ‘how do I feed my baby?’. We would recommend delaying treatment only if it is in the best interest of you and your infant to have the best chance at positive long-term outcomes.  
 
Thankfully, muscular tension (which is negatively impacting oral function and infant feeding), responds well to the bodywork undertaken in the clinic, so we commonly see improvements in both oral function and infant feeding symptoms during the initial appointment. We also ensure you leave the clinic with a feeding plan that is manageable for your family and options to book follow up appointment (at an additional fee), that doesn’t leave you unsupported for a long period of time.

Feeding will only improve with the correct treatment plan for each individual infant.  

Where can I find further support and information?

Infant Tongue Tie UK Support Group for Parents & Health Professionals | Facebook 

Home - Association of Tongue-tie Practitioners 

Lancashire - Families and Babies (FAB) 

Lactation Consultants of Great Britain - Charity (lcgb.org) 

Breastfeeding Helplines - The Breastfeeding Network 

Telephone helpline - La Leche League GB