What is tongue tie and what impact does it have?

If your baby is struggling to gain weight and finds feeding difficult, it is possible they might have a tongue tie.

This is when the frenulum, which is a small strip of skin attaching the tongue to the base of the mouth, prevents the tongue from moving as freely as it should. If a baby has a tongue tie, this may mean they cannot stick their tongue out as far as expected or they may not be able to lift it up very far.

This can stop them moving their tongue in the way they need to so they can breastfeed efficiently. Although tongue tie is more commonly associated with problems with breastfeeding, it can also make it more challenging for a baby to bottlefeed too.

You might hear medical professionals refer to tongue tie as ankyloglossia, which is the official name for the condition.

What are the different types of tongue tie?

Not all tongue ties are the same and the severity and how much of an impact they have on feeding varies. The two main types of tongue tie are known as anterior and posterior. Anterior tongue tie is when the frenulum is attached towards the front of the tongue. In contrast, posterior tongue tie is where the tissue is attached towards the back of the mouth.

Tongue ties can be tricky to spot, especially if you don’t really know what you are looking for. A baby with a tongue tie may have a heart-shaped or bowl-shaped tongue but sometimes you won’t notice anything unusual about the tongue’s appearance.

What effect does tongue tie have on feeding?

Tongue tie restricts the movement of the tongue, which can make it difficult for a baby to feed. Breastfeeding babies use their tongue to latch on to the breast correctly and get the milk flowing from the nipple.

This means babies with a tongue tie can find it difficult to get a good latch and they may not get as much milk as they should during a feed. For some infants, the impact of tongue tie can be serious, while for others, the effect may be barely noticeable.

How will I know if my baby has tongue tie?

One common sign of a tongue tie is if your baby finds it hard to latch onto your breast. They may also struggle to stay latched on during breastfeeding and keep coming on and off.

If your nipples are misshapen after a feed or they become sore or damaged, this can indicate a potential tongue tie. Breastfeeding can be painful if a baby has tongue tie as they can have a shallow latch, which means they are not getting enough of the areola (the skin around the nipple) into their mouth, so they end up sucking on the end of the nipple.

If your baby makes a clicking noise while they are feeding or they often become unsettled during a feed, this could mean that your baby has a tongue tie. Another sign is that your baby doesn’t seem satisfied after a feed and only goes a short amount of time before wanting to feed again. You may also feel like you are spending a very long time feeding before your baby comes off the breast.

One of the main reasons a health professional might suspect a tongue tie is if your little one loses a lot of weight after birth, or they gain weight very slowly and do not follow the centiles in their little red book. Babies with tongue tie may often get hiccups and suffer from wind, reflux and colic, as a poor latch can mean they swallow lots of air while feeding.

Tongue tie can affect the mother as well as the baby. Breastfeeding mums are more likely to suffer from sore nipples and they are at higher risk of getting mastitis – when the breast becomes inflamed, hot, red and sore. This is because babies with tongue tie often find it difficult to empty the breast during a feed, which can cause it to become engorged.

As well as having an impact on the mother’s physical health, tongue tie can have a negative effect on mental wellbeing too. Feeding issues and weight loss can be extremely worrying for parents and having to breastfeed very regularly for long periods can be really tiring and overwhelming.

If your baby is bottle-fed, a tongue tie may be harder to spot, but you might notice that they take ages to get through a bottle of milk or don’t take as much formula or expressed breast milk as you would expect for their age. You may find your baby is hungry again after a short period of time or that they are not gaining weight well.

Bottle-fed babies with a tongue tie will often dribble while they are feeding and can seem to chomp on the bottle’s teat. You may also find your baby struggles to cope with the flow of milk and needs to use a teat with a very slow flow. Another sign of a tongue tie is that your baby will keep pushing the teat out of their mouths.

How is tongue tie diagnosed?

When your baby is first born, they will be checked by the midwife and one of the things they might look for is a tongue tie. However, people’s experience with tongue ties will vary and some can be extremely subtle and difficult to see without specialist training.

If your baby is struggling to feed or gain weight, your midwife, breastfeeding counsellor, lactation consultant or health visitor may suspect your baby has a tongue tie. Only qualified tongue tie practitioners can actually diagnose a tongue tie so you will usually be referred to an expert so they can examine your baby’s mouth.

You will be asked questions about your baby and their behaviour during feeding and the tongue tie practitioner will look at the appearance of your little one’s tongue and how it moves.

How can tongue tie be treated?

If your baby is diagnosed as having tongue tie and it is causing issues with feeding or gaining weight, you are likely to be offered a procedure called tongue tie division. This is when a qualified professional cuts your baby’s frenulum so their tongue can move more freely.

How easily you can get a tongue tie division will depend on the area you live in. You may have to travel some distance to get the procedure carried out on the NHS or pay privately.

The procedure itself is extremely quick and it is thought to be almost completely painless. For many babies, having their tongue tie snipped will solve their feeding problems but this isn’t always the case, and in a small number of cases the tongue tie can reattach. It is also possible that your baby may continue to have some issues with feeding even when their tongue tie has been divided.

If you choose to have the procedure carried out, you can expect your baby to be unsettled for a couple of days. You will be given advice on how to look after the wound and you may be given post-surgery exercises to reduce the risk of reattachment.

In some cases, a tongue tie division might not be necessary. A lactation consultant or breastfeeding support worker can give you advice on positions to use which will make feeding a baby with a tongue tie easier. They may also be able to help your baby achieve a better latch.