Tongue-tie
This page explains what a tongue-tie is, what the implications of a tongue-tie are for both you and your baby, and what treatment options are available. We hope it will help to answer some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
What is Tongue-tie?
Tongue-tie (ankyloglossia) is a condition present at birth that restricts the movement of a baby’s tongue.
The underside of the tongue is connected to the floor of the mouth by a piece of tissue known as the lingual frenulum. In babies with tongue-tie, the frenulum is thicker and/or tighter (shorter) than usual. This restricts the movement of their tongue and can cause problems with feeding. A tongue-tie can involve the entire underside of the tongue or just part of it.
Tongue-tie is thought to affect approximately one in ten (10%) babies and is more common in boys than girls. About half of babies with a tongue-tie have someone else in the family who also has one.
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
Tongue-tie is sometimes identified during a baby’s newborn physical examination, but it’s not always easy to spot. It may not become obvious until your baby has problems feeding (breastfeeding and bottle feeding). For some babies, the effects of tongue-tie will be quite mild. For others, tongue-tie can make feeding extremely difficult. We have listed some of the common signs of tongue-tie to look out for in the table on the next page:
Method of feeding: Breastfeeding
Your baby may:
- Have difficulty attaching to the breast and/or staying attached
- Feed for a long time, have a short break, and then feed again
- Be unsettled and appear to be hungry most of the time
- Not gain weight as quickly as they should
- Be very ‘windy’ with excessive hiccups and flatulence
- Have difficulty controlling the milk flow (coughing and choking)
- Make clicking noises when feeding
You may:
- Have sore and damaged nipples
- Not produce enough milk
- Get mastitis (inflammation of the breast) more than once
- Feel exhausted from frequent feeding and having an unsettled baby
Method of feeding: Bottle Feeding
Your baby may:
- Take a long time to feed
- Only take a small amount of milk at each feed
- Dribble a lot during the feed
- Be very ‘windy’
- Not gain weight as quickly as they should
You may:
- Regularly spend a long time feeding your baby
- Find that changing the bottle teat does not help
You and your baby may experience some or all of these symptoms, so it may not be obvious that they have a tongue-tie.
Breastfeeding
Your baby may find it difficult to latch on to your breast if:
- they are not able to open their mouth wide enough
- their tongue is unable to cover their lower gum
- the movement of their tongue during suckling differs from their usual rhythmical pattern
If your baby is unable to latch on successfully, they may begin to nipple feed rather than breastfeed. This prevents them from taking the milk from your breast efficiently and it also causes damage to your nipples.
Bottle feeding
Your baby may find it difficult to create a seal around the teat. This may cause their suck to be inefficient and the feed to take longer. Your baby may also dribble a lot of milk out of the sides of their mouth.
If you are concerned about your baby’s feeding and think they may have a tongue-tie, please speak to your midwife or health visitor. They will do a feeding assessment. If a tongue-tie is suspected of causing the feeding problem, you will be asked if you would like an appointment with a tongue-tie specialist midwife. If your baby is too old to be seen in a midwifery led clinic you will be referred to a clinic specifically for older babies.
If you or your baby is experiencing a feeding problem, please ask for help. You will receive feeding support and, if a tongue-tie is suspected, a feeding assessment will take place. With your permission a referral will be made to a tongue-tie specialist. A referral does not mean your baby will definitely be offered a division. The specialist will be looking at many different factors and will talk you through the findings and options.
Tongue-tie release is a very simple procedure, particularly in babies under six months of age. The procedure only takes a few seconds and does not require an anaesthetic (medicines used to numb sensation in certain areas of the body or induce sleep). Babies are likely to cry immediately after the procedure, although the majority of babies cry for less than a minute.
The use of tongue-tie release to improve feeding is supported by the National Institute of Clinical Excellence (NICE). It is considered a safe and simple procedure which demonstrates significant improvements in feeding, particularly breastfeeding, where a reduction in nipple pain and an improved ability to latch on to the breast has been consistently identified.
Before the procedure
If we recommend that your baby has the procedure, we will discuss it with you in more detail and ask for your consent.
Your baby must have had either the Vitamin K injection or the second dose of oral drops (if they are having oral Vitamin K) more than 24 hours before the procedure.
You will also need to confirm that your baby is fit and well with no known medical conditions at the time of their feeding assessment. If you or your baby’s father has a blood clotting disorder, or there is a family history of blood clotting disorders, please discuss this with us during your baby’s feeding assessment.
During the procedure
- We will wrap your baby securely in a blanket and hold them gently to keep their head still. Some babies may not like this.
- We will then release the tongue-tie using sterile, round-ended scissors. We will then apply some pressure under your baby’s tongue to stop any bleeding using a piece of sterile gauze. There will usually only be a few drops of blood.
- Once we have released the tongue-tie, we will unwrap your baby and encourage them to feed straight away. This will help your baby’s tongue to move and may prevent the tongue-tie from re-fusing.
You may remain with your baby for the duration of the procedure or, if you prefer, your midwife can take your baby to a separate room.
We will support you to feed your baby after the procedure. We will also discuss a management plan with you to help you with your ongoing feeding experience.
The decision to have your baby’s tongue-tie released is a personal one. If you choose not to have the procedure, we will continue to give you feeding support. If at a later date you are concerned about your baby’s feeding, please contact your health visitor or GP. They can refer you for another tongue-tie assessment.
After the procedure
A small white blister may develop under your baby’s tongue in the first couple of days after the procedure. As far as we can tell, this is painless and does not interfere with feeding.
Your baby may be fussy and unsettled for a few days after the procedure. It may also take a few weeks before your baby is fully comfortable when feeding. Occasionally, the procedure may not improve a baby’s ability to feed.
Possible risks
As with any surgical procedure, there are some possible risks, but these are rare. Risks include:
- excessive bleeding
- infection
- ulcers
- pain
- damage to the tongue and surrounding tissues
Very occasionally, a tongue-tie may reoccur if the frenulum re-fuses. This may be due to residual frenulum or the development of scar tissue. If this happens, a further procedure may be necessary.
We will explain these risks to you in more detail before you agree to the procedure.
The future
Occasionally, tongue-ties can persist and while the majority of children have no difficulties with their speech, the presence of a tongue-tie has been shown to influence the ability to pronounce certain sounds in some children. However, it is impossible to predict which children will be affected, or to determine whether treatment as a baby will prevent this.
Speech difficulties are usually noticeable by the time a child reaches three years of age. If you think your child’s speech is affected or they are having problems caused by tongue-tie, contact your GP or health visitor and they will be able to refer your child to a speech and language therapist for an assessment.
Self care and Prevention
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