Tongue-tie is when the thin strip of tissue that connects the underside of the tongue to the floor of the mouth (the lingual frenulum) is shorter, thicker or tighter than usual. Its medical name is ankyloglossia. In some babies it causes no problems at all; in others it restricts tongue movement and makes feeding, and later the pronunciation of certain sounds, more difficult. So the real question is not "is there a tongue-tie?" but "is the tongue-tie causing a problem?"

How common is it?

According to a 2024 clinical report by the American Academy of Pediatrics (AAP), studies from the US, Canada and England diagnose tongue-tie in between 1.7% and 10.7% of newborns. The same report points out that diagnoses and procedures have risen markedly in recent years, and that not every division reflects a real need.

Signs of tongue-tie in babies

The signs are usually noticed during feeding:

  • Difficulty latching on to the breast (or holding a bottle teat)
  • Coming off the breast often; long but ineffective feeds
  • A clicking sound while feeding, milk dribbling from the corners of the mouth
  • Poor weight gain or weight loss
  • When the tongue is stuck out, the tip may look heart-shaped; the tongue may not lift to the roof of the mouth or move from side to side

In the mother, persistent nipple pain, cracked nipples and breasts that do not empty well are common.

None of these signs is unique to tongue-tie. Poor positioning, engorged breasts, low milk flow or oral thrush can cause similar complaints. That is why the assessment should cover both baby and mother.

In older children

In older children, being unable to stick the tongue out or lift it to the roof of the mouth, difficulty with some sounds that need the tongue tip raised (such as "r" and "l"), or difficulty clearing food from the teeth with the tongue may be noticed. Even so, tongue-tie is not a common cause of speech delay; in a child whose speech is late, hearing and language development are checked first (see signs of speech delay).

Does every tongue-tie need cutting?

No. A tongue-tie that causes no problems does not need treatment. The decision is not based on appearance alone; the baby's feeding, weight gain and tongue movement are assessed together. The order recommended by the AAP follows the same logic:

  1. A breastfeeding assessment first: positioning and latch are corrected, with help from a lactation consultant if needed. For many babies this step solves the problem (see our breastfeeding guide).
  2. Weight and feeding follow-up: whether the baby is gaining enough weight is monitored closely.
  3. Division (frenotomy): considered if marked functional restriction and feeding problems continue despite non-surgical measures.

How is it done?

In babies, the most common method is cutting the tight strip of tissue with sterile scissors in a few seconds. According to the UK's National Health Service (NHS), young babies usually have the procedure without an anaesthetic and most recover quickly and feed better afterwards; older babies and children usually need a general anaesthetic.

The AAP describes the procedure as safe, with poor outcomes being rare. The same report stresses that there is no evidence that laser is better than scissors, that parents should not routinely be given tongue-stretching exercises after the procedure, and that the benefit of cutting upper lip or cheek ties for breastfeeding has not been shown.

When to see a paediatrician

  • Feeds take a very long time every time, the baby never seems satisfied or is not gaining weight
  • Nipple pain does not go away despite good positioning
  • The baby often coughs, splutters or loses milk while feeding
  • An older child has clearly restricted tongue movement or difficulty speaking

We can follow your newborn's feeding and weight together during newborn follow-up visits. You can book an appointment at Özel Düztepe Yaşam Hospital in Şahinbey.