Oral Health›Life stages

Tongue-Tie in Babies and Children: Signs, Assessment and Treatment

What tongue-tie is, the feeding signs to look for, how it should be assessed, what the division procedure involves, what the evidence shows, and where to get help in the UK, Australia and the US.

Updated September 2026·By the OHA editorial team·8 min read·How we write
Key takeaways
  • Tongue-tie is when the strip of skin joining the tongue to the floor of the mouth is shorter or tighter than usual. Many tongue-ties cause no problems and need no treatment.
  • In babies it can make breastfeeding or bottle-feeding harder, but most feeding problems have other causes. Get feeding support first.
  • Australian and US bodies say tongue-tie should be judged by how the tongue works, not only by how it looks.
  • Cutting the tongue-tie is quick and serious complications are rare. A Cochrane review found it eases nipple pain in the short term but does not consistently improve feeding.
  • The Australian Dental Association and the American Academy of Pediatrics say to keep surgery for clear problems where other support has not worked.

Tongue-tie is something a baby is born with. The NHS describes it as the piece of skin connecting the tongue to the bottom of the mouth being shorter or tighter than usual. That skin is called the lingual frenulum (or frenum), and the medical name for tongue-tie is ankyloglossia. The NHS says it may not cause any problems, but if it does, treatment is available.

Procedures have risen sharply in recent years, and the American Academy of Pediatrics (AAP) and the Australian Dental Association have both raised concerns about over-treatment. This guide sets out what each body says. For other changes to the tongue, see tongue problems.

How common is tongue-tie?

A 2017 Cochrane review and the Australian Dental Association say 4% to 11% of newborns have tongue-tie, and the AAP estimates 4% to 10%. Pregnancy, Birth and Baby says the cause is not known, but it can run in families.

What are the signs?

Signs listed by the NHS, Pregnancy, Birth and Baby and the Better Health Channel include:

  • the tongue cannot stick out past the lips or lower front teeth, lift to the roof of the mouth, or move side to side
  • the tip of the tongue looks square, notched or heart-shaped when lifted or stuck out

Signs during feeding

The NHS says babies with tongue-tie may:

  • have difficulty attaching (latching) or staying attached to the breast or teat
  • feed for a long time and need feeding very often
  • dribble a lot, or cough, choke or make clicking noises during feeds
  • take only a small amount of milk each feed
  • lose weight or struggle to put on weight

If you are breastfeeding, the NHS says you may have sore nipples or painful, swollen breasts. Pregnancy, Birth and Baby adds nipples that change shape or have a mark after feeds, blocked ducts or mastitis, and a falling milk supply.

These signs are not proof of tongue-tie. The Better Health Channel says many also occur with other feeding issues, and that most breastfeeding problems are not caused by tongue-tie and can be solved with the right support.

How is tongue-tie assessed?

The Australian Dental Association says diagnosis should not be based on appearance alone. It should follow a full history, an objective check of how the tongue works, and an assessment of the problem itself, such as a breastfeeding observation by a lactation consultant. If the tongue works normally, the frenulum should be treated as normal, even if it looks tight. The Association also says there is a lack of evidence for "posterior" tongue-tie as a diagnosis.

What treatment is there?

The NHS says treatment is not usually needed if tongue-tie is not causing problems. Pregnancy, Birth and Baby says that for many babies the skin loosens as they get older, and the Better Health Channel says tongue-tie may improve on its own by age two or three.

Feeding support first

The Australian Dental Association says to try non-surgical treatment first, such as advice on positioning, latch, feed frequency and milk supply. The AAP also encourages non-surgical options first, and the NHS lists feeding advice from a trained health professional as a treatment.

The division procedure

If problems continue, the tongue-tie can be cut. NICE calls this division of tongue-tie, Cochrane uses frenotomy, and Australian sources such as Raising Children Network use frenectomy.

NICE describes sharp, blunt-ended scissors being used, with little or no blood loss and feeding able to start straight away. The AAP says it takes minutes, and that no evidence supports a laser over scissors. The NHS says young babies usually have no anaesthetic, while older babies, children and adults usually have a general anaesthetic. Sources draw the line differently: NICE says after "the early months of life", and Pregnancy, Birth and Baby says from 4 months.

What does the evidence say?

The main sources differ, partly because of their age:

  • NICE (UK), 2005: no major safety concerns and "limited evidence" that the procedure can improve breastfeeding, enough to support its use with normal arrangements for consent, audit and governance. Only registered, properly trained health professionals should do it. The recommendations have not changed since 2005.
  • Cochrane review, 2017: five trials with 302 babies. The procedure reduced mothers' nipple pain in the short term but did not consistently improve the baby's feeding. The evidence was very low to moderate quality, and no trial reported long-term breastfeeding.
  • AAP (US), 2024: research has not shown a clear link between tongue-tie and breastfeeding problems, and surgery is being overused. Keep it for significant problems where non-surgical help has not worked.
  • Australian Dental Association, 2025: surgery only after non-surgical management has failed, and not because of worries about future problems.

Risks

NICE and the AAP say complications are rare, and the Cochrane review found no serious complications, though few babies were studied. The Australian Dental Association lists possible complications including deep ulcers, bleeding, scarring that limits tongue movement, injury to the saliva glands and oral aversion (a baby becoming fearful of anything in the mouth). It says there is no guarantee surgery will help.

Other claims

  • Lip-ties and cheek-ties: the AAP says cutting them will not improve breastfeeding, and the Australian Dental Association says there is not enough evidence to support it.
  • Reflux, colic and sleep: the Australian Dental Association says there is not enough evidence that tongue-tie causes these. The AAP says there is no evidence the procedure improves dental health or prevents sleep apnoea.
  • Other therapies: the AAP says physical, craniosacral and myofascial therapies are not well studied, and the Australian Dental Association says there is no evidence for musculoskeletal or orofacial myofunctional therapy.

What happens after the procedure?

NHS hospital leaflets describe a small diamond-shaped wound under the tongue that turns white or yellow as it heals. Healing times differ: 7 to 14 days (Alder Hey Children's Hospital), one to two weeks (the Dudley Group) or 14 to 21 days (Kingston and Richmond).

The Dudley Group says feeding helps stop any bleeding; if it does not, press on the wound with a clean, dry cloth for five minutes. Alder Hey says infant paracetamol can be used for babies over 8 weeks; for younger babies, speak to your GP.

Advice on exercises differs. The Kingston and Richmond leaflet suggests gentle games that encourage the tongue to move, to help stop the tongue-tie reattaching. The AAP says post-procedure stretches and exercises have not been shown to help and may make babies reluctant to feed, so it does not recommend them. Follow the advice of the team that treated your baby.

Older children and adults

The Better Health Channel says tongue-tie is less common in toddlers than babies, which suggests it can resolve as a child grows. Sources differ on speech:

  • The AAP says tongue-tie will not delay speech development, though it may affect sounds such as "t", "d", "n", "l", "s", "z" and "r".
  • The Better Health Channel says a small number of children may develop speech problems.
  • Raising Children Network says it is not known whether tongue-tie affects speech development.

For speech worries, the Australian Dental Association and Raising Children Network suggest a speech pathologist (speech and language therapist). For adults, the NHS says a GP may be able to help, and the Australian Dental Association says treatment is elective, decided with your dentist.

Where to get help

  • UK: the NHS says to speak to a midwife, health visitor or GP. The National Breastfeeding Helpline is open 24 hours on 0300 100 0212.
  • Australia: Pregnancy, Birth and Baby suggests your GP or child health nurse, who can recommend a lactation consultant. The Australian Breastfeeding Association helpline is 1800 686 268, and Pregnancy, Birth and Baby's nurses are on 1800 882 436.
  • US: the AAP says your paediatrician should coordinate care with lactation consultants, feeding therapists and surgeons.
When to get advice
  • Your baby has trouble attaching, feeds for very long periods, or is not gaining weight: speak to a midwife, health visitor, child health nurse or GP (NHS, Pregnancy, Birth and Baby).
  • Breastfeeding is painful: ask for a feeding assessment before considering a procedure (Australian Dental Association, AAP).
  • You are worried about your child's speech or eating: see a speech pathologist or speech and language therapist.
Get help urgently
  • After a tongue-tie procedure, the Dudley Group advises going to an emergency department if bleeding has not stopped after feeding and pressing on the wound, keeping pressure on the way.
  • Kingston and Richmond advises an urgent GP appointment or A&E if your baby has a temperature over 37.6C, pus from the wound, or is very irritable, or very sleepy and hard to wake for feeds.

Frequently asked questions

Will cutting a tongue-tie fix breastfeeding?

Not always. The Cochrane review found it eased nipple pain in the short term but did not consistently improve feeding. The AAP says to look for other causes if feeding does not improve.

Does the procedure hurt?

The AAP says babies cry and fuss, but it takes minutes, usually without a general anaesthetic, and infant pain relief can help afterwards.

Will tongue-tie cause problems later?

The Australian Dental Association says there is no way to know, and advises against surgery for possible future problems.

Sources

  1. Tongue-tie, NHS, accessed September 2026
  2. Breastfeeding help and support, NHS, accessed September 2026
  3. Division of ankyloglossia (tongue-tie) for breastfeeding: recommendations, NICE HealthTech guidance 95 (formerly IPG149), accessed September 2026
  4. Division of ankyloglossia (tongue-tie) for breastfeeding: the procedure, NICE, accessed September 2026
  5. Surgical release of tongue-tie for the treatment of tongue-tie in young babies, Cochrane (O'Shea and others, 2017), accessed September 2026
  6. Frequently asked questions about care after baby's frenotomy, Alder Hey Children's NHS Foundation Trust, accessed September 2026
  7. Caring for your baby after a tongue-tie division, The Dudley Group NHS Foundation Trust, accessed September 2026
  8. Division of a tongue-tie, Kingston and Richmond NHS Foundation Trust, accessed September 2026
  9. Tongue-tie, Pregnancy, Birth and Baby (healthdirect Australia), accessed September 2026
  10. Tongue-tie, Better Health Channel (Victoria), accessed September 2026
  11. Tongue-tie in babies and children: frequently asked questions, Raising Children Network, accessed September 2026
  12. Tongue-tie, Australian Dental Association, accessed September 2026
  13. Policy Statement 2.13: Ankyloglossia and oral frena, Australian Dental Association, accessed September 2026
  14. Tongue tie in babies: how ankyloglossia affects breastfeeding and other concerns, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  15. AAP addresses rise in tongue-tie diagnoses for breastfeeding concerns, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

Children's Teeth: From First Tooth to Adult Teeth
When teeth come through, how to handle teething, when to see a dentist, and how much toothpaste to use at each age. The toothpaste advice differs between the UK, Australia and the US, so each is set out separately.
Dummies and Thumb Sucking: Effects on Teeth and How to Stop
Why babies and young children suck dummies, thumbs and fingers, how a long-lasting habit can affect the teeth and bite, how to use a dummy safely, and how to help a child stop.
Tooth Decay in Babies and Toddlers (Early Childhood Caries)
How tooth decay starts in babies and toddlers, the early signs to look for, how bottles, cups and night feeds play a part, and what dental teams can do, from fluoride varnish to treatment in hospital.