Newborns and Tongue Tie: A Closer Look

If you support new or expectant parents, you will almost certainly encounter questions about tongue tie (also called ankyloglossia). Even if it is not on a parent’s radar before birth, the topic often surfaces during breastfeeding—especially when challenges arise. Given the volume of information (and misinformation) out there, it is essential to be prepared to guide families with clear, evidence-based support.

The Debate Around Diagnosis

One of the biggest challenges with tongue tie is the confusion surrounding its diagnosis and treatment. In 2024, the American Academy of Pediatrics (AAP) released a clinical report noting that both tongue tie diagnoses and related procedures have increased significantly in recent decades. Some medical professionals and researchers have raised concerns about potential overdiagnosis.

This does not mean that tongue ties should be ignored—but it does highlight how frequently parents receive conflicting advice from providers, peers, and online communities. Helping families navigate this uncertainty with confidence and clarity is essential.

What is Tongue Tie?

Tongue ties happen when the frenulum—that small piece of flesh under your tongue, attaching your tongue to the bottom of your mouth (see image below)—is short, tight or restricted. A restricted frenulum makes it harder for the tongue to move properly. It’s also possible to have a lip tie, which is when the frenulum that attaches your upper lip to your upper gums is restricted.

For breastfeeding, tongue mobility is crucial. Babies need to extend their tongue achieve a deep, effective latch. A restricted tongue can lead to a cascade of challenges, including:

• Poor latch or frequent slipping off the breast
• Clicking sounds during feeding (a sign of suction loss)
• Nipple pain, cracking, or distortion
• Inadequate milk transfer and poor weight gain
• Low milk supply due to inefficient nursing
• Frustration or fussiness during feeds

Some tongue-tied babies also exhibit a heart-shaped or notched tongue tip when crying or attempting to stick out their tongue—a visual cue that may indicate restricted movement.

It’s important to note that many issues in breastfeeding can cause these challenges. Just because a baby has a restricted frenulum and has one or more of these symptoms, it doesn’t always necessarily mean tongue tie is the cause. Often, tongue tie is one of several causes contributing to breastfeeding challenges.

By using Plumtree Baby's Settling In with Baby or Breastfeeding Your Baby parent guidebooks, you can help parents understand common breastfeeding challenges—including tongue tie—by reviewing the “Challenges” section together as part of their preparation.

How Common are Tongue Ties?

The AAP and some healthcare providers have expressed that tongue ties are being overdiagnosed, making it seem that tongue ties are more common than they really are. According to the AAP, anywhere between 1.7% and 10.7% of newborns are tongue tied.

How are Tongue Ties Treated?

Tongue ties can be treated with a procedure called a frenotomy (also referred to as a tongue tie release or clipping), in which the frenulum is cut with surgical scissors or lasered to allow greater tongue mobility. Various healthcare professionals can perform the procedure, including pediatricians, ENTs, dentists, and breastfeeding medicine doctors.
 
Most of the time, frenotomies are tolerated well by babies, with a little fussing during and after the procedure, as well as light bleeding. Most babies are able to breastfeed as soon as the procedure is over. At times, babies will find the procedure more uncomfortable. According to the Academy of Breastfeeding Medicine (ABM), in less common cases, infections and other complications occur.

Is Treatment Always Necessary?

Not all tongue ties require treatment. Some babies are able to breastfeed effectively despite a restricted frenulum, especially with the guidance of a skilled lactation consultant. In other cases, a frenotomy may be recommended, but parents may choose to monitor the situation or try lactation support strategies first. With the right support, many families can improve latch and feeding without surgery. If feeding is going well and symptoms are manageable, families may decide not to proceed with a tongue tie release. It is important for parents to feel empowered to make informed decisions based on their baby’s needs, their own comfort, and their feeding goals.

Are Tongue Ties Being Overdiagnosed?

It’s hard to say whether tongue ties are being overdiagnosed. That’s partly because there is no uniform way to diagnose tongue tie, as the AAP points out. Different providers have different criteria of what constitutes a tongue tie and different ways of deciding if the tongue tie likely is causing breastfeeding issues.
 
The other issue is that the studies we have on tongue tie and breastfeeding are based on small pools of participants, according to the AAP. The reviews haven’t adequately answered the question of whether treating tongue ties with frenotomies results in decreased feeding issues or long-term breastfeeding success. Still, the studies do seem to point to a short-term decrease in nipple pain after a tongue tie release.

How to Help Families Navigate Tongue Tie

Supporting parents through the tongue tie journey requires both empathy and accurate information. Here are key strategies:

Use Visual Aids

Visuals can help parents quickly understand the concept of tongue tie. Consider sharing a photo or diagram comparing a classic tongue tie to unrestricted tongue movement, as well as an image showing a heart-shaped tongue tip, a common sign of restriction. Use these visuals to explain how a normal tongue should lift, extend, and move side to side—and what signs may indicate limited mobility.

Discuss Online Misinformation

These days, most parents turn to the internet to get information about all things baby and breastfeeding. There are numerous online groups out there for tongue tie. In these groups, parents often post pictures of their baby's tongue, descriptions of their breastfeeding issues, and get “diagnosed” by other parents. While getting support and resources from other parents online can be a lifeline, it’s important to emphasize to the parents you work with that they should only get a tongue tie diagnosis from a medical provider.

Share Tips for Finding an Experienced Provider

When a new parent suspects that their baby may be tongue tied, it’s vital for them to find an experienced provider to help. Unfortunately, not all pediatricians are well versed on the issue of tongue tie and breastfeeding. You can emphasize to your clients that:

• It’s best to find a provider who understands not only tongue tie but the varied and complex ways that it can impact breastfeeding specifically.
• It’s also important to find someone who won’t just look at your baby’s tongue, but who will watch you breastfeed, discuss your breastfeeding experiences, and look at the whole picture.
• In terms of frenotomies, you’ll want to choose a provider who has substantial experience performing the procedure—ideally someone who works with breastfeeding families regularly and provides follow-up care.
  

The Bottom Line

Tongue tie is a complex, often emotional topic for new parents. While it can cause significant breastfeeding issues, it is also frequently misunderstood. As a professional, you play an important role in offering balanced, evidence-based guidance.

By helping families understand the signs of tongue tie, providing trustworthy resources, and connecting them with knowledgeable providers, you can ensure they are equipped to make informed decisions that support both baby’s feeding and the parent’s well-being.

Wendy Wisner, Freelance Writer and Lactation Consultant (IBCLC)

Sources

Jennifer Thomas, Maya Bunik, Alison Holmes, Martha Ann Keels, Brenda Poindexter, Anna Meyer, Alison Gilliland, SECTION ON BREASTFEEDING, SECTION ON ORAL HEALTH, COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY, COMMITTEE ON FETUS & NEWBORN, SECTION ON OTOLARYNGOLOGY-HEAD AND NECK SURGERY; Identification and Management of Ankyloglossia and Its Effect on Breastfeed. Pediatrics August 2024; 154 (2): e2024067605. 10.1542/peds.2024-067605
 
LeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S. Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeed Med. 2021 Apr;16(4):278-281. doi: 10.1089/bfm.2021.29179.ylf. PMID: 33852342.

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