Key takeaways: Tongue-tie (ankyloglossia) is a tight band under the tongue that sometimes affects feeding. Many feeding problems have other causes. The AAP recommends a full feeding evaluation and nonsurgical support first, reserving frenotomy for babies with significant feeding problems that don’t improve.
If you’ve been told your baby has a tongue-tie or lip-tie, you may be wondering whether a procedure is necessary. Diagnoses and procedures have increased dramatically in recent years. In 2024, the American Academy of Pediatrics released a clinical report to help families and clinicians make evidence-based decisions.
What Is Tongue-Tie?
Everyone has a lingual frenulum, a band of tissue that connects the underside of the tongue to the floor of the mouth. In ankyloglossia, or tongue-tie, this band is short, thick, or tight enough to limit tongue movement. Estimates of how common it is vary widely, depending on how it’s defined.
Possible signs in a baby:
- Trouble latching or staying latched.
- Clicking sounds during feeds.
- A tongue that can’t lift or stick out past the gums, or a heart-shaped tongue tip.
- Long or frequent feeds with poor weight gain.
Possible signs in the breastfeeding parent:
- Persistent nipple pain or damage despite good positioning.
- Nipples that look pinched or creased after feeds.
- Low milk supply from poor milk removal.
What Is a Lip-Tie?
All babies have an upper labial frenulum connecting the upper lip to the gum. Its appearance varies a lot. There’s little evidence that upper lip ties affect breastfeeding, and the AAP report doesn’t support routine lip-tie procedures for feeding problems.
Why the Caution?
Many things can cause breastfeeding pain or poor latch: positioning, engorgement, a sleepy or premature baby, flat nipples, high palate, low muscle tone, or a baby who is still learning. A tight frenulum may not be the main cause, and a procedure won’t fix problems that come from something else.
The AAP’s 2024 Recommendations
The AAP clinical report, Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants, recommends:
- Early identification of feeding problems and a full feeding assessment.
- Team-based care, including lactation consultants, and when appropriate, speech-language pathologists or feeding specialists.
- Nonsurgical support first, such as positioning, latch help, and addressing supply.
- Frenotomy only for babies with significant functional feeding problems that haven’t improved with nonsurgical support.
- Follow-up after any procedure to make sure symptoms improved.
- No routine post-procedure stretching exercises, which haven’t been shown to prevent reattachment and can be distressing for babies.
What Is a Frenotomy?
A frenotomy is a quick procedure in which a clinician clips the frenulum with sterile scissors. It’s usually done in an office, often without anesthesia in young babies, and the baby can feed right away. Serious complications are rare. Some providers use lasers; there’s no strong evidence that lasers produce better results than scissors, and lasers are often more expensive.
Questions to Ask Before a Procedure
- Has a lactation consultant observed a full feed and helped with positioning and latch?
- What specific feeding problems do you expect the procedure to fix?
- What else could be causing these symptoms?
- Who will follow up afterward, and what happens if symptoms don’t improve?
- Will aftercare stretches be required? (The AAP doesn’t recommend them.)
- What does it cost, and is it covered by insurance?
Bottle-Fed Babies
Tongue-tie is less likely to affect bottle feeding, but some babies have trouble sealing on the nipple or tire quickly. A feeding evaluation can help decide on the best bottle and technique.
Call your baby’s doctor if your baby: isn’t back to birth weight by 2 weeks, has poor weight gain, has fewer wet diapers than expected, or chokes or coughs frequently during feeds. Call after any procedure if: bleeding doesn’t stop with gentle pressure, your baby won’t feed, or your baby has a fever.
The Bottom Line
Tongue-tie can affect feeding for some babies, but it isn’t the cause of every breastfeeding problem. Start with a full feeding assessment and lactation support. If a procedure is recommended, make sure it’s for a clear functional problem and that follow-up is planned.
My book, From First Breath to First Birthday, covers latch problems, oral restrictions, and getting the right help.
Sources
- Thomas J, et al; Section on Breastfeeding, Council on Quality Improvement and Patient Safety, Section on Oral Health, Committee on Fetus and Newborn, Section on Otolaryngology-Head and Neck Surgery. Identification and management of ankyloglossia and its effect on breastfeeding in infants: clinical report. Pediatrics. 2024;154(2). Published online July 29, 2024.
- American Academy of Pediatrics. AAP clinical report encourages pediatricians to consider nonsurgical options to breastfeeding concerns amid rise in tongue-tie diagnoses. News release. July 29, 2024. https://www.aap.org
- Messner AH, Walsh J, Rosenfeld RM, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020;162(5):597-611.
- O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3(3):CD011065.
- Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngol Head Neck Surg. 2017;156(4):735-740.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
