Tongue tie is one of the most commonly missed causes of breastfeeding difficulty , and one of the most impactful when it is identified early. I’ve seen it go undetected through multiple hospital midwife visits, child health nurse appointments, and even GP consultations, while the mother continues to struggle with pain, supply concerns, and an unsettled baby.
Here’s what tongue tie actually is, how to recognise it, and what the process looks like if your baby is assessed.
What Is Tongue Tie?
Tongue tie , medically called ankyloglossia , occurs when the lingual frenulum, the small band of tissue that connects the underside of the tongue to the floor of the mouth, is shorter, tighter, or positioned further forward than usual. This restricts the tongue’s range of motion.
For breastfeeding, tongue mobility is everything. A baby needs to extend and cup their tongue over the lower gum to draw the breast tissue deep into the mouth and compress it effectively. When tongue movement is restricted, the latch is typically shallow, the baby works harder for less milk, and the mother experiences pain because the nipple is being compressed rather than drawn in.
Lip tie, where the upper lip is tethered tightly to the upper gum, is often present alongside tongue tie and can contribute to similar feeding difficulties.
Signs That Tongue Tie May Be Affecting Feeding
Not all tongue ties cause feeding problems, and not all feeding problems are caused by tongue tie. But the following signs, particularly when several appear together, warrant an assessment:
In the baby:
- Shallow, clicking, or slipping latch
- Frequent or very long feeds that don’t seem to satisfy
- Slow weight gain or weight loss beyond the normal newborn drop
- Excessive wind, colic-type symptoms, or reflux-like behaviour
- Difficulty staying on the breast
- A heart-shaped or notched tongue tip when the tongue is raised
In the mother:
- Nipple pain throughout the feed, not just at initial attachment
- Nipple compression, blanching, or misshaping after feeds
- Damaged or cracked nipples that aren’t healing
- Recurring blocked ducts or mastitis
- Feeling that the breast is never fully drained
- Concerns about milk supply despite frequent feeding
What Does an Assessment Involve?
When I see a baby for a potential tongue tie, I do a full feeding assessment , not just a look in the mouth. I watch a complete feed first, so I can see exactly how the tongue is functioning during active feeding. I then assess the lingual frenulum and lip frenulum manually, checking both the anatomy and the functional restriction.
This is important: a tongue tie can be functionally significant even when it doesn’t look severe visually. Conversely, a frenulum that looks tight may not be causing the feeding problems. The feeding assessment is what tells the full story.
Can I See the Tongue Tie Myself?
Sometimes, yes. A classic anterior tongue tie , where the frenulum attaches close to the tip of the tongue , can be visible when the baby cries or tries to extend the tongue. The tongue may appear heart-shaped or notched at the tip.
Posterior tongue ties are much harder to see. They sit further back in the mouth, often under a mucosal layer, and are frequently missed on visual inspection alone. They can be just as functionally significant as anterior ties.
What Happens After Assessment?
If my assessment indicates that tongue tie is likely affecting feeding, the next step is a referral to a practitioner who can assess further and, if indicated, divide the frenulum. This is a procedure called a frenotomy or frenulotomy, a small, quick incision that releases the restriction.
In Perth, I have referral pathways to appropriate specialists. The referral process is straightforward, and in most cases, mothers notice an improvement in feeding relatively quickly after the procedure.
It’s worth being clear: not every tongue tie requires division. If the tie is present but feeding is going well and there is no significant restriction, treatment may not be necessary. The goal is always to support feeding, not to treat anatomy for its own sake.