What tongue-tie is, how it can affect feeding, what the procedure involves, and its benefits and risks, so you can make an informed decision for your baby.
Tongue-tie (ankyloglossia) is a condition where the small band of tissue under the tongue, called the frenulum, is shorter, tighter, or attached further forward than usual. This can restrict how the tongue moves (NICE, 2020). It is present from birth, and comes in two main forms:
of newborns have a tongue-tie (NHS). Not all of them will have feeding difficulties.
Not every baby with tongue-tie needs a procedure. Many feeding problems improve with good positioning and attachment support alone. A tongue-tie division should only be considered when feeding difficulties persist despite appropriate support, and a full assessment always comes first.
Tongue-tie is not the only cause of feeding difficulties. Positioning, milk flow and your baby's general health all play a role, which is why a full feeding assessment is always carried out before any procedure is recommended.
A frenulotomy (tongue-tie division or release) is a simple, quick procedure to cut the tight frenulum under the tongue, freeing up the tongue's movement. It is carried out with sterile blunt-ended scissors and takes only a few seconds. In babies under 6 months no anaesthetic is required, as there are very few nerve endings in the frenulum tissue.
Most parents report a noticeable improvement, though it may take days or weeks for feeding to fully settle as your baby learns to use their tongue differently. A small number of babies see little or no change, frenulotomy is not a guaranteed fix, and ongoing feeding support remains important. If I don't think a frenulotomy is likely to help your baby, I will tell you.
Following NICE IPG149 (2020) and ATP guidelines, a home-visit frenulotomy is suitable for babies who meet all of these criteria:
Healthy late preterm babies (34 to 36 weeks) feeding at home without complications may also be suitable. If a home procedure would be too risky, I will explain why and refer you to a senior practitioner or consultant surgeon at a local hospital.
Some families explore other options first, or alongside: waiting and watching (mild ties can improve as the mouth grows), continued positioning and latch support with a lactation consultant, complementary therapies (evidence is limited), or mixed feeding with expressed milk and formula. All are valid, and I will support whichever route you choose.
Frenulotomy is a low-risk procedure that most babies tolerate very well. You should still understand the possible risks before giving consent:
This is very rare. Using clean gauze or a muslin, apply firm, steady pressure under the tongue for at least 5 minutes, keeping the airway clear. If the bleeding does not stop, call 999 or go straight to your nearest A&E. A full bleeding management leaflet is provided with your appointment pack.
That is what an assessment is for: an objective, unhurried evaluation of how your baby feeds, with no obligation to proceed.
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