Private tongue-tie clinic in London, same-day paediatrics.

When it matters

A tongue tie is only significant if it is restricting function. Signs that it may be:

• In the baby — difficulty latching or staying attached, sliding off the breast, clicking during feeds, very long or very frequent feeds, falling asleep quickly then waking hungry, poor weight gain, excessive wind or reflux-like symptoms.
• In the mother — painful, damaged or misshapen nipples, a compressed or lipstick-shaped nipple after feeds, recurrent blocked ducts or mastitis, and low milk supply from poor drainage.
• Appearance — the tongue cannot lift to the roof of the mouth, cannot extend past the lower gum, or looks heart-shaped or notched when lifted.

Division

• Frenotomy is a quick procedure: the tissue is divided with sterile scissors, usually taking a few seconds.
• No anaesthetic is needed in young babies — the area has few nerve endings and little blood supply.
• There are a few drops of blood at most. A white or yellow patch forms under the tongue as it heals over one to two weeks — this is normal healing, not infection.
• Feed immediately afterwards; this comforts the baby and helps stop any bleeding.
• Many mothers notice improvement in pain and latch quickly, though it can take days to weeks as the baby learns a new pattern — and continued feeding support afterwards is what determines the outcome.
• Division is best done in the early weeks; for older babies with an established feeding pattern the benefit is less predictable.

Posterior tongue tie and after infancy

• Posterior tie — a tie further back and less visible — is a genuine entity but is also over-diagnosed. It should only be divided where feeding is clearly impaired and positioning has been optimised.
• Speech — tongue tie rarely causes speech problems. Most children with one speak normally, and division is not usually recommended for speech alone without speech and language assessment.
• Bottle-fed babies are less often affected, but a tie can still cause slow feeding, dribbling and excessive wind.
• Upper lip tie — evidence for dividing this is weak, and it is rarely necessary.