Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. This is known as tongue-tie.
The medical name for tongue-tie is ankyloglossia.
It can sometimes affect your baby's feeding, making it hard for them to attach properly to their mother's breast or a bottle.
If you're concerned about your baby's feeding and think they may have tongue-tie, speak to your GP, health visitor or midwife.
The following information explains tongue-tie and the problems it can cause, and describes a quick and painless procedure to snip the skin, known as tongue-tie division, which should be considered if your baby is severely affected.
What is tongue-tie?
Tongue-tie is a birth defect that affects 3-10% of newborn babies.
Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the frenulum. In babies with tongue-tie, this piece of skin is unusually short, holding the tongue down and restricting its movement.
Tongue-tie doesn't always cause problems. Sometimes, the skin anchoring the tongue may be so thin that it soon breaks, for example if a spoon is accidentally pushed under the tongue.
However, in some cases tongue-tie is severe and the tongue is almost fused to the base of the mouth. This prevents the baby from feeding properly and also causes problems for the mother (see below).
Problems tongue-tie can cause
Babies with severe tongue-tie will not be able to open their mouth wide enough to latch onto their mother's breast.
They cannot get any milk, so they end up sliding off the breast and chomping on the nipple with their gums. The mother's nipples soon become sore and the baby fails to gain much weight.
To breastfeed successfully, the baby needs to latch onto both breast tissue and nipple, and the baby's tongue covers the lower gum so the nipple is protected from damage.
A tongue-tied baby may also find bottle feeding hard. They cannot form a seal around the teat of the bottle, so milk leaks out as they suck. Air can sometimes get in and is swallowed, causing the baby to become windy and irritable.
In older children, tongue-tie may interfere with speech and eating, as they struggle to push food to the back of their mouth to be chewed.
In any of these cases, your GP, midwife or health visitor may recommend that you consider tongue-tie division.
Snipping the skin to free up the tongue is known as tongue-tie division or frenuloplasty. It is a simple and painless procedure that usually resolves the problems mentioned above straight away.
The National Institute for Health and Clinical Excellence (NICE) supports the use of tongue-tie division as it is safe and there is some evidence that it can improve breastfeeding.
How tongue-tie division is carried out
In babies younger than 8 months, division of tongue-tie is usually performed without any anaesthetic (painkilling medication), or with just a local anaesthetic that numbs the tongue.
A general anaesthetic is usually needed for older babies, which means they'll be put to sleep before the procedure.
The baby's head is held securely and sharp scissors are used to snip the piece of skin. This only takes a few seconds and the baby won't feel much pain. Some babies sleep through it, while others just cry for a few seconds.
There should be little or no blood loss, and you can start feeding your baby immediately.
A white patch may form under the tongue, which takes 24-48 hours to heal but does not bother the baby.