Tongue Tie Baby: How to Check and What the Release Involves

At day five with my second baby I had bleeding nipples, a baby losing weight, and a midwife who kept telling me "the latch looks fine from here." It did not feel fine. It felt like he was using my nipple like a chew toy. Every feed was forty minutes of toe-curling pain followed by a baby who fell asleep within minutes and then woke an hour later starving.

A lactation consultant I paid privately took one look in his mouth and said "he has a posterior tongue tie. The kind your midwife missed." Forty-eight hours later it was released. By the end of that week the pain was gone and he had put on five ounces.

If you are reading this with cracked nipples wondering whether tongue tie is the answer, here is what I learned from going through the whole pathway. The signs nobody mentions, how to check yourself, what the release actually involves, and how to tell when it is genuinely needed versus when something else is going on.

What tongue tie actually is

A tongue tie (the medical name is ankyloglossia, meaning "tied tongue") is when the small piece of tissue under the tongue (called the lingual frenulum) is too short, too tight, or attached too close to the tip. This restricts how far the tongue can move out, up, or side to side.

Estimates of how common it is vary widely from 4 to 11 percent of babies, partly because diagnosis is inconsistent. Some health professionals diagnose every restricted tongue. Others only the most obvious cases. The medical community is still arguing about where the threshold should be, which is one reason families get such different answers depending on who they ask.

There are two main types:

Anterior tongue tie: the tissue is visible from the front, attaching close to the tip of the tongue. The tongue often looks heart-shaped when lifted because the centre pulls down. Easier to spot. Usually picked up at the newborn check.
Posterior tongue tie: the tissue is attached further back, sometimes under the surface, less visibly tight. The tongue may look normal at rest but cannot lift, extend, or cup properly during feeding. Frequently missed by midwives doing a quick mouth check. Most often diagnosed by experienced lactation consultants or specialist tongue tie clinicians.

The posterior version is the one that catches families by surprise because the mouth looks fine at a glance.

The signs that suggest your baby has a tongue tie

Most tongue ties become apparent during feeding. A few visible signs are also useful clues.

Visible signs to check

In a quiet moment, look in your baby's mouth (a phone torch helps):

When the tongue lifts during a cry, does the tip pull down in the middle making a small V or heart shape?
When the baby is open-mouthed, does the tongue rest on the floor of the mouth rather than against the roof?
Can the tongue extend past the gum line when the baby reaches for something?
Can the tongue lift to touch the roof of the mouth?
Run a clean little finger along the underside of the tongue. Does it feel like there is a tight string or band restricting the upward movement?

If the tongue cannot stick out past the lower lip, cannot lift to the roof of the mouth, or pulls into a heart shape when raised, those are strong visual signs.

Feeding signs that suggest tongue tie

The feeding signs are often more reliable than the visual check, especially for posterior ties. Any combination of these is worth investigating:

Painful breastfeeding that does not improve even after careful latch correction
Cracked, bleeding, or misshapen nipples (often pinched flat or creased after feeds)
Clicking, smacking, or popping sounds during feeds (the tongue is breaking suction repeatedly)
The baby falls asleep within minutes of latching but is hungry again 20 to 30 minutes later
Poor weight gain or weight loss after the first week
The baby has a shallow latch no matter how you reposition
Long feeds (45 minutes or more) every time, with the baby unsatisfied at the end
Reflux, gas, or fussiness during and after feeds (the baby is swallowing air because the seal is poor)
A blistered or callused upper lip from the baby having to grip with the lips to compensate for the tongue
For bottle-fed babies: milk dribbling out the sides of the mouth, similar clicking sounds, slow feeding

Babies who only bottle-feed sometimes seem fine because bottles can be drained even with a restricted tongue. The tongue tie still affects speech and eating later for these children, so it can be worth investigating even without breastfeeding pain.

What to do if you suspect a tongue tie

The single most useful action is to see an experienced lactation professional or a specialist tongue tie clinician, not a general midwife or GP.

Hospital midwives are trained for the most obvious anterior ties. Posterior ties are routinely missed at the newborn check. A "looks fine" from a midwife is not a ruling out.
GPs typically have limited training in tongue tie diagnosis. They can refer you to a specialist but may not assess the tongue function themselves.
IBCLCs (International Board Certified Lactation Consultants) are the gold standard. They assess tongue function as well as appearance, and they understand the feeding mechanics in detail. They can also tell you whether the tongue restriction is actually causing your feeding problem or whether something else is the real issue.
Tongue tie clinics, run by specialist midwives or paediatric dentists, will both assess and (if indicated) perform the release in the same appointment. In the UK most can be accessed via NHS referral or paid privately for faster access.

What the release procedure actually involves

If a tongue tie is confirmed and your baby's feeding is being affected, the standard treatment is a frenotomy (a quick procedure to release the tongue restriction by snipping the tight tissue under the tongue).

For babies under 3 to 6 months it is usually done in an outpatient setting with no anaesthetic. The reason no anaesthetic is used is twofold: the lingual frenulum has very few nerve endings and very little blood supply, so the procedure is genuinely brief and minimally painful (most babies cry more from being held still than from the snip itself); and a general anaesthetic carries real risk that is not justified for such a quick procedure.

What actually happens, step by step:

1. The clinician examines the mouth and confirms the diagnosis 2. The baby is held swaddled, often by a parent or assistant, head supported 3. A pair of sterile blunt-ended scissors (or sometimes a laser) is used to snip the frenulum 4. The whole procedure takes about 15 to 30 seconds 5. The clinician applies gentle pressure with gauze to stop any small bleeding (usually under a minute) 6. The baby is handed back and offered a feed immediately, both for comfort and to help with healing

Most babies cry for a minute or two and then calm at the breast. Some sleep through it. A very small number have more bleeding (less than a teaspoon) that resolves with brief pressure.

After the procedure, most parents notice changes within the first feed or two. The latch feels different. The baby may take a deeper mouthful. Some babies need a few days of stretching exercises (taught by the clinician) to keep the area healing in the new open shape. Others heal completely without intervention.

For babies older than 6 months or for revisions, the procedure is sometimes done in a hospital with anaesthetic. This is less common in early infancy.

When tongue tie is not the answer

A tongue tie is sometimes blamed for problems it is not actually causing. A few situations where the issue is something else:

A latch problem with a normal tongue: most "bad latch" pain is mechanical and fixable without surgery. See a lactation consultant before assuming tongue tie. (We covered the four-step latch fix in [How to Fix a Bad Latch](/blog/how-to-fix-a-bad-latch).)
Cow's milk protein allergy: causes feeding distress that can look like tongue tie. Worth a 2 to 4 week dairy elimination trial alongside or instead of assuming tongue tie.
True low milk supply: requires its own assessment.
Severe reflux: can mimic feeding distress.
Overactive letdown: makes feeds difficult and is often mistaken for tongue tie restriction.

The fact that your baby has a slightly restricted tongue does not always mean releasing it will fix your problem. A skilled IBCLC can usually tell the difference between functional restriction (the tongue tie is causing the issue) and structural restriction with normal function (the tie exists but is not the source of the pain).

What to tell yourself at day five with bleeding nipples

If feeding is genuinely hard, if your nipples are damaged, and the standard latch advice has not worked, you are not failing. You are not being weak. You are dealing with a real, often missed, very common condition.

The pathway from suspected tongue tie to released tongue tie can take days in some areas and weeks in others. While you wait:

Get the best lactation consult you can afford (often genuinely cheaper than ongoing formula)
Use nipple shields if the alternative is stopping breastfeeding entirely
Pump and bottle-feed the affected breast for a few days while the other side heals
Hand-express to keep supply up if pumping is also painful

The pain ends, one way or another. Either the tie is released and feeds become bearable, or you switch to a feeding method that works for you both. Both endings are completely valid.

You are doing one of the harder bits of newborn parenting. The fact that you noticed something was wrong is exactly the moment that good support kicks in. Find the right person, and most cases resolve within 48 hours of that conversation.

Tongue Tie in Babies: The Signs, the Risks, and the Procedure