is my baby’s tongue-tie affecting their feeding?

A tongue-tie is when the frenulum (the tissue below the tongue that connects the tongue to the base of the mouth) is either too thick or too short and thus prevents the tongue from moving freely. Tongue movement is essential because in order to extract milk from the breast, the infant’s tongue must be able to move to pull and stretch the nipple and compress it along the soft palate.

Tongue-ties can affect some babies’ ability to breastfeed comfortably and effectively—but not all tongue-ties require treatment. The decision to pursue a frenotomy should be based on function and symptoms, not appearance alone.

Breastfeeding challenges are often the first clue. Babies with restrictive oral frenula may have difficulty maintaining a deep latch, frequently lose suction, or make clicking sounds while feeding. Feeds may be prolonged, inefficient, or followed by persistent hunger cues.

Maternal symptoms may be an indicator. Ongoing nipple pain, nipple creasing with feeds, blanching, or recurrent plugged ducts can signal poor latch which may be due to tongue-tie. If positioning and latch support do not resolve these issues, oral restriction may be contributing.

Watch milk transfer and growth. Poor weight gain, slow feeds, or reliance on very frequent feeding to maintain growth can be signs that a baby is not transferring milk efficiently. Some babies compensate well early on, so careful assessment over time is important.

Oral function is more important than appearance. A visible frenulum alone does not diagnose a problem. A functional feeding evaluation—including tongue lift, extension, lateralization, and the baby’s ability to maintain suction at the breast—is essential.

Frenotomy is one part of a care plan. When indicated, frenotomy can improve breastfeeding outcomes, but it works best when paired with skilled lactation support before and after the procedure.