Question 1

What is a Tongue Tie?

Accepted Answer

A tongue tie refers to a condition where the lingual frenulum—the piece of tissue beneath the tongue—anchors the tongue to the floor of the mouth, limiting its natural movement.

Before birth, this tissue is present in all babies. In most cases, it naturally recedes before delivery. However, in around 5–10% of babies (1–2 in every 20), it remains tight or prominent, restricting tongue movement and potentially affecting feeding.

It’s important to understand that a true tongue tie isn’t just about the visible presence of tissue. Diagnosis focuses primarily on how well the tongue functions. A properly trained professional can perform an assessment, which typically involves using a gloved finger to observe specific tongue responses and movement patterns.

Question 2

Is My Baby Tongue-Tied?

Accepted Answer

Tongue ties can't be diagnosed—or ruled out—by appearance alone. Visual inspection is only one part of the assessment process. Still, there are some common signs and symptoms that may indicate the need for a professional evaluation.

Signs to Watch For

In the Breastfeeding or Chest feeding Parent:

· Nipple pain or trauma
· Blanched (white or purple) nipples
· Nipples shaped like a lipstick after feeding
· Milk blisters (blebs)
· Recurring blocked ducts or mastitis
· Low milk supply
· Breast engorgement
· Feelings of anxiety or symptoms of postnatal depression

In the Infant:

· Pushing away from the breast or bottle
· Biting or clamping down during feeds
· Signs of colic or reflux
· Difficulty settling
· Constant or very frequent feeding
· Long pauses between sucks
· Gulping or choking during feeds
· Poor weight gain or weight loss
· Milk leaking from the mouth while feeding
· Clicking sounds when feeding
· Arching the back during or after feeding
· Mouth remains open at rest
· Presence of a sucking blister
· Frequent waking at night

Because many of these signs and symptoms can also be linked to other feeding challenges, it’s essential to seek support from professionals trained in both tongue ties and infant feeding. Accurate diagnosis is key to effective treatment.

Question 3

What Is Oral Dysfunction?

Accepted Answer

Research indicates that many procedures are performed unnecessarily due to a lack of understanding around the true causes of oral dysfunction. In some cases, issues such as a recessed jaw, low or high muscle tone, muscle tension, torticollis, plagiocephaly, or tightness in the fascial system may be contributing to feeding difficulties.

Rushing into a tongue tie release without addressing these possible causes is not only inappropriate—it may delay effective treatment. For some families, this delay could result in the premature end of their breastfeeding journey.

At The Happy Bubba Tongue Tie Clinic, I take a holistic approach. I will assess the full range of possible factors and aim to resolve feeding difficulties through gentle, functional intraoral exercises and bodywork. Only when these conservative methods have been explored do we consider whether a tongue tie division is truly necessary.

Question 4

What Is a Frenulotomy and Is It Safe?

Accepted Answer

A frenulotomy is a straightforward and generally safe procedure. It’s typically performed either in a community clinic or in the comfort of your own home. The process involves gently swaddling your baby, then using a pair of blunt-ended scissors to release the tissue (frenulum) under the tongue. The procedure is quick, and parents are encouraged to stay close to their baby throughout.

As with any medical procedure, informed consent is essential. You’ll be asked to review and sign a consent form, and the details will also be discussed with you verbally before proceeding. You may withdraw your consent at any time.

By signing the consent form, you acknowledge awareness of the potential risks, which include:

· Significant bleeding
· Infection
· Damage to surrounding structures
· Ulceration
· Pain or discomfort
· Difficulty adjusting to new tongue mobility
· No improvement or worsening of feeding issues

Though these risks exist, they are rare. Overall, frenulotomies are considered low-risk procedures with a strong safety record.

Question 5

How Likely Are Complications After the Procedure?

Accepted Answer

Severe Bleeding 
Minimal or no bleeding is expected following your baby’s tongue tie division. You'll be encouraged to feed your baby right after the procedure—this often provides enough natural pressure to stop any minor bleeding.

In rare cases (approximately 1 in 400), additional pressure may be needed using sterile gauze for around 20 minutes. It’s extremely uncommon for further medical intervention to be required beyond this.

Infection 
If your baby has an active oral infection, the procedure will be postponed until the infection is resolved. Fortunately, breastfed infants benefit from the natural protective properties of breastmilk, which can help reduce the risk of infection.

Signs of infection may include unusual sleepiness, fussiness, refusal to feed, or a fever. If any of these occur, contact your healthcare provider and let them know your baby recently had a tongue tie procedure.

Damage to Surrounding Tissue 
There are no documented cases in medical literature of damage to the surrounding structures during this procedure. However, as with any surgical treatment, this risk is still mentioned as a standard precaution.

Ulceration 
Roughly 48 hours after the procedure, a white or yellow diamond-shaped wound will appear under your baby’s tongue. This is a normal part of the healing process and resembles an ulcer because the mouth’s moist environment prevents scabbing.

Healing typically takes about 14 days. The yellow colouring you may notice is often due to bilirubin and is a typical part of recovery—not a sign of infection. It’s common to mistake these healing patches for something more serious, but rest assured they’re usually nothing to worry about.

Pain 
While it's not accurate to claim that the procedure is completely pain-free, the level of discomfort babies experience is generally comparable to that of other routine postnatal procedures—such as immunisations or heel-prick tests.

Interestingly, a study found that around 18% of infants slept through the procedure. This may be due to the limited number of nerve endings in the frenulum itself.

Anaesthetic is not usually recommended, as even local numbing agents can interfere with feeding after the procedure. For babies over three months of age, liquid paracetamol may be used if needed. If your baby is younger than three months, consult your GP ahead of time to discuss and possibly arrange appropriate pain relief. That said, most babies do not require medical pain relief afterward.

Reoccurrence of Tongue Tie 
In rare instances—about 1 in every 100 cases—the frenulum may reattach, leading to a recurrence of tongue restriction. To minimise this risk, it’s important to encourage regular tongue movement through feeding, oral play, and gentle exercises.

While many parents notice immediate improvements post-procedure, some babies need additional time and support to adjust. The tongue is controlled by eight different muscles. Some of these may have been overcompensating for the original restriction, while others may need time to develop strength and tone.

For a baby with tongue restriction, effective feeding patterns often must be learned after the procedure, rather than developed in utero like most infants. This learning process can take time, patience, and consistency.

Commitment to Aftercare 
The procedure will only be performed if you are able to commit to the recommended aftercare plan. 
This includes a combination of oral exercises, bodywork, and massage.

Proper aftercare plays a vital role in:

· Promoting healthy wound healing
· Preventing reattachment of the frenulum
· Supporting your baby in developing efficient suckling skills

These steps are essential to ensure the best possible outcome following the procedure.

No Improvement or Worsening of Feeding 
Though uncommon, there is a possibility that the procedure may not lead to noticeable improvement—or, in rare cases, may result in worsened feeding outcomes. This is why a comprehensive assessment, and a personalised care plan are key components of our approach.

Benefits of Frenulotomy (Tongue Tie Division) 
When a restricted frenulum is accurately diagnosed, a frenulotomy can be an effective solution for a variety of feeding challenges. This simple procedure can significantly improve feeding function and overall comfort for both infant and parent.

Question 6

What Does the Evidence Show?

Accepted Answer

· 95% of parents observed improved infant feeding within 48 hours after the procedure.
· 80% reported noticeable feeding improvements within just 24 hours.
· 100% of babies demonstrated normal tongue function three months following the procedure.
· 52.6% of infants experienced reduced reflux symptoms within one week, with many able to decrease or stop prescribed reflux medications.
· 88.6% of breastfeeding parents reported greater comfort during feeds.
· 83% of babies who had previously shown poor weight gain were able to continue breastfeeding and reached normal growth patterns within five days post-procedure.
· 60.7% of infants were still receiving breastmilk at six months of age.

Question 7

Do Lip Ties Need to Be Released?

Accepted Answer

It’s completely understandable that many parents feel concerned about lip ties—especially as they are quite visible and often discussed on parenting forums. However, in the UK, lip tie divisions are not routinely recommended as a treatment for breastfeeding challenges.

The reasoning behind this is based on feeding mechanics. Unlike the lower lip, the upper lip remains relatively neutral during a feed. When a baby's top lip flanges outward—often referred to as “fish lips”—it may be a sign that the baby is trying to maintain suction due to a shallow latch. Sucking blisters on the upper lip can also indicate that your baby is compensating in this way.

Releasing the upper lip frenulum may enhance your baby’s ability to maintain suction with a shallow latch, but it doesn’t address the root issue: the shallow latch itself. Rather than focusing on the lip tie, support is better directed toward improving latch technique and overall oral function.

Question 8

Can Tongue Ties Cause Speech or Dental Issues?

Accepted Answer

The National Institute for Health and Care Excellence (NICE) does not currently recommend tongue tie division as a preventative measure for future speech or dental problems. While some evidence suggests that tongue ties may contribute to speech delays or dental issues in certain children, it is not possible to predict which children will be affected. Because of this uncertainty, routine division purely for prevention is not advised, as it may lead to unnecessary procedures.

If a child’s speech is impacted by a tongue tie, a frenulotomy can still be considered at a later stage. In older children, this procedure is typically performed by a surgeon under general anaesthetic. Before any referral, the child should first be assessed and supported by a speech and language therapist. The eligibility for tongue tie release in these cases will depend on your local hospital’s policies, but it is generally not offered to children under the age of five.

In some babies, a restricted tongue may prevent the tongue from resting properly against the roof of the mouth. This can contribute to the development of a high or bubble-shaped palate, which may reduce space for emerging teeth and increase the risk of overcrowding or dental decay from trapped food particles.

Regular dental check-ups play a key role in early identification and prevention of dental problems. If you’re concerned that a tongue tie may be affecting your child’s dental health, this can be monitored by your dentist and referred for further evaluation if necessary

Question 9

Can a Tongue Tie Affect the Introduction of Solids?

Accepted Answer

Yes, restricted tongue movement due to a tongue tie may affect how a baby manages solid foods. Tongue mobility is essential for moving food around the mouth, chewing, and swallowing. These challenges may become more noticeable when solids are introduced around six months of age. Signs of difficulty might include gagging, food refusal, or struggling to manage textures.

Question 10

Why Might Feeding Become Difficult Again After Initial Improvement?

Accepted Answer

It’s not uncommon for some families to see a temporary return of feeding challenges between 1 to 3 weeks after the procedure. This is typically due to the formation of fibrous tissue as part of the body’s natural healing process. Since this new tissue is less flexible, it may cause a brief setback in tongue movement and feeding ease.

To support healing and maintain tongue mobility, it's important to continue gentle post-procedure exercises, interactive oral play, and regular feeding. These activities help encourage the wound to heal vertically—an ideal position for supporting long-term tongue function. Over time, the tissue will soften and become more flexible again.

Question 11

What Causes Relapse in Symptoms?

Accepted Answer

Another common reason for a temporary setback is oral muscle fatigue. Because the tongue muscles have been restricted, they may not yet have the strength or tone needed for efficient movement. Just like building strength at the gym, it takes time and consistent effort for these muscles to adapt and improve.

Additionally, your baby’s oral muscles have developed compensatory feeding habits to cope with the original restriction. Although the tongue tie has been released, the tongue will not yet have the "muscle memory" to function without it. Ongoing feeding and dedicated post-procedural exercises are key to helping your baby relearn effective suckling techniques.

These skills are useful throughout your feeding journey, as any changes within your baby's mouth, such as teething and colds, may prompt them to use old compensatory methods of suckling.

Question 12

Why don't you recommend disruptive wound massage?

Accepted Answer

Disruptive wound massage entails massaging the open wound and stretching it into the optimal healing position numerous times a day.

This post- procedural aftercare is not widely used in the UK. It is, however, more common in the USA.

We do not advocate or recommend disruptive wound massage, as many parents find this intolerable and will increasing the risk of poor adherence to postoperative care. There is also a risk of increasing the amount of inflammation, which would increase fibrous tissue, further restricting tongue function. Alongside this, parental reports have often shown subsequent feeding aversions.

Why Ongoing Support Matters 
These new oral motor skills are valuable throughout your baby's feeding journey. Even future changes, like teething or illness, may prompt a return to old, less effective suckling patterns. Consistent practice and support will help your baby build lasting, functional oral habits for both breast and solid feeding.

The Bottom Line 
When babies experience distress, it’s natural for parents to feel the same. Since there is no conclusive evidence supporting the benefits of disruptive wound massage, we cannot, in good conscience, ask families to undertake this process—nor would we want to.

Question 13

How Can We Encourage Our Baby to Move Their Tongue?

Accepted Answer

We recommend a combination of regular feeding, gentle oral exercises, playful games, bodywork, and fascial massage. This approach is rooted in scientific principles of muscle rehabilitation, fascial tension release, and wound care.

Our focus is to use your baby’s natural reflexes to promote tongue movement, helping to build muscle tone, strength, and re-train their neuromuscular pathways.

We encourage parents to follow their baby’s cues and only continue exercises if the baby enjoys them. Our priority is resolving any muscle or fascial tension before considering a tongue tie division. This ensures the best possible chance for positive outcomes and optimises healing.

In some cases, it may be necessary to reschedule a tongue tie release to allow time for any tension to resolve. While this might be disappointing, it is sometimes required, as releasing the tongue tie will not improve function if the muscles are still constricted.

Question 14

Will a Tongue Tie Resolve on Its Own?

Accepted Answer

Each tongue tie is unique in its anatomy. We use a specific assessment tool to help us determine if a surgical division is necessary (if conservative methods such as positioning, attachment support, and oral exercises don’t resolve the issue).

This is particularly true for tongue ties that consist of the same tissue as the webbing between fingers, which doesn’t “stretch” over time.

As your baby grows and gains more space in their mouth, you may not notice the same symptoms of a tongue tie. Additionally, your baby may develop new ways of using their oral muscles to compensate for the restriction.

Question 15

What If My Baby Hasn’t Received Vitamin K?

Accepted Answer

A frenulotomy can still be performed if your baby hasn’t received vitamin K, but you must fully understand and accept the increased risk of uncontrolled bleeding.

While the risk of Vitamin K Deficiency Bleeding (VKDB) is low, it cannot be predicted in infants who haven't received vitamin K. VKDB occurs in three forms:

· Early VKDB (within 24 hours): affects approximately 1 in 250 to 1,000 infants.
· Classical VKDB (2–7 days old): affects around 1 in 10,000 to 25,000 infants.
· Late VKDB (2 weeks to 6 months): occurs in about 1 in 50,000 to 150,000 infants.
Without vitamin K supplementation, there is a chance your baby may experience heavier bleeding than expected after the procedure, which in extremely rare cases could be life-threatening.

If your baby hasn't received vitamin K, you will be asked to give informed consent before proceeding with the frenulotomy. I will clearly explain the potential risks, answer any questions, and ensure you feel confident in your decision.

You also have the option to delay the procedure until your baby has received vitamin K. If you are still unsure or have concerns about vitamin K, VKDB, or the frenulotomy, feel free to speak with your midwife, GP, or myself—I am here to help you make the safest and most informed choice for you.

Question 16

Conservative Feeding Strategies for Tongue-Tied Babies

Accepted Answer

While waiting for a tongue tie release, or if you’ve chosen not to proceed with a release, the following strategies may help:

· Breast shaping
· "Flipple" technique
· Laid-back breastfeeding positioning
· Paced bottle feeding
· Frequent smaller feeds for bottle-fed infants
· Upright positioning after feeds
· Access to reliable advice on positioning and attachment
· Hand expressing to soften breasts if engorged before latching baby
· Encouraging tongue movement through exercises and games

If you are unable to breastfeed directly, it is important to maintain your milk supply by expressing at least 8 times within 24 hours, including overnight.

If you notice bleeding or oozing from the wound after being discharged, please follow these steps:

1. Feed your baby.
2. If the bleeding continues, apply gentle pressure to the tongue by pressing it on top of the wound with two fingers and a clean muslin cloth for 10 minutes.
3. If the bleeding persists, is soaking through the cloth, or if you are concerned, please contact emergency services by calling 999 and go to your nearest A&E.

Please keep a copy of the bleeding guidelines, which can be found in the confirmation email, to assist with continued treatment at the hospital.

After, discharge inform The Happy Bubba Tongue Tie Clinic by emailing so I can report the incident through our national reporting system.

Question 17

Where can I access further support and information?

Accepted Answer

· Infant Tongue Tie UK Support Group for Parents & Health Professionals | Facebook
· Home - Association of Tongue-tie Practitioners
· Lactation Consultants of Great Britain - Charity (lcgb.org)
· Breastfeeding Helplines - The Breastfeeding Network
· Telephone Helpline - La Leche League.

FAQ

Frequently asked questions