Tongue-tie and breastfeeding

Most babies have a band of tissue or frenulum attaching their tongue to the base of their mouth. This allows for the right mix of mobility and stability of the tongue.

Tongue-tie is when a baby cannot move their tongue freely because they have a shorter, tighter frenulum.

Tongue-tie happens in 1 in every 14 babies.

Many babies with tongue-tie will not have any feeding difficulties or symptoms. Half of babies with tongue-tie can successfully breastfeed. The band of tissue under the tongue usually stretches naturally over time.

But in some cases tongue-tie can make feeding difficult. If this happens it's important to get support.

Tongue-tie and feeding challenges

Most babies with tongue-tie do not have any feeding problems.

In some babies, tongue-tie may make it difficult for them to breastfeed or bottle-feed.

Your baby may:

have difficulty attaching (latching) or staying attached to the breast
push the bottle teat out
feed for a long time and need to be fed very often
dribble a lot during feeds
cough, choke or make clicking noises when feeding
only take a small amount of milk at each feed
lose weight or struggle to put on weight

These symptoms may not necessarily be caused by tongue-tie. Talk to your GP, PHN or lactation nurse or midwife if you have concerns. They may need to rule out other health conditions.

If your baby has tongue-tie and you're breastfeeding, you may have sore nipples or painful and swollen breasts. This can sometimes result in engorgement or mastitis.

Concern about your breast milk supply

Feeding support

You will need feeding support if your baby has tongue-tie and feeding problems.

Techniques that can help with feeding challenges include:

If this works, further treatment may not be needed.

You can get feeding support from your:

GP
midwife
public health nurse (PHN)
lactation nurse or midwife
neonatologist
paediatrician

Ask our breastfeeding expert

Midwife Susan O'Driscoll talks about overcoming breastfeeding challenges

Treatment for tongue-tie

A tongue-tie release (frenotomy) may be needed if you and your baby continue to have breastfeeding difficulties. For example, breast pain that does not improve with breastfeeding advice and support.

A frenotomy is a small surgery to cut the piece of skin connecting the tongue to the bottom of the mouth.

A trained healthcare professional does the frenotomy procedure.

Your baby is given sucrose (sugar drops) by mouth about 2 minutes beforehand to reduce any pain. The baby can feed immediately afterwards.

Your baby will be wrapped in a blanket and supported at the shoulders to steady their head.

The tongue-tie is then released. There should be little or no blood loss. Your baby may be able to feed immediately afterwards.

In some cases, breastfeeding difficulties can continue after the procedure. It's important to talk with your healthcare provider before deciding to have the procedure done.

When a frenotomy is not recommended

Frenotomy is not usually recommended for babies who are only bottle-fed. This is because the tongue movement a baby uses to get milk from a bottle is different than when latching to the breast.

Changing your baby's feeding technique will often help to improve bottle-feeding. For example, you could try paced bottle feeding.

There is no evidence that having a frenotomy can prevent speech difficulties. If your child has speech difficulties, talk to their GP or PHN. They may refer them to a speech therapist.

Follow-up and support

Both you and your baby will have a check-up after the procedure to see how feeding is going. This can either be in-person or by phone.

Some babies may be unsettled for a couple of days after a frenotomy. Cuddling and feeding will help.

There is no evidence that stretching exercises and craniosacral therapy can help. These can be costly for parents and are not recommended after a frenotomy.

You will need support to feed your baby after a frenotomy.

There is a wide range of breastfeeding support available in Ireland.

Breastfeeding support groups are run by: