Tongue Ties, Lip Ties and Breastfeeding: What Parents Should Know Before Any Procedure
When breastfeeding is painful, feeds are exhausting or a baby is not gaining weight as expected, parents naturally want a clear explanation. Tongue-tie and lip-tie are often raised as possible causes. Sometimes a restrictive frenulum does contribute to feeding difficulty. Sometimes it does not.
I want to approach this subject carefully because the appearance of a frenulum is only one part of the picture. Before considering any procedure, assess the mother and baby together, observe how feeding is actually working and look for other explanations.
What are tongue-tie and lip-tie?
A tongue-tie, clinically known as ankyloglossia, occurs when the lingual frenulum : the band of tissue beneath the tongue : restricts the tongue’s movement.
A baby may have difficulty lifting, extending or moving the tongue from side to side. In some cases, the tongue cannot extend beyond the lower gum comfortably. This can affect the coordinated movements needed for an effective latch and milk transfer.
A lip-tie generally refers to a prominent or restrictive maxillary labial frenum, the tissue connecting the upper lip to the gum. Parents may notice that the upper lip does not flange easily during feeding or that the tissue appears to attach low on the gum.
However, remember this important point: a visible frenulum is not automatically a problem. Almost every baby has oral frenula. What matters clinically is whether the tissue restricts function and contributes to a feeding problem that cannot be resolved with appropriate support.
How can a restrictive tongue-tie affect lactation?
Breastfeeding requires coordination between the baby’s tongue, jaw, lips, cheeks and breathing pattern. The tongue helps create a seal around the breast and generate the pressure needed to draw milk efficiently.
If the tongue cannot move adequately, a baby may:
Struggle to achieve or maintain a deep latch
Remain on the nipple rather than taking in sufficient breast tissue
Make clicking or smacking sounds during feeds
Lose suction repeatedly
Feed for a long time but take relatively little milk
Become tired, frustrated or unsettled at the breast
Gag, cough or appear poorly coordinated
Show slow or inconsistent weight gain
For the breastfeeding mother, the effects may include nipple pain, cracking, bruising or trauma. Incomplete breast drainage may contribute to engorgement, blocked ducts and mastitis. When each feed becomes painful and stressful, early weaning can become a real possibility, even when the mother had hoped to continue breastfeeding.
Some babies also show symptoms that resemble reflux, including frequent swallowing, irritability, back arching or milk spilling from the mouth. A feeding difficulty may contribute to swallowed air and discomfort, but do not assume that tongue-tie is the cause. Gastro-oesophageal reflux and other medical conditions require their own assessment.
What about lip-tie?
Upper lip frenula vary considerably in newborns. Some extend towards the gum margin and may look prominent without restricting feeding. Current evidence does not clearly establish that an upper lip-tie causes breastfeeding problems, and routine lip-tie release is not supported as a standard treatment for infant feeding concerns.
In practical terms, do not diagnose a lip-tie simply because you can see a band of tissue or because the upper lip does not look exactly as expected. Ask whether there is a demonstrated functional restriction during feeding.
If a baby has both a suspected tongue-tie and a visible upper lip frenulum, evaluate the tongue function first. Optimise positioning and latch, then reassess the feeding pattern. Avoid automatically combining tongue-tie and lip-tie procedures without a clear, separate clinical reason.
Understand the spectrum of tongue-tie
Tongue-tie is not a simple “present or absent” condition. Restriction exists on a spectrum, and babies compensate in different ways.
An anterior tongue-tie is usually more visible towards the front of the tongue. A posterior tongue-tie is located further back and may be less obvious on a quick visual inspection. Posterior tongue-tie is also more debated because there is no universally accepted definition, and different clinicians may interpret the same anatomy differently.
Use labels carefully. Do not let a classification score or photograph replace a functional examination. Do not assume that a baby with a visible frenulum needs surgery, and do not dismiss a genuine feeding problem merely because the restriction is not obvious at first glance.
Assess what the tongue can actually do.
Begin with a complete feeding assessment
Before recommending frenotomy, I would want the clinical team to understand both the mother’s experience and the baby’s feeding pattern.
Start with a detailed history:
How painful are feeds?
Is there nipple damage?
How often does the baby feed?
Can the baby remain attached?
Are there audible swallows?
How are wet nappies and stools progressing?
Is weight gain following the expected trajectory?
Does the mother experience engorgement, blocked ducts or mastitis?
Has the baby been premature or had other health concerns?
Then observe a complete feed where possible. Look at the baby’s position, latch depth, lip posture, tongue movement, swallowing and breathing. A pre-feed and post-feed weight may provide a useful estimate of milk transfer during that particular feed, although it cannot predict every feed.
Examine tongue function, including the ability to:
Lift the tongue towards the palate
Extend the tongue over the lower gum
Lateralise from side to side
Cup and maintain contact during sucking
Sweep across the mouth
Coordinate movement with swallowing
Palpation may help identify a restrictive sublingual frenulum that is not clear from appearance alone. At the same time, rule out other causes such as positioning difficulties, low or excessive milk supply, prematurity, poor muscle tone, craniofacial differences, neurological conditions, metabolic problems or reflux.
Treat the whole feeding problem, not just the tissue beneath the tongue.
Use a multidisciplinary approach
No single professional should make this decision in isolation. A lactation consultant can assess attachment, maternal comfort and milk transfer. A paediatrician can review growth, general health and alternative diagnoses. An ear, nose and throat specialist may assess airway and oral anatomy where appropriate. A speech and feeding specialist can evaluate oral-motor coordination, swallowing and feeding development.
A dentist with experience in infant oral assessment can assess the frenulum, tongue mobility and the relationship between oral anatomy and function. At Nuffield Dental, I believe dental care should connect sensibly with medical and wellness support rather than operate as a separate conversation.
Think of mother and baby as one feeding unit. Support the mother’s pain, milk supply and confidence while also assessing the baby’s oral function, growth and comfort.
When might frenotomy help?
A frenotomy is a procedure in which a restrictive lingual frenulum is divided to allow greater tongue movement. In some infants, it is performed quickly in an appropriate clinical setting. The procedure may be considered when:
There is a clearly restrictive tongue-tie on functional examination.
Breastfeeding remains difficult despite skilled, practical lactation support.
The mother has persistent nipple pain or trauma, or the baby has poor milk transfer or inadequate weight gain.
The family understands the possible benefits, uncertainties and risks.
There is a plan for feeding support and follow-up afterwards.
Research suggests that frenotomy may reduce maternal nipple pain and improve latch in some dyads, particularly in the short term. Evidence for improved long-term breastfeeding duration and wider health outcomes remains limited.
Do not proceed because someone promises that the procedure will prevent future speech problems, sleep apnoea, reflux or dental problems. These conditions have multiple possible causes, and infant frenotomy has not been shown to prevent them.
Frenotomy is generally considered a minor procedure, but it is not risk-free. Possible complications include bleeding, infection, persistent pain, feeding refusal, oral aversion, scarring or injury to nearby tissues. Deeper procedures require particular caution because important nerves and blood vessels are present beneath the tongue.
Ask how the clinician manages complications, what method will be used and what will happen if feeding does not improve.
Plan aftercare and reassessment
Do not regard the procedure as the end of treatment. A baby may need time to learn a new tongue movement, and the mother may still need help with positioning and latch.
Arrange follow-up with the feeding team. Monitor pain, milk transfer, weight gain, swallowing and the baby’s willingness to feed. Discuss wound care clearly and obtain specific instructions for any exercises or stretches.
Recommendations about post-procedure stretching vary, and evidence for routine wound manipulation remains limited. Never force the wound open or place substances on it unless the treating clinician has given clear, appropriate guidance. Contact the clinical team promptly if there is persistent bleeding, fever, worsening pain, refusal to feed, unusual lethargy or signs of dehydration.
If feeding does not improve, reassess the diagnosis. Do not assume that the procedure has “failed” or that another procedure is automatically required. Look again for positioning, supply, reflux, swallowing, neurological or other medical factors.
Ask these questions before any procedure
Take your time and ask:
What functional problem are you trying to address?
Can I see the feeding assessment and understand what was observed?
Has a lactation consultant assessed the feed?
What other causes have been considered?
What evidence supports the proposed procedure?
What improvement should we realistically expect, and by when?
What are the possible complications?
Who will perform the procedure and what experience do they have with infants?
What aftercare is required, and what evidence supports it?
Who will review my baby’s feeding, weight and recovery afterwards?
What should we do if breastfeeding does not improve?
Reassurance for anxious parents
If you have been told your baby has a tongue-tie or lip-tie, try not to panic. You have not caused the problem, and seeing a frenulum does not mean that you have missed something urgent.
Ask for help early. Protect your milk supply if transfer is poor, manage pain promptly and ensure that your baby’s weight and hydration are monitored. Choose a team that explains its reasoning, acknowledges uncertainty and gives you time to make an informed decision.
Ties can matter later in childhood or adulthood in selected cases, including difficulties with speech sounds, swallowing, oral hygiene, gum recession or a gap between the front teeth. Those concerns require age-appropriate assessment. They should not be used as a reason to operate on a well-feeding infant without a current functional indication.
At a dental clinic in Singapore, or when speaking with a practitioner described as a holistic dentist in Singapore, look for integrated thinking rather than a single-procedure answer. Support the mother. Assess the baby. Observe the feeding. Treat only when the likely benefits justify the risks.
This article provides general educational information and is not a diagnosis or substitute for individual medical, lactation, paediatric, ENT or dental advice. If your baby is feeding poorly, has fewer wet nappies, appears lethargic, is losing weight or you are experiencing severe breast pain, seek prompt professional care. Do not attempt to release a frenulum at home.
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