Understanding Tongue-Tie and Feeding Challenges in Babies

Short or tight tongue-tie in babies

The small fold of tissue under the tongue, the lingual frenulum, plays a role in guiding tongue movement. Its shape, length and position vary naturally from baby to baby. In some infants, the frenulum appears shorter, tighter or attached closer to the tip of the tongue. This is sometimes described as a short or tight tongue-tie, also known as ankyloglossia.

These variations can influence how freely the tongue moves. Some babies show no challenges at all, while others may find certain movements, such as lifting the tongue or extending it beyond the lower gum, less easy. In infancy, some families notice feeding or latching difficulties; in older children or adults, tongue mobility may occasionally play a role in speech development, though this varies widely between individuals.

Signs parents may notice

Parents sometimes observe the following characteristics in babies with reduced tongue mobility:

• The tip of the tongue appears slightly heart-shaped when the baby cries
• The tongue does not extend easily past the lower gum or lip

Some parents also notice feeding-related challenges such as:

• Finding it harder for the baby to latch or maintain suction at the breast
• Discomfort for the breastfeeding parent

These signs can have many possible explanations, and a healthcare professional such as a midwife, GP or lactation consultant can help assess whether tongue movement is contributing.

How common is tongue-tie in babies?

Awareness of tongue-tie has grown in recent years, and many new parents now encounter the term through midwives, lactation consultants, health visitors or online discussions. This increased awareness has also led to more babies being assessed for tongue mobility.

Research from several countries, including Denmark, shows that the number of babies diagnosed with tongue-tie has risen over the past few decades. One Danish study reported an increase in recorded diagnoses between 1996 and 2015, along with a rise in the number of babies receiving tongue-tie procedures during the same period.

These findings highlight that tongue-tie is being recognised and discussed more frequently, although the reasons behind the increase – including changes in assessment methods, clinical awareness or parental expectations – are still being explored. Not all variations in the lingual frenulum require intervention, and many babies feed well despite differences in tongue mobility.

How tongue-tie is assessed in babies

Tongue-tie can be assessed in several ways, and different professionals may use different approaches. This can sometimes feel confusing for parents, as guidance may vary depending on whether the assessment is done by a midwife, lactation consultant, GP, paediatric specialist or another healthcare professional.

In babies who show feeding challenges where restricted tongue movement is suspected, many clinicians use structured assessment tools to help build a clearer picture. One commonly used tool is the Tongue-tie and Breastfed Babies Assessment Tool (TABBY), which looks at both the appearance of the lingual frenulum and how freely the tongue moves.

TABBY includes four simple observational points:

1. The shape of the tongue tip
2. Where the frenulum attaches under the tongue
3. How high the tongue lifts when the mouth is open
4. How far the tongue can extend

Each point is scored to give an indication of tongue mobility. The overall score helps healthcare professionals consider whether reduced movement may be contributing to feeding challenges and whether further support, guidance or referral is appropriate.

What may contribute to a short or tight tongue-tie?

The exact reasons why some babies have a shorter or tighter lingual frenulum are not fully understood. Some research suggests that tongue-tie may run in families, which could explain why it is seen more frequently in certain groups, but the underlying causes are still being explored, why it is seen more frequently in some families than others.

When should parents seek guidance?

It can be helpful to seek professional support if:

• a breastfed baby is not gaining weight as expected
• feeding feels consistently uncomfortable or painful
• the baby becomes very unsettled or struggles to latch
• breastfeeding does not feel manageable or enjoyable for parent or baby

Breastfeeding should ideally be a positive and comfortable experience. If challenges arise, there are several professionals who can offer support.

Who can help?

Midwife

Midwives are often the first point of contact in establishing breastfeeding and can offer early assessment and guidance.

Health visitor / Health care nurse

Health visitors play an important role in monitoring a baby’s wellbeing and supporting parents. Many have extensive knowledge of infant feeding and can provide practical advice.

Breastfeeding consultant / lactation specialist

These professionals offer additional support for feeding challenges and can help parents with positioning, latching and feeding techniques.

ENT specialist (ear, nose and throat doctor)

An ENT specialist is the appropriate clinician to assess whether a baby has restricted tongue mobility and can advise on whether a tongue-tie release (frenotomy) is appropriate.

Pediatrician

Paediatricians assess overall health, rule out medical issues and provide guidance on feeding concerns or growth patterns.

Osteopath

Osteopaths can offer gentle, hands-on support to explore a baby’s overall comfort, posture and movement. Some babies with feeding challenges also show tightness around the jaw, neck or upper body, and osteopaths can help parents understand these patterns and suggest ways to support comfort during everyday handling and feeding.

Why is tongue movement important?

The tongue plays an important role in many everyday functions. It helps guide food around the mouth, supports chewing and works with saliva to begin the digestive process. The tongue also moves food towards the back of the mouth so it can be swallowed comfortably.

Tongue movement, together with the lips, also contributes to early sound formation and, later in childhood, clear speech.

For babies, free tongue movement is especially relevant during feeding. A mobile tongue helps the baby grasp the breast, maintain a comfortable latch and create an effective seal during sucking. When tongue movement is limited, some parents notice that feeding takes more effort or feels less efficient. This may show up as:

• difficulty maintaining suction
• clicking sounds during feeds
• swallowing more air
• fussiness at the breast
• discomfort for the breastfeeding parent

In these situations, it can be helpful to seek guidance from a midwife, health visitor, lactation consultant or other appropriate professional. They can assess feeding, offer practical support and help determine whether tongue function may be contributing to the challenges.

Approaches to supporting babies with reduced tongue movement

Research into the effectiveness of different approaches for babies with restricted tongue movement, including manual therapies, is still limited. Current evidence does not provide clear recommendations for or against manual treatment in relation to a short or tight lingual frenulum.

For infants with feeding challenges where tongue-tie is suspected, there are weak research recommendations suggesting that a tongue-tie release (frenotomy) may be considered in addition to breastfeeding support in babies under 4 months. This assessment should always be made by qualified medical or lactation professionals.

When it comes to gentle manual approaches such as osteopathy, the research base is not yet strong enough to draw firm conclusions about benefits for breastfeeding infants with tongue-tie. At the same time, there is no clear evidence suggesting harmful effects when such techniques are used appropriately by trained practitioners.

Every baby is different, and their needs can vary depending on feeding patterns, comfort, posture and general mobility. If parents choose to see an osteopath, the focus is typically on supporting relaxation and ease of movement in the jaw, neck and upper body – not on treating the tongue-tie itself.

For feeding-specific concerns, it is essential to seek guidance from professionals experienced in infant feeding, such as midwives, health visitors, lactation consultants, GPs or ENT specialists.

Tongue-tie and breastfeeding in babies

During breastfeeding, the tongue helps the baby latch onto the breast and maintain a comfortable seal. When the lingual frenulum is shorter, tighter or positioned in a way that affects tongue mobility, some babies may find certain tongue movements more challenging – such as lifting the tongue fully or extending it beyond the lower gum.

In these situations, parents may notice that feeding feels less easy for either the baby or the breastfeeding parent. Some babies may slip off the breast more frequently, make clicking sounds during feeds, or appear more unsettled while trying to maintain suction. Some breastfeeding parents may also experience discomfort or sensitivity during feeding.

Feeding patterns can influence many aspects of the breastfeeding experience, including how efficiently the baby transfers milk. Signs such as slower weight gain or persistent discomfort for the parent may indicate that additional support could be helpful.

It is important to emphasise that many babies with tongue-tie variations breastfeed well, babies are highly adaptable and can often develop their own techniques. With additional guidance from professionals such as midwives, health visitors or lactation consultants, many families find strategies that improve comfort and feeding efficiency.

Above all, breastfeeding should ideally be a positive and comfortable experience for both parent and baby, and seeking early guidance can provide reassurance and support.

Considering treatment options for reduced tongue mobility

For babies under four months who show clear feeding challenges and reduced tongue mobility, some clinical guidelines give a weak recommendation that a tongue-tie release (frenotomy) may be considered alongside breastfeeding support. This assessment should always be made by qualified medical or lactation professionals who can evaluate the individual situation.

A frenotomy is typically performed by an ear, nose and throat (ENT) specialist after a detailed examination. The procedure can vary depending on the type of frenulum and the clinician’s approach. Parents are encouraged to speak directly with the specialist to understand how the procedure is carried out, including what to expect before, during and after.

Discussions with the clinician may include topics such as:

• whether local or general anaesthetic is used
• whether the frenulum appears more anterior or posterior
• potential benefits, limitations and possible side-effects

The most important thing is that parents feel well-informed and able to make a decision that feels right for their baby.

When might a tongue-tie release be considered?

Current clinical guidance (e.g. 2020 recommendations on the assessment of ankyloglossia in breastfed infants) suggests that the appearance of the lingual frenulum alone is not a sufficient reason to perform a tongue-tie release (frenotomy). If a baby is feeding comfortably and gaining weight as expected, intervention is generally not considered necessary.

If breastfeeding is consistently painful, difficult to maintain, or if parents notice a tongue shape that appears restricted, such as a heart-shaped tongue, it can be helpful to seek assessment from a healthcare professional. This may be done by a GP, paediatrician, lactation consultant or an ear, nose and throat (ENT) specialist.

For babies under four months who have both clear feeding challenges and reduced tongue mobility, some guidelines note that a frenotomy may be considered alongside breastfeeding support. This decision should always be made by qualified clinicians who can evaluate the individual situation, discuss potential benefits and limitations, and help parents make an informed choice.

Osteopathy and reduced tongue mobility

Some babies have a shorter or tighter lingual frenulum that affects how freely the tongue can move. In many cases, this can be diagnosed without necessarily requiring a tongue-tie release. The decision to proceed with a frenotomy is always individual and should be made in consultation med appropriate healthcare professionals such as an ENT specialist, GP, paediatrician or lactation consultant.

Osteopathy does not change the length or structure of the frenulum and does not treat tongue-tie itself. However, some families choose to consult an osteopath because babies with reduced tongue mobility may also show areas of tightness or reduced ease of movement around the jaw, neck or upper body, which can influence comfort during feeding.

During an osteopathic session, the focus is typically on:

• Gently exploring overall comfort and mobility in the neck, jaw and upper chest
• Supporting relaxation in the surrounding muscles and soft tissues
• Encouraging ease of movement that may complement feeding strategies suggested by other professionals
• Providing practical, gentle ideas for positioning and soothing during everyday routines

These techniques are extremely soft and adapted to the needs of infants. The aim is always to support comfort and calm within the baby’s body, not to correct the frenulum or influence specific nerves or structures.

If there are concerns about tongue function or feeding efficiency, the osteopath will encourage parents to seek assessment from professionals trained in infant feeding and tongue-tie evaluation.

Tongue-tie and speech in babies and children

A shorter or tighter lingual frenulum does not prevent children from learning to speak. However, in some cases it may influence how certain tongue movements feel, which can occasionally make specific sounds more challenging to produce. Speech development is influenced by many factors, and most children learn to speak normally regardless of variations in tongue mobility. If parents have concerns about speech, a speech and language therapist can offer guidance.

Heart-shaped tongue in babies

Some babies display a small notch or “heart shape” at the tip of the tongue when crying. This appearance is one of the features included in the TABBY (Tongue-tie and Breastfed Babies) assessment tool, which looks at both the structure of the frenulum and how freely the tongue moves.

A heart-shaped tongue can suggest reduced mobility, but it is not enough on its own to diagnose a tongue-tie. A full assessment, ideally by a trained clinician such as a midwife, health visitor, lactation consultant, GP or ENT specialist – is needed to understand whether tongue movement is contributing to feeding or comfort challenges.

TABBY is recommended as a systematic way to evaluate tongue appearance and mobility.

Can a tight or short tongue-tie be prevented?

Tongue-tie is a congenital variation, and there is no known way to prevent it from occurring. Most babies with tongue-tie variations feed and develop well without intervention. If parents notice significant feeding challenges or reduced tongue mobility, early assessment by appropriate professionals can offer clarity, reassurance and guidance on available options.