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Understanding Tongue-Tie and Feeding Challenges in Babies
Learn more about tongue-tie and feeding challenges in babies on this page
What is tongue-tie?
Under the tongue is a thin band of tissue called the lingual frenulum, which connects the tongue to the floor of the mouth and helps guide tongue movement. In some individuals, this tissue may be shorter, thicker, or tighter, which can be associated with reduced tongue mobility. This variation is known as ankyloglossia, commonly referred to as tongue-tie (1).
Tongue-tie is an anatomical variation that may or may not affect function, depending on the individual(1).
There are several ways to assess tongue-tie, and assessment tools are not universally standardised. The most commonly used tools include the Bristol Tongue Assessment Tool (BTAT) and the Tongue-tie and Breastfed Babies (TABBY) assessment tool. Clinical assessment focuses on both the appearance and function of the tongue.
Some clinicians describe tongue-tie as anterior, when the membrane is visible closer to the front of the tongue, or posterior, when the restriction is located further back and may be less noticeable (9).
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Symptoms and variability
Many babies with a visible frenulum variation have no feeding difficulties and require no intervention. Others may experience latch or breastfeeding challenges, but symptoms can vary widely between individuals (1,2).
Breastfeeding difficulties may include reduced tongue movement affecting latch or suction. However, feeding outcomes are influenced by multiple factors, including maternal milk supply, positioning, and infant coordination, and are not solely determined by tongue anatomy (2).
In older children and adults, differences in tongue mobility may sometimes be associated with variations in speech articulation, oral function (such as mouth breathing or dental alignment), or swallowing patterns. These associations vary significantly and are not present in all individuals (3).
Gentle support and understanding
How common is tongue-tie?
Tongue-tie is reported in approximately 4-11% of infants, although reported prevalence varies depending on diagnostic criteria and clinical setting (4).
Variation in reported prevalence is thought to be influenced by:
• Differences in assessment methods
• Increased awareness among healthcare professionals and parents
• Variation in diagnostic thresholds
What causes tongue-tie?
The exact causes of tongue-tie are not fully understood. It is considered a congenital variation, meaning it is present from birth. Current research suggests possible multifactorial influences, including genetic and developmental factors, although no single confirmed mechanism has been established (5).
Signs that may be noticed
Some parents may observe:
• Reduced tongue elevation towards the palate or extension over the lower lip
• Heart-shaped appearance of the tongue
• Difficulty maintaining latch during feeding
• Clicking sounds during feeding and increased air intake
• Prolonged feeding sessions
• Feeding fatigue or frustration
• Maternal nipple discomfort
(1)
It is important to note that these signs are non-specific and may occur for reasons unrelated to tongue-tie.
When to seek advice
Parents are encouraged to seek support if:
• Feeding is painful or difficult
• The baby is not gaining weight as expected
• Latch is inconsistent or uncomfortable
• Feeding is stressful for parent or baby
(6)
Breastfeeding should not be painful and should be a comfortable and positive experience for both parent and baby. If difficulties arise, several professionals can offer support.
Gentle tongue-tie exercises you can explore at home
Who can help?
Support may be provided by:
• Midwives – often the first point of contact and can provide early guidance
• Health visitors – monitor baby wellbeing and support parents
• Breastfeeding and lactation consultants – provide support with feeding challenges
• Paediatricians – assess overall health and rule out medical concerns
(6)
These professionals can help assess feeding function and determine whether further evaluation is needed.
Osteopathy and tongue mobility
Osteopathy does not change the structure or length of the lingual frenulum and does not treat tongue-tie itself.
However, some infants with feeding difficulties may also present with muscle tension or reduced comfort in surrounding structures such as the jaw, neck, and upper body. Manual therapy approaches used in osteopathy aim to support relaxation and mobility in these areas.
Some research has explored manual and functional approaches in infants with feeding difficulties. These studies report improvements in feeding-related outcomes in some cases (7).
During an osteopathic consultation, care may include:
• Gentle assessment of musculoskeletal tension
• Supportive hands-on techniques aimed at comfort and mobility
• Advice on positioning and handling during feeding routines
In children and adults, myofascial approaches have been associated with reported improvements in tongue mobility and function in some studies (8).
Conservative and surgical approaches
Assessment of tongue-tie typically involves functional evaluation by qualified healthcare professionals. Common assessment tools include the Bristol Tongue Assessment Tool (BTAT) and the Tongue-tie and Breastfed Babies (TABBY) assessment tool (9).
Where significant restriction affects feeding, a frenotomy (tongue-tie release) may be considered by trained clinicians (10).
In cases where symptoms are mild or functional impact is unclear, a conservative approach may be appropriate. This may include feeding support and, in some cases, oral motor or functional exercises aimed at supporting tongue movement and reducing associated tension (11).
Why tongue movement matters
The tongue plays a role in:
• Feeding and latch in infants
• Chewing and swallowing
• Speech development
• Oral coordination
• Facial and oral development
Reduced tongue mobility may influence these functions in some individuals, although outcomes vary and are influenced by multiple factors (3).
Can tongue-tie be prevented?
Tongue-tie is a congenital variation and cannot be prevented. Many individuals with tongue-tie have no functional difficulties and do not require intervention (5).
Early assessment by a trained professional can provide clarity, reassurance, and guidance on appropriate management options (7).
References
(1)Messner, A. H., et al. (2000). Ankyloglossia: Incidence and associated feeding difficulties. Archives of Otolaryngology–Head & Neck Surgery, 126(1), 36–39. https://doi.org/10.1001/archotol.126.1.36
(2)Bruney, T. L., et al. (2022). Systematic review of the evidence for resolution of common breastfeeding problems—Ankyloglossia (tongue-tie). Acta Paediatrica, 111(5), 940–947. https://doi.org/10.1111/apa.16289
(3) O’Connor-Reina, C., et al. (2025). Clinical consequences of ankyloglossia from childhood to adulthood. International Journal of Orofacial Myology and Myofunctional Therapy, 51(1).
(4) Evans, L., et al. (2023). Tongue-tie and breastfeeding problems. British Journal of General Practice, 73(732), 297–298. https://doi.org/10.3399/bjgp23x733221
(5) Cruz, P. V., et al. (2022). Prevalence of ankyloglossia according to different assessment tools. Journal of the American Dental Association, 153(11). https://doi.org/10.1016/j.adaj.2022.07.011
(6) NHS. (2024). Tongue-tie. NHS UK. https://www.nhs.uk/conditions/tongue-tie/
(7) González-Garrido, M., et al. (2022). Effectiveness of myofunctional therapy in ankyloglossia: A systematic review. International Journal of Environmental Research and Public Health, 19(19), 12347. https://doi.org/10.3390/ijerph191912347
(8) Zaghi, S., et al. (2025). Lingual frenuloplasty with myofunctional therapy: Improving outcomes for treatment of ankyloglossia. International Journal of Orofacial Myology and Myofunctional Therapy, 51(2).
(9) Ingram, J., et al. (2019). The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY). International Breastfeeding Journal, 14(1). https://doi.org/10.1186/s13006-019-0224-y
(10) Muldoon, K., et al. (2017). Effect of frenotomy on breastfeeding variables in infants with ankyloglossia: A prospective before-and-after cohort study. BMC Pregnancy and Childbirth, 17(1). https://doi.org/10.1186/s12884-017-1561-8
(11) Shah, S. S., et al. (2024). Orofacial myofunctional therapy and tongue-tie: A narrative review. International Journal of Clinical Pediatric Dentistry, 17(1), 109–113.
