Written by Dr James Tran, principal dentist at Lumi Dental.
If feeding has been painful or your baby struggles to latch, someone may have mentioned tongue-tie. It is a common finding, and a quick online search can make it sound like an urgent problem that needs cutting straight away. The evidence tells a more measured story. Many babies with a tongue-tie feed perfectly well, skilled feeding support solves a large share of difficulties without any procedure, and a release is best reserved for babies with a genuine, persistent feeding problem. This guide explains what tongue-tie is, how to tell if it matters, and when a release is worth considering.
Key takeaways
- Tongue-tie (ankyloglossia) is a tight or short band of tissue under the tongue that can limit its movement.
- Reported prevalence varies widely, from under 1 percent to around 10 percent, largely because there is no single agreed way to diagnose it.
- Skilled lactation and feeding support is the recommended first step, and it resolves many feeding difficulties without surgery.
- A release (frenotomy) is best considered when there is a real, ongoing feeding problem that persists despite good feeding support.
- Australian dental guidance reflects caution about routine release, so an assessment of function, not just appearance, is what matters.
The one rule: function matters more than appearance
The single most useful idea for parents is this: a tongue-tie is only worth treating if it is causing a functional problem. A visible band of tissue under the tongue on its own is not a reason to operate. What counts is whether the tongue can move enough to feed effectively, and whether feeding is actually going badly. Plenty of babies have a noticeable frenulum and feed with no trouble at all. The decision to release should follow a careful look at how feeding is going, ideally with a lactation consultant involved, rather than a glance at the tongue.
What tongue-tie is
The frenulum is the small band of tissue connecting the underside of the tongue to the floor of the mouth. In a tongue-tie, this band is short, tight, or attached close to the tip, which can restrict how far the tongue lifts or extends. The degree varies a great deal. Some are thin and near the tip, others are thicker and further back, and the same appearance can affect two babies quite differently.
Signs it might be affecting feeding
Because function is what matters, the signs to watch are about feeding rather than the look of the tongue. Possible indicators include:
- A shallow or slipping latch that is hard to maintain
- Ongoing nipple pain or damage for the breastfeeding parent
- Clicking sounds during feeding, or a lot of dribbling of milk
- Poor weight gain or very long, frequent, tiring feeds
- A bottle-fed baby who struggles to seal around the teat
Importantly, these signs have many possible causes besides tongue-tie, including positioning, latch technique, and milk supply. That is exactly why a feeding assessment comes before any thought of a procedure.
Why feeding support comes first
Optimising the basics resolves a large proportion of early feeding problems. Positioning, latch depth, and milk transfer can all be improved with skilled help, and a lactation consultant or trained midwife is the right person to guide this. Australian clinic data reflects this in practice: a substantial share of babies seen for feeding difficulty are managed successfully with feeding support alone, without any release. Starting here costs nothing surgical, carries no procedural risk, and often fixes the problem.
What the evidence says about releasing a tongue-tie
Research on frenotomy is mixed and, in many studies, of limited quality. Reviews have noted that a large volume of published work sits on top of relatively few high-quality randomised trials. What the better evidence supports is narrow and sensible: a release can help babies with a clear tongue-tie and a genuine, documented feeding difficulty, particularly where the breastfeeding parent has ongoing pain or the latch is poor despite good support. It is not supported as a routine step for every baby with a visible frenulum, and Australian dental guidance reviewed in 2025 reflects that caution.
What a frenotomy involves
When a release is warranted for a thin anterior tie, the procedure itself is usually quick. The band is divided with sterile scissors or a laser, bleeding is typically minimal, and babies can often feed straight afterwards. It is generally low-risk in experienced hands, though like any procedure it is not entirely without risk, which is another reason it should be reserved for babies who genuinely need it. Thicker or posterior ties are a more involved decision and warrant assessment by an appropriately experienced clinician.
Looking after the mouth as your baby grows
Whether or not a tongue-tie is released, early oral care sets good habits. Wipe the gums with a clean, damp cloth, and once the first tooth appears, begin brushing with a smear of fluoride toothpaste. A first dental visit around the first birthday lets any concerns be checked early, as covered in our guide to a child's first dental visit. If teething is on the horizon, our article on baby teething symptoms and safe relief is a useful next read, and for feeding and oral health more broadly, see breastfeeding and dental care.
Frequently asked questions
Does every tongue-tie need to be cut?
No. Many babies with a tongue-tie feed well and need nothing done. A release is considered only when there is a real, ongoing feeding problem that has not improved with skilled feeding support. Appearance alone is not a reason to operate.
Will a tongue-tie affect my child's speech later?
For most children, a tongue-tie does not cause speech problems, and the evidence linking it to speech difficulties is weak. If speech concerns arise as your child grows, a speech pathologist can assess whether the tongue's movement is genuinely a factor before any treatment is considered.
Is a frenotomy painful for the baby?
For a thin anterior tie, the procedure is quick and bleeding is usually minimal, and many babies settle rapidly and can feed soon afterwards. Any discomfort is generally short-lived. Thicker or deeper ties are a bigger decision and need experienced assessment.
Who should assess my baby?
Start with a lactation consultant or trained health professional who can assess feeding as a whole. If a release is being considered, it should be by a clinician experienced in the procedure who looks at function, not just the appearance of the tongue.
The takeaway
Tongue-tie is common, and most babies with one feed well or improve with skilled feeding support. A release has a place, but a narrow one: a clear tie with a genuine, persistent feeding problem. The right first step is almost always a proper feeding assessment rather than a rush to the scissors. If you would like your child's mouth checked, the team at Lumi Dental in Melrose Park is happy to help and to point you toward the right feeding support. See our general dental care or current offers on the deals page. This article is general information and not a substitute for personal medical or dental advice.
