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By the Peanutbean parent · checked against CDC, NHS and AAP guidance · how we fact-check

Tongue-tie in babies: symptoms, feeding problems, and why surgery is not always the answer

Last verified: July 18, 2026

The short answer: tongue-tie is when the strip of skin under the tongue is shorter or tighter than usual. It is common, affecting somewhere between about 2 and 11 babies in every 100 depending on the study, and it often causes no problems at all. When it does affect feeding, non-surgical support is the recommended first step, and the AAP is clear that most breastfeeding pain is not actually caused by tongue-tie, even though diagnoses have risen sharply in recent years.

What it looks like

Tongue-tie is where the piece of skin connecting the tongue to the bottom of the mouth is shorter or tighter than usual. The tongue may also look heart-shaped when it is lifted or stuck out (NHS: Tongue-tie). It is most common in babies, and it may not cause any problems at all (NHS).

When it does restrict movement, a baby may not be able to move their tongue side to side, lift it, or stick it out fully (NHS).

Signs it might be affecting feeding

In babies, tongue-tie can make breastfeeding or bottle-feeding harder. The NHS lists the signs to watch for:

• difficulty attaching to, or staying attached to, the breast or bottle teat
• feeding for a long time and needing to feed very often
• dribbling a lot during feeds
• coughing, choking, or clicking noises while feeding
• taking only a small amount of milk at each feed
• losing weight, or struggling to gain weight (NHS)

If you are breastfeeding a baby with tongue-tie, you may also notice sore nipples or painful, swollen breasts yourself (NHS).

Worth saying plainly: plenty of babies with a visibly short frenulum (the technical name for that strip of skin) feed completely normally. The presence of tongue-tie on its own is not the same as a feeding problem.

Why the AAP wants doctors to slow down before surgery

This is the part of the story that is genuinely useful to know, because it runs against what a lot of parents encounter online. Diagnoses of tongue-tie, medically called ankyloglossia, have risen sharply in recent years, roughly tenfold between 1997 and 2012 in one US study, and doubling again by 2016 (AAP: AAP Addresses Rise in Tongue-Tie Diagnoses for Breastfeeding Concerns).

The AAP’s own clinical report, published in Pediatrics in August 2024, says the quiet part out loud: most difficulties with breastfeeding, including pain, are not due to ankyloglossia, according to the chair of the AAP Section on Breastfeeding (AAP). Some clinics and social media discussion promote the diagnosis and the surgery that treats it, called a frenotomy, more readily than the evidence supports.

That evidence, honestly stated: research on frenotomy’s effectiveness is limited, but two reviews suggest it causes a short-term reduction in nipple pain for breastfeeding mothers, alongside an inconsistent effect on the baby’s actual feeding (AAP). Inconsistent is the key word. It sometimes helps the baby feed better, and sometimes does not.

What the AAP recommends instead

The clinical report lays out a clear order of operations for pediatricians:

• Identify feeding problems early, so support can start before things spiral.
• Try non-surgical support first, working with lactation consultants, speech-language pathologists, and other feeding specialists.
• Reserve frenotomy (the snip) for clear functional problems that have not responded to non-surgical help. The AAP notes the procedure itself is safe and poor outcomes are rare, but it should follow, not replace, feeding support (AAP).
• Skip the post-procedure stretching exercises where parents are told to reopen the wound repeatedly to stop it healing back together. The AAP specifically advises against this (AAP).

On method: scissor clipping is the most common approach, and while laser frenotomy has become more popular through some providers, the AAP states there is no evidence that laser works better than other methods, despite sometimes being marketed as an upgrade (AAP).

The NHS describes the same basic procedure: a small surgery to cut the strip of skin, done without anaesthetic in young babies and usually with general anaesthetic in older babies and children (NHS). After surgery, most babies feed better quickly (NHS).

What to do if you’re worried

Speak to a midwife, health visitor, or GP if you think your baby has tongue-tie, or if your baby is having difficulty breastfeeding or bottle-feeding for any reason (NHS). Feeding trouble has plenty of causes beyond tongue-tie, so getting seen is more useful than diagnosing it yourself from an online checklist. If weight gain is part of your worry, our milk amounts guide can help you track what normal intake looks like at your baby’s age.

If your baby is later found to have tongue-tie and it is not causing problems, treatment is not usually needed at all (NHS). If it is causing problems, expect feeding support to come first, with surgery as an option if that does not resolve things.

Keep reading

• How much milk does my baby need?
• Is my baby’s poop normal?
• Baby reflux and spitting up: normal or not
• All the first-year windows

Sources

• NHS: Tongue-tie (page last reviewed March 2024)
• AAP: AAP Addresses Rise in Tongue-Tie Diagnoses for Breastfeeding Concerns (published July 2024, summarising the AAP clinical report in Pediatrics, August 2024)

Peanutbean provides general information for educational purposes only. It is not medical advice. Every baby develops at their own pace. Always talk to your pediatrician about your child’s health.