Also known as ankyloglossia, tongue-tie is a condition some babies are born with where the strip of tissue under the tongue (the frenulum) is shorter, tighter or thicker than usual. This can restrict how the tongue moves.

In some babies, tongue-tie doesn’t cause any problems. In others, it can make breast and bottle feeding more difficult, and may affect speech as the child grows.

When to consider tongue-tie treatment

Not all babies with a tongue-tie need treatment. Some can feed normally and aren’t affected by it. For others, the tongue may be restricted enough to limit how it moves, which can make feeding more difficult. This is not always obvious at birth and may only become clear when the baby tries to feed.

If a baby is struggling to latch (attaching their mouth to the nipple) or feed, they may take in less milk and swallow more air. This can lead to tongue tie symptoms such as wind, colic (intense crying), coughing or choking during feeding, reflux (when milk comes back up from the stomach into the mouth) and needing to be fed for a long time or more often.

For mothers, it can cause sore nipples, mastitis (inflammation or infection of the breast), reduced milk supply, or overly full (engorged), tender breasts caused by a build-up of milk.

Signs your child may benefit from tongue-tie treatment

Seek advice if your child is experiencing any of the following:

• Difficulties with feeding, such as poor latch or slow feeds
• Ongoing feeding discomfort for parent or child
• Problems putting on weight
• Speech difficulties related to tongue movement
• Trouble moving their tongue

Who is tongue-tie treatment suitable for?

Tongue-tie treatment is suitable for babies and children where a tongue-tie is causing feeding or developmental difficulties. Treatment for a tied tongue in newborns is most commonly carried out if they’re having problems with breastfeeding or bottle feeding. It’s considered for older children or adults if restricted tongue movement is affecting everyday function.

Before recommending a tongue-tie procedure, a healthcare professional will assess your child to confirm whether the tongue-tie is likely to be causing symptoms and whether a simple release procedure would be beneficial.

Alternative treatments

In some cases, monitoring the child rather than treating the tongue-tie is recommended. This allows time to see whether feeding or tongue movement improves as your child grows.

You may be offered additional support for specific issues, such as:

• Feeding advice from a breastfeeding specialist
• Ongoing monitoring of weight gain and feeding progress
• Speech and language assessment in older children

If symptoms persist or worsen, tongue-tie surgery may be considered at a later stage.

Tongue-tie treatment, also called tongue-tie division, is a quick and straightforward procedure that only takes a few minutes. The tongue is gently lifted, and the small piece of tissue (lingual frenulum) under it is carefully cut to release it using sterile scissors. No stitches are required.

In babies, anaesthesia is not usually needed. Older children will be given a general anaesthetic, which means they’ll be asleep during the procedure.

Before the procedure

Before the procedure, your child will have an assessment with a healthcare professional to confirm whether the procedure is needed. This may include a feeding assessment and a discussion about your child’s symptoms.

Food and drink

For most babies, the procedure is carried out without anaesthesia and there are no restrictions on feeding beforehand.

Older children often have a general anaesthetic, where they’re asleep, or local anaesthetic, to numb the area. Your care team will advise you on whether your child needs to stop eating (ie to fast) before the procedure, and for how long.

Medication

It’s important to tell your doctor about any medication your child is taking, including prescribed and over-the-counter medication or supplements.

Preparing for the day

It’s understandable to feel anxious before the procedure. Knowing what will happen at every stage can be reassuring.

You may be advised to feed your baby shortly before the procedure so they are settled and comfortable. Feeding afterwards can also help soothe and reassure them.

Parents and carers are encouraged to stay close to their child throughout the procedure to provide comfort, for example, by holding and gently soothing their child before and after treatment.

Who will be involved?

Your care will be led by a Spire Healthcare expert experienced in diagnosing and treating tongue-tie, often an ENT (ear, nose and throat) or paediatric (children’s) surgeon. Many of our consultants also hold senior NHS roles and are recognised across the UK and internationally for their specialist expertise.

You can choose which consultant you want to see and book a time that suits you. They will guide you every step of the way and answer any questions you may have.

The procedure

How long does the procedure take?

The procedure only takes a few minutes to complete. In most cases, children are in and out of the procedure room within a short time. Timing can vary slightly depending on the baby’s age, how straightforward the tongue-tie is to release, and whether anaesthetic is needed.

Anaesthetic choices

In young babies, no anaesthetic is usually needed. This is because at this stage in their development, there are not many nerve endings in this area, and so the procedure does not seem to cause them pain.

However, for older babies and children, a general anaesthetic is usually used to ensure they do not feel any pain or discomfort and remain still.

Pain during and after tongue-tie treatment

For most young babies, who do not have any anaesthetic for their procedure, they usually only experience minimal discomfort or none at all. They may be unsettled for a short time afterwards, but usually calm down quickly with feeding or comfort from a parent.

For older babies and children who have a general anaesthetic for their procedure, they may feel groggy, nauseous or dizzy as the general anaesthesia wears off.

What happens straight after the procedure

Parents are usually encouraged to feed babies straight after the procedure, which can help soothe them. A healthcare professional will observe feeding to check whether it’s easier for the parent and child.

Similarly, older children can eat as normal straight after their procedure. However, if they experience any soreness or discomfort, they can start by eating softer foods.

Your hospital stay

Tongue-tie treatment is usually carried out as a day case procedure, meaning your child will not need to stay overnight. Most families can go home shortly after the procedure once feeding and comfort have been checked.

Recovery time

Most babies recover very quickly in a few hours or days. You may notice a small white blister under the tongue, which should heal in 1–2 days.

Feeding after treatment

Your baby can usually feed straight away after the procedure. Some improvements may be noticed straight away, while in other cases it may take a few days for feeding to feel easier as tongue movement improves.

Pain relief and discomfort

Tongue-tie release shouldn’t be painful, and most babies are comfortable shortly after the procedure. For this reason, pain relief medication is not usually needed or recommended.

In children older than 8 weeks, you can give them over-the-counter pain relief if needed.

Bleeding

A small amount of bleeding may occur immediately after the procedure, but this is usually minimal and settles quickly.

Infection

The risk of infection after tongue-tie release is very low. Signs of a possible infection include fever, increased pain, reluctance to feed, or swelling under the tongue that causes the tongue to lift upwards in the mouth.

If you think your child may have an infection, contact your care team immediately as they may need antibiotics.

Return to normal activities

Normal feeding and daily activities can continue as soon as your child is comfortable. Some babies may still have symptoms such as reflux, which can take time to improve and may need further support.

Follow-up appointments

A follow-up appointment may be arranged if needed to check healing and feeding progress. Contact your consultant if you have any concerns at any point.

As with any surgical procedure, there’s a small risk of complications. These include a small amount of bleeding, infection, and a blister or scar tissue developing under the tongue.

Sometimes feeding issues or reflux may continue, and in rare cases, the tongue-tie may reattach and need a second procedure (re-snipping).

If your child has anaesthesia, they may feel sick or dizzy for 24 hours, but serious complications are rare.