For many new mothers, breastfeeding doesn't unfold the way they expected. Nipple pain that doesn't ease, a baby who seems constantly hungry, or a strange clicking sound during feeds can all point to tongue tie in newborns, a structural issue rather than a supply problem.
Understanding the signs, how it's diagnosed and how it can affect feeding can help parents feel more informed and less anxious during those early weeks.
What Is Tongue Tie?
Tongue tie, medically known as ankyloglossia, occurs when the lingual frenulum (the band of tissue connecting the underside of the tongue to the floor of the mouth) is shorter, tighter or thicker than usual. This restricts the tongue's range of motion, which can interfere with the mechanics of feeding. Tongue tie is present from birth and is thought to affect a notable proportion of babies, though estimates vary depending on how strictly it's assessed.
Signs of Tongue Tie in Babies
Some signs of tongue tie in babies are visible, while others only show up during feeding. Common indicators include:
- A tongue that looks heart-shaped or notched at the tip when the baby cries
- Restricted tongue movement, particularly difficulty lifting the tongue past the gum line or extending it past the lower lip
- A clicking sound while feeding, often signalling a break in suction
- Poor weight gain in a newborn despite frequent nursing
These signs alone don't confirm tongue tie, but they're often what prompts a closer assessment.
Tongue Tie and Breastfeeding
A restricted tongue can make it difficult for a baby to form a deep, effective latch. Instead of drawing the breast in well, the baby may compensate with the jaw or lips, resulting in a shallow latch. This is one of the most common tongue tie feeding problems, and it can cause significant nipple pain during breastfeeding for mothers alongside inefficient milk transfer for babies.
Can tongue tie affect bottle feeding too? Yes. Babies with tongue tie can struggle to maintain a seal around a bottle teat, leading to clicking, gulping air or milk spilling from the corner of the mouth.
Types of Tongue Tie: Posterior vs Anterior
Tongue tie is generally classified as anterior or posterior:
- Anterior tongue tie involves the frenulum attaching closer to the tip of the tongue and is usually easier to identify visually.
- Posterior tongue tie sits further back, is less visible, and is often missed on a quick visual check alone.
This is one reason a thorough lactation consultant assessment matters as much as a visual inspection.
Tongue Tie Diagnosis in Newborns
How soon after birth is tongue tie picked up? It's often identified in the first days to weeks, frequently once feeding difficulties have already emerged. In Australia, diagnosis typically involves an International Board Certified Lactation Consultant (IBCLC) referral, a GP, paediatrician or another appropriately trained health professional. Assessment usually combines a physical examination of the tongue's appearance with an observed feed, since function matters as much as anatomy.
Does Tongue Tie Always Need Surgery?
Not necessarily. Mild tongue tie that isn't affecting feeding may simply be monitored. When it's significantly impacting latch, milk transfer or maternal comfort, a tongue tie release (frenectomy) may be recommended. Frenectomy recovery is generally quick, though some babies benefit from post-procedure support to re-establish an effective feeding pattern.
What happens if tongue tie is left untreated? For some babies, mild tongue tie causes no lasting issues. For others, ongoing feeding difficulties can contribute to slow weight gain and, over time, reduced milk supply if latch and transfer aren't addressed.
Supporting Feeding and Recovery
Tongue tie is a structural feeding issue, so its assessment and treatment sit with an IBCLC or your baby's health practitioner. Alongside this care, many mothers also turn their attention to their own nutrient support during breastfeeding recovery, since a demanding feeding journey takes a physical toll.
Frequently Asked Questions
How do you know if your baby has tongue tie?
Signs include a notched or heart-shaped tongue tip, restricted tongue movement, clicking during feeds and slow weight gain, though a proper assessment requires a health professional.
Can tongue tie cause low milk supply?
An ineffective latch caused by tongue tie can reduce milk transfer, which over time may affect supply if not addressed.
Does tongue tie always need surgery?
No. Mild cases that aren't affecting feeding may simply be monitored rather than treated.
Who diagnoses tongue tie in Australia?
IBCLCs, GPs and paediatricians are all commonly involved in assessing tongue tie and its effect on feeding.
