Display Patient Information Leaflets

Date issued: September 2025 

For review: September 2027

Ref: B-536/GB/Child Health/Tongue Tie 

PDF: Tongue Tie.pdf [pdf] 403KB

About this leaflet

This leaflet has been provided to you because a healthcare professional suspects that your baby may have a tongue tie. It offers additional information about tongue tie and the available treatment options.

What exactly is a tongue tie?

Everyone has a fold of skin under their tongue that connects the tongue to the bottom of the mouth, if a baby has a tongue tie, this fold of skin is usually shorter or thicker and may restrict the movement of the tongue. 

The condition can range from very mild to more severe. In some circumstances, a tongue tie can make it harder to breastfeed or for your baby to take a bottle; they may struggle to bring their tongue forward and up to create a full suction. If a baby is not feeding efficiently, they may struggle to gain weight at a normal rate.

Many babies will have a tongue tie and will have no issues with feeding or weight gain; in these circumstances we do not recommend intervention.

How is it diagnosed?

Most tongue ties do not cause any issues, which is why many go undiagnosed. Others may be obvious from the start, and some are harder to identify to the untrained eye.

If a clinician believes your baby has a potential tongue tie, accompanied with feeding concerns, and your baby is under 28 days old, they will complete an online referral to the Tongue Tie Assessment Clinic. If your baby is over 28 days old, you will be referred via the Ear Nose and Throat (ENT) referral pathway.

Signs that your baby maybe finding breastfeeding difficult due to tongue tie: 

•  Struggling to create or maintain a deep latch, slipping off the breast frequently.

•  Making a ‘clicking’ noise at the breast, this occurs when the suction is breaking.

•  Baby’s cheeks may suck in, but this isn’t always due to a tongue tie.

•  Excessive dribbling at the breast, choking or spluttering regularly.

•  Baby may want to feed for a long time (>40 minutes), have a short break, and then want to feed again.

•  Baby may be unsettled and appear to be hungry all the time.

•  They may struggle to gain weight at a normal rate.

•  Showing signs of wind, colic or reflux.

•  Breast/Chest feeding parent may have painful nipples throughout the feed- this may lead to cracked, sore, or bleeding nipples.

•  Reduced milk supply due to the lack of efficient stimulation.

•  Engorgement due to baby not draining the breast effectively. In some circumstances this can lead to mastitis. 

Signs a tongue tie may be affecting a bottle-feeding baby:

• Baby may take a long time to finish their feed.

• They may be unable to seal their mouth around the teat of the bottle; this often leads to excessive dribbling.

• Being noisy during their feed, making clicking noises and lip smacking.

• Slow or minimal weight gain.

What happens during a tongue tie division?

This procedure involves a trained practitioner cutting through the fold of the skin under your baby’s tongue with sharp sterile scissors with rounded tips. The procedure is quick and will only take a few seconds.

When your baby is approximately halfway through a feed and is settled and content, we will wrap your baby in a blanket.

We will then lay your baby on flat surface; it is up to you whether you want to help support your baby’s head or whether you would prefer another member of the team do this. 

We will then visualise and snip the tongue tie. There may be a few drops of blood after the procedure, and we may need to hold a small piece of gauze in place to stop any bleeding. When the practitioner is happy, you can then give your baby the remainder of their feed. This helps to reduce bleeding and provides comfort. 

For a baby under 3 months old, research suggests it is a well-tolerated procedure. Pain relief is not required, and they tend to return to feeding straight after.

What is the referral process?

If your baby is more than 28 days old or there are any complicating medical factors, you will be referred via the ENT pathway. This referral pathway can take longer than 1 week to make contact, and the appointment will be at Derriford Hospital, University Hospitals Plymouth Trust.

What to expect after the initial referral?

When a referral is made to our specialist service, it is important for parents to understand that this will be for a full assessment of your baby’s feeding and possible tongue tie. This appointment will help to determine whether the tongue tie is affecting feeding and the kind of support that may be helpful. The specialist practitioner may have a different view from the person who first raised the concern.

Being referred does not automatically mean the tongue tie will be divided. Tongue tie division is a surgical procedure and is never the first step in treatment. Our aim is to start with less invasive approaches and provide tailored feeding support to help improve feeding without surgery where possible. If these strategies do not lead to improvement, division may be reconsidered.

Risks of tongue tie division

Bleeding: During the procedure, a small amount of bleeding post division is expected. In very rare circumstances bleeding may require your baby to be reviewed in the emergency department.

Infection: Following the division, a small diamond-shaped wound will remain under the tongue. As with any wound, there is a risk of infection, so it’s important to keep the mouth as clean as possible. Any teats or dummies used must be thoroughly sterilised. If you are breastfeeding, regular feeds will help, as the natural antibacterial properties of breastmilk can aid in healing and reduce the risk of infection.

Re-attachment: there is a small chance of the tongue tie    re-attaching. It is important to regularly feed your baby to encourage movement of the tongue and reduce the chance of re-attachment.

Damage to the nerves or submandibular ducts are very rare risks.

The clinician will explain these risks in more detail during the consultation.

What should I expect after the tongue tie has been divided?

Your baby will be left with a diamond shaped wound under the tongue. This heals by itself over 7-14 days. The wound may be pink, white or yellow in colour. 

It can take your baby some time to learn how to use their newly divided tongue to feed. Your baby may appear ‘unsettled’ at the breast and some discomfort may continue for up to a week whilst they learn how to feed effectively. Ongoing support will be available via our infant feeding team and maternity triage if required.

It is normal for babies to have a streak of blood in the first vomit after the tongue tie, the same applies to their stools. This is due to a small amount of blood they may have swallowed after the procedure, this is completely normal. 

Your baby may be a little unsettled for a couple of days, we advise you to cuddle and reassure them.  Feeding will help to settle and comfort your baby; it also helps the healing of the wound.

If for any reason you are concerned that the wound is not healing (swelling, redness, inflamed), your baby appears unwell or has a temperature, it is important to contact a health professional. Phone the Maternity Triage number on 01752 430200. Alternatively, you can make an urgent appointment with your GP for baby to be reviewed. You can also call NHS 111. In a medical emergency, please call 999.

In the rare circumstance of bleeding from the wound, try to feed your baby for up to five minutes. This will help the bleeding to settle. If after five minutes the bleeding continues, place continuous pressure on the wound with a clean muslin or gauze until it stops. Please ensure you do not push on the baby’s throat or obstruct their breathing. If the bleeding does not stop after these steps, keep pressure on the wound and attend the Accident and Emergency department at your closest hospital. You can also call Maternity Triage, NHS 111, or 999 for further advice.

Will I receive any further support or follow up?

On going support will be available via our Infant Feeding Team and Maternity Triage if required.

The Infant Feeding Team will aim to contact you 7-14 days after the procedure.

We will also signpost you to plenty of resources to support you on your feeding journey.