Tongue tie

Tongue tie means the band of tissue under the tongue is short or tight enough to limit how the tongue moves. About 4 to 10% of newborns have it. Many feed well and never need treatment, and some grow out of it.

Signs

In your baby:

• The tongue doesn't lift or move side to side, or can't reach past the gums.
• The tongue looks heart-shaped or notched at the tip when stuck out.
• Trouble latching or staying on, long feeds, hungry again soon, clicking sounds, or slow weight gain.

In you:

• Sore or cracked nipples, lower supply, or very full breasts, which can lead to mastitis.

These signs have other causes too, like latch, positioning or milk flow. The AAP warns that tongue tie can be blamed when something else is the cause.

Who checks

• A midwife may check at the newborn exam, but tongue tie isn't always easy to spot. It can show up later when feeding gets hard.
• Your pediatrician and an IBCLC (lactation consultant) can watch a feed, test how the tongue moves, and track weight before anyone suggests a procedure.

What to try first

• Feeding help. The AAP treats tongue tie as a problem only when it causes breastfeeding trouble that lactation support doesn't fix.
• Position and latch. A new hold can change a lot. See the latch guide.

Frenotomy

• A quick snip of the tight tissue by a trained doctor, nurse or midwife. It takes seconds to minutes, usually without general anesthesia for young babies.
• Serious problems are rare. Watch for bleeding or pain that doesn't settle.
• The evidence doesn't support releasing a tongue tie to prevent speech or sleep problems later.
• Lip and cheek ties are normal mouth structures, and cutting them doesn't help breastfeeding.

When to call your pediatrician

• Breastfeeding is very painful, or you're worried your baby isn't getting enough.
• Fewer pee or poop diapers than usual, or slow weight gain.
• Bleeding that won't stop, or pain that doesn't settle after a frenotomy.