What Is Tongue Tie Surgery…and Does My Baby Need It?

When you hear the phrase “tongue tied” your mind may wander to the phrase people use when someone’s at a loss for words. But for babies being “tongue tied” can be…quite literal! 

What is newborn tongue tie?

Newborn tongue tie (or ankyloglossia: “tie” “tongue”) is a pretty uncommon condition where a baby’s frenulum tightly holds the bottom of the tongue to the floor of the mouth. (It’s estimated that 4% to 10% of newborns have tongue tie.)

Their frenu-what?? Let’s back up for a second.

The frenulum is a little flap under the tongue that anchors it to the floor of the mouth. (Touch your tongue to the roof of your mouth and under the tongue—about halfway back—you’ll feel a little bit of tissue stretching between your tongue and the bottom of your mouth. That’s your frenulum!) Frenulum comes from Latin for “little bridle”—and indeed, it acts as an itty-bitty bridle that holds your tongue in place.

For infants who are tongue tied, the frenulum is too short or thick, tethering the tip of the tongue so that the baby can’t stick it out. Doctors and lactation consultants recognize that having a tongue tie may interfere with breastfeeding.

Though keep in mind that there are currently no uniform accepted criteria for the diagnosis of tongue-tie.

Can tongue tie interfere with breastfeeding?

It is possible, but research has not shown a clear link yet. The theory is that during nursing, the baby opens the mouth widely, latches onto the breast, and sticks out the tongue. Cupped under the nipple, the tongue then darts in and out, stripping milk out of the breast and pulling it to the back of the throat to be swallowed. So, if the tongue is tied down, it’s possible that the baby won’t efficiently pull the milk out. They will seem to be sucking, but won’t be drinking very much milk. That means, the baby’s pee will get darker, they won’t have many poops, or gain weight well.

Baby tongue tie can also potentially hurt the nursing parent. The bunched-up tongue can’t move in long strokes. Rather, it has tiny little back and forth movements, rubbing and rubbing on the same one spot…until it gets blistered and raw. Since the baby isn’t emptying the breast well, tongue tie often results in engorgement, plugged milk ducts, and mastitis.

What is tongue-tie surgery?

Simply put, tongue-tie surgery is when the frenulum is snipped with scissors or cut with a laser. This is called a frenotomy (or frenulotomy or frenulectomy) and it is actually a very fast and simple procedure that is usually done without general anesthesia. The word “snipped” might make you cringe, but babies cry very little, and then calm when cuddled or put to the breast. Tongue-tie surgery can be performed by a pediatrician, a pediatric dentist, otolaryngologist, or other healthcare provider trained in the procedure

Does my baby need tongue-tie surgery?

Some experts worry that tongue-tie releases have become far too common. According to one estimate, tongue-tie surgeries have increased tenfold between 1997 and 2012, with more than 12,000 tongue-tie surgeries performed in 2012. Today, it’s thought that the number may be closer to 100,000+ a year.

This uptick is concerning considering that a 2019 study from the Massachusetts Eye and Ear Infirmary on 115 babies referred for tongue-tie surgery found that 63% ended up not needing the procedure. Another 2019 study found a short-term reduction in breast pain, the positive effects on breastfeeding were inconsistent. 

Then, in 2024, the American Academy of Pediatrics (AAP) came out with a report that found tongue-tie is clearly over-diagnosed and unnecessarily treated with surgery—and that breastfeeding problems were rarely caused by infant tongue tie. That said, the authors noted that surgical intervention for symptomatic tongue tie may be a reasonable solution, after other causes of breastfeeding problems have been evaluated and treated.

Final Thoughts on Tongue-Tie Surgery

If your baby is having difficulty latching, staying attached to your breast, and/or you are battling nipple pain, frequent engorgement, or other breastfeeding issues, do not hesitate to speak with your pediatrician and a lactation consultant about your options! Your healthcare team will help figure out if your baby’s tongue-tie is the culprit—and they can suggest some other ways to alleviate breastfeeding pain, too. Because while Baby has gotta eat, you don’t need to suffer!

More Breastfeeding Need-to-Knows:

• How to Treat and Prevent Clogged Milk Ducts
• The Nutrients You Need While Nursing 
• Will Power Pumping Increase Your Milk Supply?
• Lactation Resources for New Parents

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.