My baby clicks when feeding. Is that tongue tie?

It is on the NHS's list of signs, but a click most often means the seal is breaking, and the seal breaks for several reasons — positioning, attachment depth, a fast let-down the baby is coping with. It is a reason to have a feed watched, not a diagnosis on its own.

Someone has offered to do it privately today. Should I?

It is reasonable to ask two questions first: what else has been ruled out, and who assessed the feed rather than just the mouth. The AAP recommends non-surgical options be considered first, coordinated by your baby's own doctor. A procedure that is available immediately and paid for directly is not automatically wrong, but it should still follow an assessment of feeding, not replace one.

Will it affect their speech later if we don't do it?

That is a common reason given for acting, and it is not a well-supported one. The evidence base here concerns breastfeeding, and the case for dividing a tongue tie in the newborn period to prevent later speech difficulties is not established. If speech concerns arise later, that is the point to assess them, with a speech-language pathologist.

Lip tie is part of the same conversation and the same caution applies — the AAP's report addresses it alongside tongue tie, and the recommendation to try non-surgical approaches first does not change. Ask your pediatrician rather than accepting a diagnosis made by someone who only performs the procedure.

We had it done and feeding is better. Was it unnecessary?

No — and this page is not an argument that the procedure never works. Some babies genuinely need it and improve. The point is about the decision beforehand, not about second-guessing one that turned out well.

Newborn days · 6 min read

Tongue tie, and whether it's the problem

Feeding hurts, someone has looked in your baby's mouth and said the word, and you are now being offered a procedure — sometimes within the hour, sometimes for a fee.

This page is not here to tell you tongue tie is not real. It is here to help you tell whether it is your problem, because the honest answer is that it often is not, and the alternative explanations have better solutions.

Last updated August 20, 2026

What it is

The band of tissue connecting the tongue to the floor of the mouth — the frenulum — is unusually short or tight, which limits how far the tongue can move. The medical name is ankyloglossia. The AAP estimates four to ten percent of newborns have it.

Crucially, having one and having a problem from one are different things. Plenty of babies with a visible tongue tie feed perfectly well and need nothing done, and the NHS says so directly: not every baby with tongue-tie needs to be treated.

The diagnosis has risen much faster than the condition

This is the context nobody hands you in the room, and it changes how you should read a confident diagnosis.

The AAP reports an almost tenfold increase in diagnoses of ankyloglossia between 1997 and 2012, and a further doubling between 2012 and 2016. The number of babies born with tight frenulums did not change over that period.

Their concern is stated plainly: surgery is often unnecessary for breastfeeding concerns, and there is limited research on its effectiveness. The worry is not only the procedure itself — it is that a confident tongue-tie diagnosis stops the search, and the real cause of the feeding problem goes unaddressed.

The sentence to hold onto is the AAP's: most difficulties with breastfeeding, including pain, are not due to ankyloglossia.

What it looks like when it genuinely is the problem

The NHS list is about function, and it is worth comparing honestly against what is happening at your feeds. In the baby: difficulty attaching to the breast or staying attached for a full feed, feeding for a long time then breaking off and feeding again, seeming hungry all the time and unsettled, a clicking sound while feeding, and not gaining weight as quickly as they should.

In you: sore or cracked nipples that make feeding painful, and breasts that stay engorged or go on to mastitis because they are not being drained well. Low milk supply can follow from the same root cause, since supply responds to how effectively milk is removed.

Notice that none of these are about what the frenulum looks like. A photograph of the underside of a tongue does not make this diagnosis.

Function, not appearance — and who should look

The NHS approach is a thorough assessment of both breastfeeding and the baby's tongue function before deciding anything, and often a feeding plan first with a review the following week to see whether feeding has improved. That week is not a delay tactic; it is the test.

The AAP frames it as coordinated care: your baby's pediatrician or primary care provider should be running a team that includes lactation support and feeding therapists alongside any surgeon. The reason is specific — breastfeeding issues have many possible causes, which also means there are many solutions, and a practitioner who only offers one is not well placed to rule the others out.

There is also a simple biological point in the AAP's material worth knowing: the muscle under the baby's tongue can stretch and lengthen with continued feeding, which sometimes resolves the nursing problem on its own.

What the evidence actually says about the snip

Frenotomy is quick. The NHS describes it as taking a few seconds, generally without anesthetic, and you can feed your baby immediately afterwards, which helps settle any bleeding. It is not a big procedure and that is part of why it is offered so readily.

But quick is not the same as effective. The AAP's read of the research is that two reviews suggest frenotomy causes a short-term reduction in nipple pain among breastfeeding mothers, and an inconsistent positive effect on infant breastfeeding. In other words, the clearest measured benefit is to the mother's pain, in the short term — which is a real benefit, and worth having, but it is not the same claim as fixing the feed.

The AAP also notes that among babies referred for the procedure, sixty-three percent did not need it to solve their nursing issues.

On technique: laser frenotomy has become more common, and no evidence supports laser over other methods. If you are being charged more for a laser, you are not buying a better outcome.

The aftercare stretches

If a procedure happens, you may be sent home with instructions to perform stretching exercises several times a day, opening the wound to prevent it reattaching. Many parents find this genuinely distressing to do.

The AAP's recommendation is that practitioners avoid recommending post-frenotomy stretching exercises in which parents open the wound several times to prevent reattachment. It is not established that they help.

If you have been given those instructions, do not simply stop on the strength of this page — but do ask your own pediatrician, because this is a live disagreement between what some practitioners advise and what the AAP recommends, and you are entitled to know that before you spend a fortnight doing it.

If feeding hurts, that is worth acting on regardless

None of the above means you should endure it. Pain is a signal that something about the feed needs changing, and it is one of the most common reasons feeding ends earlier than a parent wanted.

What it means is that the useful first move is getting a skilled person to watch a whole feed — positioning, attachment, how your baby is holding the breast, how you are holding them. That is where most of these problems are solved.

Get help sooner rather than later. Cracked nipples and a baby who is not transferring milk well both compound quickly, and the earlier someone looks, the more options there are.

Common questions

My baby clicks when feeding. Is that tongue tie?: It is on the NHS's list of signs, but a click most often means the seal is breaking, and the seal breaks for several reasons — positioning, attachment depth, a fast let-down the baby is coping with. It is a reason to have a feed watched, not a diagnosis on its own.
Someone has offered to do it privately today. Should I?: It is reasonable to ask two questions first: what else has been ruled out, and who assessed the feed rather than just the mouth. The AAP recommends non-surgical options be considered first, coordinated by your baby's own doctor. A procedure that is available immediately and paid for directly is not automatically wrong, but it should still follow an assessment of feeding, not replace one.
Will it affect their speech later if we don't do it?: That is a common reason given for acting, and it is not a well-supported one. The evidence base here concerns breastfeeding, and the case for dividing a tongue tie in the newborn period to prevent later speech difficulties is not established. If speech concerns arise later, that is the point to assess them, with a speech-language pathologist.
What about lip tie?: Lip tie is part of the same conversation and the same caution applies — the AAP's report addresses it alongside tongue tie, and the recommendation to try non-surgical approaches first does not change. Ask your pediatrician rather than accepting a diagnosis made by someone who only performs the procedure.
We had it done and feeding is better. Was it unnecessary?: No — and this page is not an argument that the procedure never works. Some babies genuinely need it and improve. The point is about the decision beforehand, not about second-guessing one that turned out well.

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