Holistic Babies London

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26. Jan, 2022

Let's talk tongue-tie, step by step

 “I was told my baby has a tongue-tie – now what?”


First things first: take a long, deep breath. This can feel overwhelming, whether feeding has been challenging or if you felt you were breastfeeding well, but someone mentioned this and now you’re concern.


You're doing brilliantly by seeking clarity and support. Let’s walk through this step by step.


1. Who told you your baby has a tongue-tie?


Only a trained tongue-tie practitioner can officially diagnose a tongue-tie. Why? Because they are qualified to carry out a comprehensive oral assessment.

This goes well beyond simply looking in your baby’s mouth or offering a finger to suck. A proper assessment will evaluate:

  • Tongue protrusion– can the tongue move past the lower gums?
  • Lateral movement– side-to-side mobility
  • Elevation– can the tongue lift to the roof of the mouth?

A breastfeeding specialist or IBCLC lactation consultant may suspect a tongue-tie if feeding issues are present, and refer you for further assessment.


2. What is a tongue-tie?


Tongue-tie (or ankyloglossia) occurs when the thin strip of tissue under the tongue (the frenulum) is shorter and/ or tighter than usual, limiting movement.


“Some babies who appear to have a tongue-tie don’t have any feeding problems, while others with no visible restriction may struggle a lot.”
– NHS Start for Life


The presence of a frenulum is not the same as a tongue-tie – this is why just looking is not enough.


3. Let’s look at the whole picture.


Before jumping to conclusions or rushing into procedures, it’s important to ask:

  • Why was a tongue-tie suspected?
  • Are there signs of feeding challenges, such as:
    • Pain or cracked nipples despite good positioning?
    • Recurrent blocked ducts or mastitis (without other cause)?
    • Baby latching but not gaining weight?
  • What was your baby’s position in the womb?
  • What kind of birth did you have (e.g. quick, long, instrumental)?


Sometimes, what looks like a tongue-tie is actually related to muscle tension, birth strain, or other factors.


4. Is your baby latching or not latching?


Your baby is latching – but it’s painful or ineffective?

Not all tongue-tied babies struggle to latch. Some may breastfeed well, gain weight, and be pain-free. Others may feed often but not transfer milk efficiently.

Protecting your milk supply is essential.


Here's how:

  • Offer shorter, more frequent feeds – around 5–10 minutes per side
  • Pump after feeds (tailor to your milk supply and baby’s needs/ work on a plan with your Lactation Consultant or Breastfeeding Specialist)
  • Begin suck training exercises 
  • Book an appointment with acranial osteopath to release tensions
  • Get a full tongue-tie assessment
  • Top-up with paced bottle feeding, using a wide-neck teat to promote an open-mouth latch

Be cautious with nipple shields: while sometimes suggested, they still require a deep, wide latch – something many babies with restricted tongue movement struggle to achieve. In some cases, shields can reinforce a shallow latch and worsen pain- so speak to a professional who understands tongue-ties. 


Your baby is not latching?


You are doing an incredible job by responding quickly and seeking help.


To protect your supply and support feeding:


  • Pump every 2–3 hours during the day, and every 4 hours at night (or more frequently if manageable)
  • Begin daily suck training  
  • Book a session with acranial osteopath
  • Seek a fulltongue-tie assessment


A quick note on positioning: hands off the neck!


Yes – I know. Everyone so far has probably told you to support your baby by the neck to latch. But this often makes things worse.


Why?

  1. It interferes with your baby’s natural reflexes – when something brushes their cheek or mouth, their rooting reflex will kick in and they’ll open wide.
  2. Many babies already hold tension in their neck and jaw, especially after birth. Placing your hand there can make both of you more tense, leading to a shallower, more painful latch.


Try these gentle alternatives:

  • After a vaginal birth: Try side-lying feeding – both you and baby rest, and your baby can approach the breast in their own time.
  • After a caesarean: Try biological nurturing – recline slightly and place your baby tummy-to-tummy with you, their chin at your breast and nose in line with the nipple. Hold baby close and allow them to self-latch.
  • The cuddle hold (a parent favourite): Hold your baby like you would for a cuddle – tummy to tummy, chest to chest, chin to breast, nose to nipple. Support their whole body snugly with no gaps. Relax your shoulders, support your back – and let your baby do what they’re wired to do.


5. The tongue-tie was confirmed – now what?


If your baby is under 6 weeks and gaining weight:


  • Continue to breastfeed responsively
  • Weigh weeklywith your health visitor until 8 weeks
  • After 8 weeks:
    • If weight gain remains steady → weigh every 2 weeks until 4 months, then monthly
    • If weight gain slows → work with a lactation consultant. As your milk becomes less hormonally driven and more supply-demand regulated, your baby may struggle to transfer milk effectively. Reassess the latch and tongue-tie.


6. Do you need a frenotomy (tongue-tie release)?


Not necessarily – and not immediately.


A tongue-tie is only part of the picture. Babies with a tight frenulum often carry body tension from birth, which can affect feeding.


Before considering a release, try:

  • A full assessment and feeding plan from alactation consultant
  • Position adjustmentsbased on your baby’s body tension and feeding patterns
  • Daily suck training
  • Gentle oral massage
  • A few sessions with acranial osteopath


“Complications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to evaluate other confounding problems... before referral.”
– International Breastfeeding Journal, 2022


7. What if it’s not a tongue-tie? What else could be going on?


Many feeding difficulties are caused by tension, not tongue-tie.

Your baby has muscles, joints, and a skeletal system too – and birth can be a big physical journey.


Common scenarios that can mimic tongue-tie symptoms:

  • Ventouse (Kiwi) delivery: The suction often pulls baby’s head upwards, creating tightness in the jaw and raising the palate. These babies may tire quickly or feed sleepily.
  • Forceps birth: Can cause compression in the cheeks and jaw, making wide-mouth latching harder.
  • Long pushing phase or low station: May result in compressed head or neck tension.
  • Caesarean section: Especially when the baby is pulled out by the head, this can cause restricted movement or neck tightness.


8. Micrognathia (small jaw) and breastfeeding


Micrognathia, a smaller-than-usual lower jaw, can interfere with feeding due to limited mouth space and tongue function:


Support strategies include:



9. Speech outcomes & ENT referral for severe cases



10. Wound care & no-need for stretching


  • Recent evidence shows wound stretching or massagepost-frenotomy does not reduce reattachment.

  • A 2019 study by Mills et al. linked stretching to a higher risk of oral aversion.

  • The NHSand UK Association of Tongue‑tie Practitionersnow advise against wound disruptionafter procedure.bjgp.org+13tongue-tie.org.uk+13verywellhealth.com+13



11. Epidural analgesia and early oral skills


Recent evidence shows that epidurals can influence infant feeding and oral reflexes:


Despite these findings, some studies (mostly retrospective) show no major impact on breastfeeding if early support is provided sciencedirect.com+7reddit.com+7reddit.com+7. But the strongest evidence supports:

  • Starting breastfeeding ASAP
  • Earlyskin-to-skin contact
  • Rooming-in and frequent feeds
  • Close lactation support in the first week

 

 Final thoughts

A suspected tongue-tie can be confusing and emotionally charged – especially when feeding isn’t going to plan. But a careful, holistic approach – one that includes skilled breastfeeding support, bodywork, and patience – can make a world of difference.

If in doubt, don’t navigate it alone. A qualified lactation consultant, infant feeding specialist, or tongue-tie practitioner can guide you. You're not failing. You're learning alongside your baby – and that is more than enough. 

 

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