Tongue Tie: What It Is, When It Matters, and What the Evidence Shows

The signs linked to tongue tie are nipple pain that does not ease after the first week or so, a shallow latch, a baby who slips off the breast or feeds for a long time, and slow weight gain, but most breastfeeding difficulty has other causes, so a skilled feeding assessment comes first.⁠^1,2 Frenotomy can reasonably be offered for a symptomatic tongue tie once other causes have been treated, and it may ease nipple pain in the short term.⁠^1,3

What is tongue tie (ankyloglossia)?

Under every tongue is a band of tissue called the lingual frenulum. It is normal anatomy. “Tongue tie,” or ankyloglossia, describes a frenulum that is short or tight enough to restrict the tongue’s movement — and the important word is restrict. The frenulum itself isn’t the problem; whether it limits function is.⁠^1,6

The frenulum is not a separate cord. Anatomical work cited by the AAP shows it is a fold of the layer of tissue under the lining of the mouth that rises when the tongue lifts, and it ranges from thin and see-through to thick, sometimes with tongue muscle drawn into the fold.⁠¹

Prevalence estimates vary widely — a 2021 meta-analysis pooled roughly 8% but noted that the tools used to diagnose it lack solid psychometric validity, so numbers shift depending on who is looking and how. That uncertainty is the backdrop to everything else on this page.⁠^7,9

Having one is not the same as having a problem. Fewer than half of babies whose mouths look tongue-tied have trouble breastfeeding, and the AAP says babies with tongue tie who feed normally need no treatment.⁠¹

Tongue tie symptoms in breastfed babies

Where tongue tie matters most is breastfeeding in the early weeks. The signs linked to it are the signs of a feed that is not working:⁠^1,2

Every one of these symptoms has many possible causes — positioning, milk supply, the baby’s coordination, and more. Tongue tie is one of them, not the default explanation. That’s why a skilled feeding assessment comes before any conclusion.⁠^1,2

Tongue tie evaluation: what a clinician checks in a baby

A tongue tie is not diagnosed from how the frenulum looks. The Australian Dental Association says diagnosis should not rest on appearance alone, and of the six published scoring tools the AAP reviewed, none has been validated.⁠^1,6

What a pediatrician looks at is how the tongue moves and how the baby feeds:⁠¹

• Whether the baby can stretch the tongue out over the lower gum, and lift it at least halfway to the roof of the mouth⁠¹
• A heart-shaped or V-shaped tongue tip when the tongue is pushed out⁠^1,6
• The baby’s suck on a gloved finger, and the shape of the palate⁠¹
• The face, jaw and mouth as a whole, including a small or set-back jaw and a cleft lip or palate⁠¹

Sucking blisters on a newborn’s lips are normal and are not a sign of a tie, although they are often presented as one online.⁠¹

Is it tongue tie or something else?

It’s tempting to reach for a single label, and “tongue tie” is the one that circulates most. But the AAP is plain that most breastfeeding difficulty is not related to tongue tie.⁠¹

Positioning problems are the most common finding: 70% to 90% of mothers and babies having difficulty breastfeeding have been found to have suboptimal positioning at the breast.⁠² The other causes a clinician works through include:⁠^1,2

• On the mother’s side

  The common discomfort of the first weeks, nipple anatomy, positioning and support at the breast, milk supply, and breast infection.⁠²

• On the baby’s side

  Prematurity, the shape of the palate or jaw, neurological or heart conditions, and an obstructed upper airway.⁠²

• When a baby is not growing

  Infection, congenital heart disease, metabolic and hormonal conditions, and bowel obstruction are on the AAP’s list to rule out.⁠¹

Tongue tie is one possible contributor among several — which is exactly why a full feeding assessment comes before any conclusion, rather than jumping to a procedure.⁠^1,2

What a skilled feeding assessment involves

The specialist for breastfeeding difficulty is an International Board Certified Lactation Consultant (IBCLC), working with your pediatrician; the Australian Dental Association names a breastfeeding observation by an IBCLC among the steps before tongue tie is even considered.⁠^1,6

A good assessment watches a whole feed: how the baby latches and stays on, how milk transfers, positioning, and the mother’s comfort, alongside a look at the baby’s mouth and tongue movement.⁠¹

1. History. The pregnancy and birth, breastfeeding so far, any breast surgery, and breast and nipple anatomy.⁠¹
2. The baby’s feeding. Any coughing, choking, color change or early tiring at feeds.⁠¹
3. Examination. A full examination of the baby, with attention to how the tongue moves.⁠¹
4. Milk transfer. Weighing before and after a feed, and weight gain plotted on the WHO growth standards.⁠¹
5. The latch. A structured look at it, with a tool such as the LATCH score.⁠¹

Where oral-motor or swallowing questions come up, a speech-language pathologist adds a further layer, and the ENT consensus advises that families hear about observation, lactation consultation and speech-language pathology before surgery.⁠²

The point is to understand the feed as a whole — not to judge the tongue by its appearance alone.⁠^2,6

When to get help for a painful or difficult latch

Reach out early rather than waiting it out: the AAP asks for close monitoring, early follow-up after discharge and weight checks for any newborn who may have a symptomatic tongue tie.⁠¹

Early, skilled support is the step most likely to help, whatever the underlying cause: breastfeeding difficulty can often improve with time or with help from a lactation consultant or a speech-language pathologist who specializes in breastfeeding.⁠²

What to do if feeding is difficult

The most useful model available comes from a 2025 University of California, San Francisco study of 1,454 infants seen for tongue tie: a pathway that put assessment by a certified lactation consultant and a speech-language pathologist ahead of the surgical visit. Visits to those specialists rose from under 1% of infants to 51%, frenotomies fell from 45% to 18%, and the gap in care for families on public insurance narrowed.⁠⁸

A similar pathway in Canterbury, New Zealand, cut the frenotomy rate from 11.3% to 3.5% of infants without lowering breastfeeding rates: fewer procedures, without sacrificing breastfeeding success.⁠²

The practical version: get skilled feeding help first. Surgery, if it’s considered at all, is for a clearly restricting anterior tongue tie that support hasn’t resolved.⁠^1,6

For babies and older children whose difficulty goes beyond the latch, feeding therapy covers what a feeding evaluation and treatment involve.

When frenotomy helps: what the evidence supports

There is a real, if narrow, place for frenotomy:⁠^1,3

• A Cochrane review of five trials (302 infants) found frenotomy reduced mothers’ nipple pain in the short term.⁠³
• The AAP’s 2024 clinical report states frenotomy can reasonably be offered for a symptomatic tongue tie after other causes of breastfeeding problems have been evaluated and treated — while noting the evidence is not strong.⁠¹
• A frenotomy for a clearly restricting anterior tongue tie, when skilled feeding support hasn’t resolved the problem, is a reasonable option to discuss.⁠^1,2

When that point is reached, the ENT consensus favors not waiting long: a mother who has stopped breastfeeding rarely restarts, so a frenotomy that is indicated should be done soon.⁠²

Doing it straight away, before support has had a chance, has less behind it. In a UK trial of 107 babies under 2 weeks old with mild to moderate tongue tie and breastfeeding difficulties, immediate frenotomy did not objectively improve breastfeeding at 5 days compared with standard support, though mothers felt more confident; by 8 weeks the groups did not differ, and most of the comparison group had chosen a frenotomy after the 5-day visit.⁠¹⁰

The honest summary: frenotomy is not proven to have no effect, but the evidence that it improves breastfeeding is limited, and it belongs after feeding support, not before.⁠^1,3

The FROSTTIE trial: the study built to settle it did not finish

The FROSTTIE randomized controlled trial set out to compare frenotomy plus breastfeeding support against breastfeeding support alone, in 12 infant feeding services in England. It was stopped early, having randomized 169 of a planned 870 babies, about a fifth of the intended sample, which left it with 31% power to detect the difference it was designed to find. A trial that size can’t reliably detect a moderate effect in either direction.⁠⁷

Recruitment ended during the COVID-19 pandemic, when breastfeeding support services were withdrawn, and about a quarter of the babies assigned to support alone had a frenotomy anyway. At 3 months, 88% of babies in the frenotomy group and 86% in the support group were still getting breast milk, with no evidence of a difference.⁠⁷

That’s the honest state of the evidence: not that frenotomy has been shown not to work, but that the study built to answer the question never completed. Combined with the Cochrane finding that frenotomy may ease maternal nipple pain without consistently improving infant feeding, the picture is one of genuine uncertainty about the feeding benefit — alongside clear statements from professional bodies that the other claimed benefits aren’t supported.⁠^1,3,7

In the UK, NICE guidance allows the procedure because it raises no safety concerns, while noting very limited evidence that it works.⁠⁷

What the evidence does not support

Each of these is drawn from a professional body or systematic review, not from opinion:⁠^1,2,6

• Releasing a “posterior tongue tie” for feeding — the AAP calls the term poorly defined and says it should not by itself justify surgery.⁠¹
• Releasing a lip tie for feeding — no randomized trial of it has been done, and the AAP calls the lip and cheek frena normal structures that do not need surgery to improve breastfeeding; the ENT Clinical Consensus Statement notes lip tie is being overdiagnosed in some communities.⁠^1,2
• Releasing a cheek (“buccal”) tie — the ENT consensus is that it should not be done.⁠^1,2
• Release to prevent speech problems — not evidence based, according to the AAP; as a treatment, the ENT consensus found the studies conflicting, and that tongue tie does not typically affect speech.⁠^1,2
• Release in a baby for orthodontic reasons — bite problems cannot be predicted from how the frenum looks in infancy, and there is insufficient evidence for releasing a baby’s lip or cheek frenum for orthodontic issues, including a gap between the front teeth.⁠⁶
• Tongue tie as a cause of sleep-disordered breathing, reflux, colic, or difficulty with solids — insufficient evidence to draw that link; the ENT consensus found no evidence that tongue tie causes sleep apnea.⁠^2,6
• Laser as superior to the conventional technique — not supported: the ENT panel found the evidence insufficient and conflicting, and techniques can differ in what they cost.⁠^1,2
• Post-procedure stretching exercises — no evidence they prevent reattachment, and the AAP recommends against them because they may cause oral aversion.⁠^1,2
• Bodywork and exercise programs for tongue tie — physical therapy, craniosacral and myofascial therapy are not well studied, and the Australian Dental Association finds no evidence for musculoskeletal or orofacial myofunctional therapy.⁠^1,6

A note on wording that matters: “insufficient evidence” is not the same as “proven useless.” It means the science needed to justify these procedures does not exist — which, for an elective procedure on a baby, is the point.⁠⁵

What about posterior tongue tie?

“Posterior tongue tie” describes a frenulum that attaches further back under the tongue, away from the tip. The anatomy behind the label is disputed: the AAP notes the frenulum does not connect to the back of the tongue at all, and the anatomists it cites call the term anatomically incorrect.⁠¹

Experts have not agreed on a definition. The ENT consensus panel could not reach one and found little evidence that frenotomy helps these babies, and the AAP concludes the term should not be used as a reason for surgery on an infant.⁠^1,2

Where thicker tissue under the tongue contains muscle, the AAP notes that the muscle may lengthen with feeding, so a baby’s feeding can improve with time.⁠¹

Lip tie and buccal tie

Every baby has an upper lip frenulum, the fold joining the lip to the gum; the AAP describes it as a normal structure present in all infants.⁠¹

The grading system often used to label lip ties, Kotlow’s four grades, has never been validated. The AAP report says examiners who applied it to newborns scored more than 80% at the highest grade, but the Stanford study it cites rated 80% of its 100 newborns at grade 2 or 3 and 14% at grade 4, the highest; only 8 of the 100 photos got the same grade all 12 times they were rated, and the authors concluded the scale is not reproducible by experts.⁠^1,14 No randomized trial of lip frenulum release for breastfeeding has been done.⁠¹

Nor is release a way to prevent a gap between the front teeth: such gaps narrowed as much with age in children who had no surgery, and the ENT consensus is that lip frenulum release is not indicated to prevent a gap in the permanent teeth.⁠²

The cheek (“buccal”) frena help keep milk and food in place while a baby feeds; there are no criteria for calling one restrictive, and the ENT panel recommends against releasing them.⁠²

Our guide to lip ties covers what is normal and what the evidence says about release.

Tongue tie and speech: what the evidence shows

Restricted tongue movement can affect specific speech sounds in some children. But tongue tie is not an established cause of speech disorders, and frenotomy is not an established treatment for them.⁠²

The ENT consensus statement found that tongue tie does not typically affect speech: even the sounds that need the most tongue lift and reach, such as l, r and th, can usually be made with a significantly restricted tongue tip. The AAP adds that frenotomy to prevent future speech problems is not evidence based, and the ENT panel agreed that in babies with little or no restriction it does not prevent later feeding or speech disorders.⁠^1,2

If you have concerns about speech, an assessment by a speech-language pathologist comes first; the ENT panel encourages that consultation before any frenotomy for speech.⁠²

For how a tight frenulum, oral-motor skills and speech delays fit together, see tongue ties, oral-motor development and speech delays.

Tongue tie in older children

Most research is in babies; there is little on older children and teenagers.⁠²

In older children the concerns change. The ENT panel agreed that tongue tie may cause social and mechanical problems: difficulty licking, trouble keeping the teeth clean, a gap between the lower front teeth, and embarrassment.⁠²

There are no randomized trials of surgery for these problems, but the panel concluded that some older children have a better quality of life after release, and that there is no upper age limit for it.⁠²

In an older child the procedure is usually a frenuloplasty, an incision with the tissue rearranged, rather than the simple snip done in babies, and it is likely to need general anesthesia.⁠²

As part of orthodontic care, a minority of older children and adults with a frenum linked to misaligned teeth may benefit from having it released at the right time.⁠⁶

What happens in a frenotomy, and what are the risks?

In a baby, a frenotomy is a quick snip of the frenulum, most often with blunt-tipped scissors; it usually needs no anesthetic or stitches, and the ENT consensus calls it generally safe and well tolerated.⁠^1,2

Done in the office without general anesthesia, it has been found safe in infants. Numbing gels are not recommended: two small trials found no benefit, and the FDA warns against benzocaine products for children under 2. A little sugar water (oral sucrose) beforehand can ease the pain response.⁠²

Before it starts, the AAP asks the clinician to take a time out to:⁠¹

• Get signed consent⁠¹
• Discuss the alternatives, including waiting and more lactation help, and the risks and benefits⁠¹
• Discuss and provide pain control⁠¹
• Confirm the baby had the vitamin K injection after birth⁠¹
• Explain aftercare and follow-up⁠¹

Serious problems are rare but real. The ENT consensus lists bleeding, airway obstruction, injury to the salivary structures, oral aversion and scarring, and the Australian Dental Association adds deep ulceration, swelling, infection and restricted tongue movement. In the FROSTTIE trial, three babies had an adverse event after surgery: bleeding in one and salivary duct damage in two.⁠^2,6,7

Some babies need extra caution. The ENT panel lists a small or set-back jaw, neuromuscular conditions, low muscle tone and bleeding disorders as relative contraindications, because releasing the tongue can let it fall back and block the airway.⁠²

Does it always work? No. The ENT panel agreed that consent should mention that breastfeeding may not improve, and there are few data on how often a tongue tie comes back.⁠²

Does insurance cover frenotomy, and what does it cost?

Frenotomy can be covered by medical or dental insurance, and most babies have medical coverage, private or Medicaid, soon after birth; some state Medicaid programs cover it, and some require approval first.⁠¹

Prices vary. When the AAP searched online in 2023, practitioners were asking several hundred dollars, often without telling parents that a visit to an ear, nose and throat specialist is covered by Medicaid and commercial insurance. In US commercial claims from 2010 to 2022, the cost per infant rose 33%, from $350.79 to $467.08, and families’ out-of-pocket costs more than doubled, from $56.26 to $117.85.⁠^1,11

Before booking, ask whether the provider bills your insurance, what the total will be, and whether a covered option is available.

Why tongue tie diagnoses and frenotomies rose

The numbers are striking. Frenotomies recorded in US hospital stays rose 866% between 1997 and 2012, and diagnoses 834%, while the number of births stayed stable. These are inpatient figures, which do not count procedures done outside a hospital admission, so they understate the total.⁠⁴

Inpatient diagnoses roughly doubled again between 2012 and 2016, with similar increases in frenotomy.⁠¹² Australian frenotomy rates for children under 5 rose about 420% between 2006 and 2016, from 1.22 to 6.35 per 1,000.⁠¹³

The rise has since leveled off in the US. In commercial insurance claims for more than 10 million infants, the diagnosis rate climbed from 0.77% in 2010 to 4.03% in 2022, while frenotomy rose from 0.47% to 1.78% and plateaued after 2018; dental specialists’ share of the claims grew from 1.7% to 13.1%.⁠¹¹

A 2025 systematic review of 462 articles found publications climbing exponentially while randomized controlled trials made up just 2.8% of the literature.⁠⁵

Increased awareness explains part of the rise. Over-focus explains part of it. The ENT consensus points to a wider definition of tongue tie, more attention to breastfeeding, more lactation consultants looking for it, social media, and more practitioners, particularly dentists, offering treatment, and agreed that in some communities babies are being overdiagnosed and having unnecessary surgery. What the rise is not matched by is evidence that the procedure improves breastfeeding outcomes.⁠^2,5

Who is diagnosed also varies: US babies diagnosed or treated were more often boys, privately insured and from higher-income zip codes.⁠^1,4

Questions to ask before agreeing to a frenotomy

If your child has already had a frenotomy

This page is not a criticism of that decision. Many were made with the best information available, and many babies improved: much of the published research reports better breastfeeding after frenotomy, though not for every mother and baby.⁠²

If there is ongoing difficulty, discuss it with the provider who performed the procedure, and go back to a lactation consultant, who can help make sure a good latch has been established afterward.⁠²

Related guides on DrSensory

• Lip tie

  What a lip tie is, what is normal, and what the evidence says about release.

• Tongue ties and speech delays

  How tongue movement, oral-motor skills and speech fit together.

• Feeding therapy

  Help for babies and children who struggle to eat or drink.

• Drooling in sleep

  What is normal at each age, and when to get it checked.

• Baby teeth and speech

  How tooth eruption and speech milestones relate.

• Mouth breathing

  What persistent mouth breathing means for feeding, speech and sleep.

Sources

1. Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, et al.; American Academy of Pediatrics. Identification and management of ankyloglossia and its effect on breastfeeding in infants: clinical report. Pediatrics. 2024;154(2):e2024067605. doi:10.1542/peds.2024-067605 (PMID 39069819).
   Show the passageHide the passage

   “Fewer than 50% of infants with physical findings consistent with ankyloglossia had difficulty breastfeeding”; “most breastfeeding difficulty is not related to symptomatic ankyloglossia”; surgery “can reasonably be offered after other causes of breastfeeding problems have been evaluated and treated”; “Postoperative stretching exercises are not evidence-based and are not recommended.”
2. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngology–Head and Neck Surgery. 2020;162(5):597–611. doi:10.1177/0194599820915457 (PMID 32283998).
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   The American Academy of Otolaryngology–Head and Neck Surgery panel: “ankyloglossia does not typically affect speech”; “there is no evidence that ankyloglossia causes sleep apnea”; “in some communities, lip tie is being overdiagnosed”; “There are few data regarding ankyloglossia recurrence”.
3. O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. 2017;3:CD011065. doi:10.1002/14651858.CD011065.pub2 (PMID 28284020). Five trials, 302 infants: “Frenotomy reduced breastfeeding mothers' nipple pain in the short term. Investigators did not find a consistent positive effect on infant breastfeeding.”
4. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngology–Head and Neck Surgery. 2017;156(4):735–740. doi:10.1177/0194599817690135 (PMID 28168891).
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   “There was an 834% increase in the reported diagnosis of ankyloglossia and an 866% increase in the reported frenulum procedures from the 1997 data to the 2012 data”; the database “does not capture procedures or diagnosis being made outside of the hospital admission.”
5. Thornton AR, Montgomery EA, Graham ME, Riley CA, Lawlor CM. Systematic review of tongue tie publications: exponential rise in publications without exponential increase in evidence. Otolaryngology–Head and Neck Surgery. 2025;173(2):324–331. doi:10.1002/ohn.1264 (PMID 40366002).
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   “Overall, 462 articles were included for full-text extraction, of which cohort studies were the most common (179, 38.7%), and randomized controlled trials (RCTs; 13, 2.8%) were among the least common.”
6. Australian Dental Association. Policy statement 2.13: ankyloglossia and oral frena. Amended by the ADA Board October 24, 2025. Checked October 7, 2026.
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   “Diagnosis of ankyloglossia should not be based solely on anatomic appearance”; “Malocclusion, gum recession and dental decay cannot be predicted based on the anatomical appearance of the frenum in infancy or early childhood”; “There is no evidence supporting the use of musculoskeletal therapy or orofacial myofunctional therapy for the management of ankyloglossia.”
7. Knight M, Ramakrishnan R, Ratushnyak S, Rivero-Arias O, Bell J, Bowler U, et al. Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: the FROSTTIE RCT. Health Technology Assessment. 2023;27(11):1–73. doi:10.3310/WBBW2302 (PMID 37839892).
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   “169 infants were randomised, 80 to the frenotomy with breastfeeding support arm and 89 to the breastfeeding support arm from a planned sample size of 870 infants”; “the study had 31% power to detect this difference”; NICE guidance “allows for the procedure, based on lack of safety concerns, but notes very limited evidence of efficacy.”
8. Khalsa IK, Pappas A, Cafferkey M, Banik G, Rosbe KW. Avoiding frenotomies and improving health equity: findings from a paradigm shift newborn feeding difficulties model. International Journal of Pediatric Otorhinolaryngology. 2025;194:112355. doi:10.1016/j.ijporl.2025.112355 (PMID 40344796).
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   University of California, San Francisco; 1,454 infants: “increased SLP/CLC visits (50.9% vs. 0.9%, P < 0.001), reduced ENT visits (61.8% vs. 99.7%, P < 0.001), and decreased frenotomy rates (17.7% vs. 45.4%, P < 0.001)”.
9. Hill RR, Lee CS, Pados BF. The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis. Pediatric Research. 2021;90(2):259–266. doi:10.1038/s41390-020-01239-y (PMID 33188284). 15 studies, 24,536 children: “Overall prevalence of tongue-tie (N = 24,536) was 8%”; “Available assessment tools for diagnosis of tongue-tie do not have adequate psychometric properties.”
10. Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, et al. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014;99(3):F189–F195. doi:10.1136/archdischild-2013-305031 (PMID 24249695). “Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy.”
11. Zhao J, Cho A, Jenks C, Tunkel D, Walsh J. Plateau in growth or losing influence? Costs and shifting national trends of ankyloglossia treatment 2010-2022. Otolaryngology–Head and Neck Surgery. 2026;online ahead of print. doi:10.1002/ohn.70399 (PMID 42611539).
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    US commercial claims for 10,353,534 infants: “the annual rate of surgical treatment of ankyloglossia increased from 0.47% to 1.78%, plateauing after 2018”; “Out-of-pocket costs per infant increased 109% from $56.26 to $117.85.”
12. Wei EX, Tunkel D, Boss E, Walsh J. Ankyloglossia: update on trends in diagnosis and management in the United States, 2012-2016. Otolaryngology–Head and Neck Surgery. 2020;163(5):1029–1031. doi:10.1177/0194599820925415 (PMID 32427523). “From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures.”
13. Kapoor V, Douglas PS, Hill PS, Walsh LJ, Tennant M. Frenotomy for tongue-tie in Australian children, 2006-2016: an increasing problem. Medical Journal of Australia. 2018;208(2):88–89. doi:10.5694/mja17.00438 (PMID 29385976). Medicare items for children aged 0 to 4: “the rate increased from 1.22 per 1000 population in 2006 to 6.35 per 1000 in 2016” (420% nationally).
14. Santa Maria C, Aby J, Truong MT, Thakur Y, Rea S, Messner A. The superior labial frenulum in newborns: what is normal? Global Pediatric Health. 2017;4:2333794X17718896. doi:10.1177/2333794X17718896 (PMID 28812052). Checked October 22, 2026.
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    100 newborns at Stanford, photographs rated by six examiners: “raters classifying 80% of the photographs as grade 2 or 3”; “6% rated as grade 1, 41% rated as grade 2, 39% rated as grade 3, and 14% rated as grade 4”; “only 8 of 100 photographs had the same rating all 12 times they were evaluated”; “The Kotlow classification of lip-tie fails to be reproducible by relevant experts.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical or dental advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.