Tongue Tie in Babies and Children: What the Evidence Shows

What tongue tie is

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.

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.

When it genuinely affects feeding

Where tongue tie matters most is breastfeeding in the early weeks. The signs actually associated with it include:

Nipple pain during nursing, and cracked or irritated nipple skin
A shallow or poor latch that is hard to correct with positioning
Difficulty transferring milk, long or exhausting feeds
Poor weight gain

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.

What the evidence supports

There is a real, if narrow, place for frenotomy:

A Cochrane review found frenotomy may reduce maternal nipple pain in the short term.
The AAP's 2024 clinical report states frenotomy can reasonably be offered for a symptomatic tongue tie after a full breastfeeding assessment has looked for other causes — while noting the evidence is not strong.
A frenotomy for a clearly restricting anterior tongue tie, when skilled feeding support hasn't resolved the problem, is a reasonable option to discuss.

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.

The trial designed to settle the question didn't get to finish

The FROSTTIE randomized controlled trial set out to compare frenotomy plus breastfeeding support against breastfeeding support alone. It was stopped early, having recruited 169 of a planned 870 participants — around 31% of the intended sample. A trial that size can't reliably detect a moderate effect in either direction.

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.

What the evidence does not support

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

Releasing a "posterior tongue tie" for feeding — the AAP calls the term poorly defined and says it should not by itself justify surgery.
Releasing a lip tie for feeding — no supporting evidence (AAP 2024); the ENT Clinical Consensus Statement notes lip ties are over-diagnosed and over-treated in some communities.
Release for speech outcomes — insufficient evidence (Australian Dental Association policy statement).
Release for orthodontic outcomes — insufficient evidence (ADA).
Tongue tie as a cause of sleep-disordered breathing, reflux, colic, or difficulty with solids — insufficient evidence to draw that link (ADA).
Laser as superior to the conventional technique — not supported, and more expensive.
Post-procedure stretching exercises — no evidence they prevent reattachment.

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.

Why diagnosis rates rose

The numbers are striking. Inpatient US frenotomy rates rose about 866% between 1997 and 2012 (hospital-inpatient data — most frenotomies are now done in offices, so total volume is higher still), and roughly doubled again between 2012 and 2016. Australian rates rose about 420% between 2006 and 2016; NHS England procedures rose about 49% between 2010 and 2017. A 2025 systematic review of 462 articles found publications climbing exponentially while randomized controlled trials made up just 2.8% of the literature.

Increased awareness explains part of the rise. Over-focus explains part of it. What the rise is not matched by is evidence that the procedure improves breastfeeding outcomes.

What to do if feeding is difficult

The most useful model available comes from a 2025 UCSF study of about 1,454 infants: a pathway that put skilled feeding assessment — an IBCLC lactation consultant, and a speech-language pathologist where indicated — before any surgical referral. It cut frenotomy rates (from about 45% to 18%), increased use of feeding and lactation support, and improved access for families on public insurance. Fewer procedures, without sacrificing breastfeeding success.

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.

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Questions to ask before agreeing to a procedure

Is this an anterior tongue tie, and how restricted is tongue movement specifically?
What feeding assessment has been done, and by whom?
What exactly are we expecting this to change?
What is the evidence for that specific outcome?
What happens if we try skilled feeding support first?
What is the reattachment rate, and what is your view on post-procedure stretching?
What does it cost, and does the technique change the price?

Older children and speech

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. If you have concerns about speech, an assessment by a speech-language pathologist comes first.

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. Reattachment occurs in a minority of cases; if there is ongoing difficulty, discuss it with the provider who performed the procedure.

Frequently Asked Questions

Does my baby have a tongue tie?

Tongue tie means the band of tissue under the tongue (the frenulum) restricts the tongue's movement enough to cause a problem — most often difficulty breastfeeding. A frenulum on its own is normal tissue; the question is whether it limits function. Because there is no single agreed way to measure this, tongue tie is both under- and over-diagnosed. A skilled feeding assessment matters more than the appearance alone.

Does tongue tie cause speech problems?

There is no good evidence that tongue tie causes speech disorders, or that releasing it prevents or treats them. Restricted tongue movement can affect specific sounds in some children, but a speech-language pathologist assessment comes first — surgery is not an established treatment for speech.

Does a frenotomy improve breastfeeding?

The evidence is limited. A Cochrane review found frenotomy may reduce maternal nipple pain in the short term but did not consistently improve infant feeding. The FROSTTIE trial found no difference between frenotomy plus breastfeeding support and support alone, though it was stopped early and was underpowered. Frenotomy may be reasonable for a symptomatic anterior tongue tie after skilled feeding support has been tried — not as a first step.

Is laser better than scissors for frenotomy?

There is no strong evidence that laser frenotomy outperforms the conventional scissors technique, and it typically costs more.

Do post-procedure stretching exercises help?

There is no published evidence that stretching exercises after frenotomy prevent reattachment. They are often recommended but not supported by evidence.

Why are so many babies being diagnosed with tongue tie?

Diagnosis and frenotomy rates have risen steeply — inpatient US frenotomy rates rose about 866% between 1997 and 2012, and Australian rates rose about 420% between 2006 and 2016. A 2025 review found publications on the topic rose exponentially while randomized trials made up just 2.8% of studies. Greater awareness is part of it; over-diagnosis is part of it too.

My baby already had a frenotomy — did we make a mistake?

No. Many frenotomy decisions were made with the best information available at the time, and many babies did improve. This page is not a criticism of that choice. Reattachment happens in a minority of cases; if feeding difficulty continues, discuss it with the provider who performed it.

Should we release a posterior tongue tie or lip tie for feeding?

Major bodies say no. The AAP's 2024 report calls "posterior tongue tie" a poorly defined term that should not by itself justify surgery, and found no evidence supporting upper lip or buccal releases for feeding. The Australian Dental Association reached the same conclusion.

Sources

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)
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)
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)
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)
Australian Dental Association. Policy statement 2.13: ankyloglossia and oral frena. Board amendment October 2025. Checked August 19, 2026.
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)
Thornton AR, Montgomery EA, Graham ME, Riley CA, Lawlor CM. Systematic review of tongue tie publications: exponential rise in publications without exponential rise in evidence. Otolaryngology–Head and Neck Surgery. 2025;173(2):324–331. doi:10.1002/ohn.1264 (PMID 40366002)
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)
Khalsa I, Pappas A, Cafferkey M, Banik G. Avoiding frenotomies and improving health equity: findings from a paradigm shift newborn feeding model. International Journal of Pediatric Otorhinolaryngology. 2025;194:112355. doi:10.1016/j.ijporl.2025.112355

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. If your baby is struggling to feed, a skilled feeding assessment by an IBCLC lactation consultant, and where indicated a speech-language pathologist, should come before any decision about surgery. Discuss your child's specific situation with their own clinicians.

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