Tongue tie (ankyloglossia) and lip tie are among the most discussed — and debated — diagnoses in newborn feeding. Here's what we know about how they affect feeding and what the evidence says about treatment.
What Tongue Tie Is
Tongue tie occurs when the frenulum — the band of tissue connecting the underside of the tongue to the floor of the mouth — is unusually short, thick, or tight, restricting tongue movement. The tongue cannot lift adequately, extend past the lower gum, or cup around the breast or bottle nipple properly.
What Lip Tie Is
Lip tie occurs when the labial frenulum (the tissue connecting the upper lip to the gum) is thick or tight enough to restrict lip flange (the way the lip flanges outward for a good latch). It is usually assessed alongside tongue tie rather than in isolation.
Signs Tongue Tie Is Affecting Feeding
- Painful breastfeeding for the mother — nipple pain, compression, blistering
- Baby cannot sustain a latch and repeatedly slips off
- Clicking sound during feeding (air ingress)
- Slow weight gain or weight loss
- Gassy baby from swallowing air
- Baby frustrated at the breast, pulling off and crying
How Tongue Tie Is Diagnosed
Tongue tie is graded 1–4 based on how far the frenulum extends and how much it restricts movement. Assessment should include a feeding observation — not just anatomy. A short frenulum that does not affect function is not clinically significant.
| Grade | Description | Feeding Impact |
|---|---|---|
| Grade 1 (mild) | Frenulum at tip of tongue | Usually minimal |
| Grade 2 (mild) | Mid-tongue | Variable |
| Grade 3 (moderate) | Anterior floor of mouth | Often significant |
| Grade 4 (severe) | Frenulum at base of tongue — 'submucosal' | Significant but harder to see |
Treatment: Frenotomy
A frenotomy (frenulotomy) is a simple procedure — the frenulum is snipped with scissors or a laser under local anaesthetic or none at all in very young babies. It takes seconds. Most babies feed immediately after. Aftercare involves stretching exercises to prevent reattachment.
Finding help in Singapore
KKH and NUH have lactation consultants and ENT specialists who assess and treat tongue tie. A qualified lactation consultant (IBCLC) should assess feeding before and after any procedure.