Does your baby have tongue-tie or other oral connective tissue or fascial restrictions resulting in breastfeeding problems?
True tongue-tie (or ankyloglossia) sometimes causes breastfeeding problems but is not that common
Does your baby really have tongue-tie, lip-tie, buccal ties, or fascial restrictions which are causing breastfeeding problems, and how can you sort this out? What does the science actually tell us? What are the limitations to this science?
We definitely don't want to miss diagnosing and treating a classic tongue-tie in your baby. You can find out about tongue-tie starting here, infant fascial restrictions starting here, and other oral connective tissue restrictions here.
The research gives us wildly variable estimates of how many babies have tongue-tie because there is no clear definition
The true rate of tongue-tie is difficult to know, because there is no agreement in the research about how to define tongue-tie. Estimates range from 1.7% to 10.7% of babies, or even more.
In my view, the search for objective numeric measures and cut-offs to help us diagnose tongue-tie misunderstands the nature of 'continous variable traits' or 'spectrum presentations' in human anatomy. This search might also misunderstand just how many complex and dynamic elements interact together when a baby breastfeeds to affect tongue movement and shape. It might be that we can never create a single, validated screening or diagnostic tool, but will always need to rely upon clinical judgement.
You can find out why you and your baby form a complex biological system here.
Certainly at the moment, there are no reliable diagnostic screening tools for ankyloglossia - and worse, screening tools are often being wrongly used as diagnostic tools. None of the screening tools in use currently are based on accurate understandings of the biomechanics of infant suck and swallow in breastfeeding.
You can find out about the gestalt biomechanical model of infant suck here and here.
Tongue-tie is overdiagnosed and overtreated in babies
Tongue-tie and fascial restrictions are currently overdiagnosed and overtreated in breastfeeding babies in advanced economies. Sometimes you might read that rates of tongue-tie diagnosis and treatment have only increased because breastfeeding rates have increased, or because we are better at diagnosing it. You'll specially hear this said by health professionals who have a special interest in treating ankylofrenula.
This claim is not accurate. The research clearly demonstrates an exponential increase in numbers of infant frenotomies performed in various countries in recent years, which is consistent (applying the science of epidemiology) with overdiagnosis and overtreatment.
In bringing you Possums Breastfeeding & Lactation, I hope to help you avoid inaccurate diagnoses of tongue-tie and oral connective tissue or fascial restrictions, and to avoid unnecessary expense and worry. I also hope to help protect your baby from unnecessary side-effects of treatments - which can sometimes be severe, or even on rare occasions life-threatening.
-
You can find out about possible side-effects of frenotomy, and why laser risks more side-effects than scissors, here.
-
You can find out what drives overdiagnosis and overtreatment of tongue-tie and oral connective tissue restrictions here.
-
You can find the help of an NDC Accredited Practitioner here.
It's not possible to tell if the baby in the photograph at the top of this page would benefit from a frenotomy, again because a single image can be very misleading. There is certainly a prominent opaque anterior membrane, which would be easy to snip. The baby's tight lips don't tell us anything - other than at the moment of the photograph, the little one is somewhat dialled up or defensive, and pulling his lips, and in particular his upper lip, is held tight at this moment - which doesn't mean that his orbicularis oris muscles have developed abnormal functional patterns. A full assessment is required, including of breastfeeding (or, if relevant, bottle feeding).
Recommended resources
Your baby's tongue doesn't cause friction, pinching, or compression during breastfeeding
Does your baby have a classic tongue-tie (or true ankyloglossia)?
Does your baby have a posterior tongue-tie?
Does your baby have an upper lip-tie or buccal ties?
Selected references
Borowitz SM. What is tongue-tie and does it interfere with breast-feeding? - a brief review. Frontiers in Pediatrics. 2023;11:1086942.
Dinha LA, El-Rabbany M, Aslam S, Ricalde P. Does lingual frenotomy improve breastfeeding in newborns with ankyloglossia? A randomized controlled trial. Journal of Oral and Maxilliofacial Surgery. 2025:DOI: https://doi.org/10.1016/j.joms.2025.1004.1006.
Dixon B, Gray J, Elliot N, Shand B, Lynn A. A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: observational study. international Journal of Pediatric Otorhinolaryngology. 2018;113:156-163.
Ellehauge E, Schmidt Jensen J, Gronhoj C, Hjuler T. Trends of ankyloglossia and lingual frenotomy in hospital settings among children in Denmark. Danish Medical Journal. 2020;67(5):A01200051.
Fraser L, Benzie S, Montgomery J. Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain. BMJ. 2020;371:m3928.
Hill R, R, 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.
Joseph KS, Kinniburg B, Metcalfe A, Raza N, Sabr Y, Lisonkova S. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study. CMAJ Open. 2016;4:e33-e40
Kapoor V, Douglas PS, Hill PS, Walsh L, Tennant M. Frenotomy for tongue-tie in Australian children (2006-2016): an increasing problem. MJA. 2018;208(2):88-89.
Larrain M, Stevenson EGJ. Controversy over tongue-tie: divisions in the community of healthcare professionals. Medical Anthropology. 2022:DOI:10.1080/01459740.01452022.02056843.
Lisonek M, Shiliang L, Dzakpasu S, Moore AM, Joseph KS. Changes in the incidence and surgical treatment of ankyloglossia in Canada. Paedaitrics and Child Health. 2017;22(7):382-386.
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.
Wei E, 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:https://doi.org/10.1177%1172F0194599820925415.